HealthAssessment Cases

1.What’s the difference?

Theperipheral vascular system is made up of veins and arteries found inthe arm, legs, feet, and hands. From the picture, it is evident thatthe patient is suffering from peripheral artery disease (PAD). Thisdiagnosis is supported by the presence of protrusions on the legs ofthe patient. The protrusions are as a result of narrowing of thearteries, characterized by the disease. Other than using theinformation on the protrusions on the leg, the nurse can also observethe nature of the skin of the patient. The nurse can observe thecolor of the patient’s skin, whether bluish or not. Of greatimportance is to observe the nature of hair growth. From the picture,one can conclude that there is poor hair growth. All theseobservations seem to point to one condition peripheral arterydisease (Gardner, 2012). However, it would be wrong to conclude thediagnosis without performing further assessments like recording theskin temperature.

Reference

Gardner,A. W. (2012). Peripheral arterial disease. Encyclopedia of ExerciseMedicine in Health and Disease, 697-700.

2.How Do I know if it is serious?

Beloware some critical interviewing questions a nurse ought to ask toisolate risk factors for abdominal issues

• Doyou experience any abdominal pains? To assess the nature of abdominalissues (Weber&amp Kelley, 2013).

• Whendid the abdominal pain start? Helps in assessing whether the pain ischronic or acute (Weber&amp Kelley, 2013).

• Whereexactly to you experience the pain? This answer will help determineif the pain is focal or diffuse (Weber&amp Kelley, 2013).

• Doyou have a history of being alcoholic? The answer would helpestablish the risk of liver disease (Weber&amp Kelley, 2013).

• Haveyou ever experience the pain like this before? If the patient hadexperienced the pain before that is similar to the pain he/she iscurrently experiencing then it would greatly expedite his/herdiagnosis as well as treatment (Weber&amp Kelley, 2013).

• Wouldyou please describe the pain? The patient’s description of the painwill help give both the clues to the cause of the abdominal issue, aswell as slightly tell me of the patient’s primary concerns (Weber&amp Kelley, 2013).

Reference

Weber,J. R., &amp Kelley, J. H. (2013). Healthassessment in nursing.Lippincott Williams &amp Wilkins.

3.My Stomach Hurts

Thefirst major information that the nurse should obtain about Ms.Johnson’s conditions is whether she has been involved in anyknocks, trauma or other injuries in the recent past. Even a minorphysical trauma that occurred several weeks before the screening islikely to cause abdominal pain. This additional information is likelyto lead the nurse to the cause of the condition. Another additionalimportant information that the nurse should consider is the previousmedications the patient has been taking. Some of these medicationsmay be the reason Ms. Johnson is experiencing the stomach pains. Thenurse could also ask Ms. Johnson to describe the nature of the pain.The information will help in diagnosis of the condition given thatthere are various illnesses that have close similarities based onsymptoms. In understanding the nature of the pain, the nurse couldask Ms. Johnson to clarify whether the pain usually radiates to otherareas, what makes the pain worsen, and what improves the pain (Weber&amp Kelley, 2013).

Reference

Weber,J. R., &amp Kelley, J. H. (2013). Healthassessment in nursing.Lippincott Williams &amp Wilkins.

4.How Would You Respond

Iwould use the history of the patient in checking for similarities anddifferences that may exist between the time of pregnancy and afterthe birth of the baby. In comparing this information, I woulddetermine whether the pregnancy has anything to do with thecondition. At the same time, I would assess the patient’s historyso as to determine whether the disease is acute or chronic. Theinformation of the patient’s history would also enable me todetermine which physical assessments may be necessary, and which ofthese have been conducted already. The information from the historywould also help identify the additional physical assessments thatneed to be done so as to produce more accurate results from thosealready produced. In conclusion, the history of the patient would beintegrated into the assessment so as to save me the time ofdiagnostic as well as determine the best way to deal with thecondition once and for all, given the previous interventions havealready failed (Estes,2013).

Reference

Estes,M. E. Z. (2013). Healthassessment and physical examination.Cengage Learning.

5.I’m Awake!

