Post a summary of the interview and a description of the communication techniques you would use with your assigned patient. Explain why you would use these techniques. Identify the risk assessment instrument you selected, and justify why it would be applicable to the selected patient. Provide at least five targeted questions you would ask the patient.
WK1 Health assessment amin post-
Interview
A 26-year-old female student of Lebanese descent comes into where I practice for a well student exam. This is how I would proceed.
I would first review vital signs obtained and the reason for the visit. I would proceed to the exam room and knock at the door. I would enter and introduce myself as a nurse practitioner working with the doctor of the office. I would ask the patient her full name and date of birth and how would like to be addressed such as by first name, or Ms. and last name. Knowing ahead of time she is just here for a well visit, I would still ask how she is feeling today to see if that leads to any non-disclosed issues she may have not reported to the medical Helpant that took her vitals. If there are no leads to pressing issues, I would then explain to her the next sequence of events as such.
Chief complaint. Which was already established
A review of the present illness-if she was sick this may be an when was the onset of symptoms and if she took any over the counter medications.
Past medical history. This will include PMH, medications, allergies, past surgeries, hospitalizations, immunizations. (Ball, Dains, Flynn, Soloman, and Stewart, 2019)
Family history. (Something to remember is that she could be adopted and have no knowledge of her biological family’s health history)
Social history. I would begin by asking if the patient has traveled out of the country especially back to her home country in the past 30 days. I would continue by asking what she is studying and if she also works. I would include questions such as alcohol and tobacco use. I would also ask about any illicit drugs. Asking about vaping would be very important for her age. Also, important to ask are age-related questions such as sexual orientation, gender orientation, marital status, being sexually active, the form of birth control. Religious and cultural beliefs would be asked as well. This may have a great influence on the patient’s health. (Ball et al, 2019). I would document food allergies, food intake, and exercise in this section as well. Insurance coverage would be discussed too.
I would then explain that I would be doing a head to toe assessment as described in our text. (Sullivan, 2019).
Communication techniques
Throughout the assessment I would show empathy if touchy issues arise, I would use careful listening in case there are subtle words. I would have an open mind since there may be cultural or religious beliefs about healthcare since this patient is Lebanese. I will always display friendliness and compassion. I believe in displaying a genuine interest in the patient, being attentive, and have the willingness to ask questions and initiate conversations. It is important to have great communication skills in healthcare. When we communicate well it fosters patient engagement which leads to a wide range of benefits, such as increased patient satisfaction and participation, trust, and a higher quality of care better patient adherence to treatment and improved physical outcomes. (Sheridan HealthCare, 2016). It is also essential to establish a positive relationship, providing comfort, concern, and again trust will ease a connection with patients (Ball et al. 2019).
Risk assessment tool
I feel the best risk assessment tool to use on this patient that is new to me is the one based of family history. This would best allow for me to address genetics, her past and current lifestyle, and exposure to family members. This will allow me to look at any familial conditions such as diabetes, cancers, and hypertension which could lead to other comorbidities. (Sullivan, 2019). Wu & Orlando, 2015 also explains how looking at being presymptomatic, where the condition may be present, but the patient feels just fine and has no idea of the condition. An easy example who being hypertension. If the patient indicates there is hypertension in her family, target questions to ask maybe, “Do you tend to get frequent or severe headaches?”, “Do you ever have blurry vision?” “Do you ever have heart palpations, chest pain, or shortness of breath.?” I would proceed to ask about if diabetes runs in the family. If so if it is type 1 or type 2, and age of onset. Even if negative I still would ask my patient if she experiences extreme thirst, extreme hunger, and excessive urination. There would be a host of other questions asked dealing with the body systems. The last thing I would touch on is if there is any mental health diagnosis in the family. Keeping in mind that this is a 26-year-old female in graduate school. My thoughts are, is she here in the country alone? Where is here family? Is she here on a student visa? Does she have friends here of Lebanese descent or is she isolated? How is she doing in school, is she struggling, is she depressed, is there a huge pressure from her family? If so, does she have a support system, or who can she talk to? Is she concerned about confidentially if there are problems? Are there medical matters that she does not want discussed with anyone else, or who does she authorized to discuss medical matters with?
As with any patient there are numerous questions to ask if this is the first time at your practice and establishing care. We must be mindful to not overwhelm the patient and to pace or questions. We must assure the patient that we want to provide preventive care, health promotion, and disease management services. We want to, in the long run, reduce health disparities, and improve health outcomes by identifying patients’ modifiable health risks (Center for Disease Control and Prevention, 2011) and together we can accomplish this.
Resources
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby
Center for Disease Control and Prevention. 2011. Goetzel, R., Staley, P., Ogden, L; Stange, P., Fox, J., Spangler, J., Tabrizi, M., Beckowski, M., Kowlessar, N., Glasgow,R., Taylor, M. (201). A framework for patient-centered health risk assessments. Providing health promotion and disease prevention services to Medicare beneficiaries. Atlanta, GA US
Sheridain Health Care. (2015). Six Communication Strategies to Increase Patient engagement and improve outcomes.
Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.
Wu, R. R., & Orlando, L. A. (2015). Implementation of health risk assessments with family health history: Barriers and benefits. Postgraduate Medical Journal, 91(1079), 508.