Thereare cases of misdiagnosis of various conditions associated with theold. One of these conditions is the abnormal variation which isusually misdiagnosed for normal neurological functioningcharacterized by aging. For a nurse to recognize these normalneurological functionings associated with aging, there is a need fora comprehensive Geriatric assessment. The assessment is amultidisciplinary and multidimensional study instrument that isdesigned to obtain data on the medical, functional, and psychosocialcapabilities and limitations of an elderly person. The informationgenerated is used by the nurse to develop a treatment intervention aswell as a long-term follow-up care plan to be given to the patient.The information also helps arrange for primary care, optimizeplacement as well as make the best use of health resources. Throughthe comprehensive geriatric assessment, the nurse would be able toconduct several physical examinations that would help in separatingthe abnormal variations from the conditions associated with aging(Meiner,2013).

Reference

Meiner,S. E. (2013). Gerontologicnursing.Elsevier Health Sciences.

6.I’m Confused!

Serioushigh blood pressure like the one Mr. Smith has a high probability ofleading to other diseases like neurological diseases. There arecertain risk factors that the nurse should consider. Some of the keyrisk factors include:

Age:It is necessary to determine the age of Mr. Smith since high bloodpressure is experienced more by the aging, and there is a highpossibility of the condition leading to other neurological diseases(Nettina&amp Nettina, 2013).

Weightthe nurse should determine whether Mr. Smith is obese by examiningthe weight against height (Nettina&amp Nettina, 2013).

Physicalactivity of the patientpatients with a low rate of activity has a high tendency of havinghigh rates of hypertension that possess the risk of contracting theneurological disease (Nettina&amp Nettina, 2013).

Stresslevelsthe nurse should determine whether Mr. Smith experiences a lot ofrisks.

Measuresof reducing the risks include: exercising, eating healthily (balanceddiet) and avoiding stressful situations (Nettina&amp Nettina, 2013).

Reference

Nettina,S. M., &amp Nettina, S. M. (2013). Lippincottmanual of nursing practice.Lippincott Williams &amp Wilkins.

7.You Decide

Aspecific strategy for decision making: In determining the healthhistory questions to ask, I considered those questions that wereclosely related to the condition at hand. At the same time, I ensuredthat the questions were simple and short so that the patient couldeasily answer them. In selecting the physical assessment techniquesto use, I considered those techniques that would produce immediateresults so that the condition of the patient did not worsen (Estes,2013).

SurpriseMoments: The main surprise came when I realized that a simple mistakeby an ER nurse could lead to a totally undesirable result. I was alsosurprised that the fall could cause the patient his arm. I thoughtthe patient would just have a bone breakage that may have made thearm nonfunctional, instead of having to be amputated as a result ofcompartment syndrome. I was also surprised when I realized that thereare specific questions to ask, and how the answers to these questionsaffect the process of the decision-making process (Estes,2013).

Howmy decisions affected the safety of the patient: My decision offocused physical assessment enabled me to order an immediate x-ray ofthe hand. Through this decision, Dr. Douglas was able to performfasciotomy of the left lower arm, as well as surgery to repair bothfractures. This decision further helped the patient recover withoutfurther complication. The focused assessment enabled quick response,ensuring safety to the patient. I would still make the same decisionagain since it ensures patients quick recovery (Estes,2013).

NursingPractice: The information from the exercise has enabled me to realizethe importance of timely response. In future, I intend to emphasizeon more focused approach when practicing nursing (Nettina&amp Nettina, 2013).

Reference

Estes,M. E. Z. (2013). Healthassessment and physical examination.Cengage Learning.

Nettina,S. M., &amp Nettina, S. M. (2013). Lippincottmanual of nursing practice.Lippincott Williams &amp Wilkins.

8.Why Is This Important?

Specifichealth screening recommendation:

-Cervicalcancer screening: This screening is a technique of identifying andremoving unusual tissues or cells on the cervix before the cancer ofthe cervix develops. The screening’s main goal is the secondaryprevention of cancer of the cervix. There are several screeningmethods that could be used. However, the main ones include pap smeartest and liquid-based cytology.

Differentcountries have different recommendations for screening cervicalcancer. According to the USPSTF,the age at which the screening should be done is from 20 yearsonwards. The USPSTFrecommend that the screening should be done every three years. Thedisease is more prevalent in women aged between 30 and 39 years old. Also, it is recommended that the screening of women aged above 65years may be discontinued if there are no abnormal results ofscreening in the last ten years, and if there is no history oflesions (high-grade) (CDC.(2012).

Reference

Centersfor Disease Control and Prevention (CDC. (2012). Cancerscreening-United States, 2010. MMWR.Morbidity and mortality weekly report,61(3),41.

9.Is This Normal?

Asearlier stated, there are several cases of misdiagnosis of normalconditions. To avoid this situation, nurses and health practitionersoften examine the history of the patients as the initial step. Inthis case study, the various additional history information of thepatient include:

-themedical history of the patient the nurses should consider asking thepatient if she is on any medication (Bickley&amp Szilagyi, 2012).

-thenature of the condition does the pain move to other regions of thebody.

-Doesthe patient abuse any substance or have any history of drug abuse.

-Thecharacteristics of the breast discharge is the discharge bilateralor unilateral, and the color of the discharge. A milky discharge ischaracterized with hypothyroidism, hyperprolactinemia, and othermedications, like oral contraceptives. While, a bloody discharge ischaracterized with intraductal papilloma (Bickley&amp Szilagyi, 2012).

-Thenurse can also assess any information of the patient’s breastsbiopsy

Thesequestions are focused on determining whether the condition is normalor abnormal, and the decision can be made immediately these pieces ofinformation are obtained (Bickley&amp Szilagyi, 2012).

Reference

Bickley,L., &amp Szilagyi, P. G. (2012). Bates`guide to physical examination and history-taking.Lippincott Williams &amp Wilkins.

10.Finding the Clues!

Progressionof the patient’s symptoms from the timeline, it is evident thatthe patient’s symptoms are worsening. There seem to be additionalsymptoms with time. For instance, the patient’s pain in the lowerabdomen has become more severe with time. At the same time, it seemsthat the initial symptoms experienced six months ago are stillpresent, showing that the condition may be chronic and not acute.These observations are a cause for alarm since it means that thepatient’s condition is worsening with time. Therefore, there is aneed for an immediate intervention to address some of these symptoms(Weber&amp Kelley, 2013).

Whatto include in an education plan for the patient: I would have thedescription of the patient’s nature of the condition. I would seekfor additional information about the patient’s condition. I wouldask If the patients are on any medication. I would also use a focusedphysical assessment to examine the patients so as to accuratelydiagnose the condition once and for all (Weber&amp Kelley, 2013).

Reference

Weber,J. R., &amp Kelley, J. H. (2013). Healthassessment in nursing.Lippincott Williams &amp Wilkins.

11.Working Well With Others!

Thehealthcare professionals include:

TheNurse the nurse is the one responsible for conducting a primaryassessment of the patient as well as examining the history of thepatient. The nurse is better placed at understanding the condition ofMrs. Jones. The nurse plays a huge part in attending to the basicneeds of the patient when she visits the outpatient facility(Pelzang,2010).

Physicaltherapist the therapist would help the patient to stay healthy byexercising. The exercise would help improve the condition of thepatient.

Doctorthe doctor would help in giving prescriptions as the patient goesthrough the intervention. The doctor is responsible for assessing theeffectiveness of the intervention (Pelzang,2010).

Thekey elements of this patient’s history and physical examinationthat should be communicated to the other healthcare professionalsinclude:

-previousmedication to help determine whether it is still necessary tocontinue with the medications.

-natureof the condition helps in determining the appropriate interventionto use.

-ageand when the patient was diagnosed

Reference

Pelzang,R. (2010). Time to learn: understanding patient-centred care. Britishjournal of nursing,19(14).

12.You Decide

Aspecific strategy for decision making: In determining the healthhistory questions to ask, I considered those questions that wereclosely related to the condition of Ms. Henderson. I ensured that thequestions I was asking were simple and short such that Ms. Hendersoncould easily answer them. In selecting the physical assessmenttechniques to use, I considered those techniques that would produceimmediate results so that the condition of the patient did not worsenwhile still diagnosing the condition (Nettina&amp Nettina, 2013).

SurpriseMoments: The main surprise came when I realized that a simple mistakeof missing the clues by the nurse could lead to a totally undesirableresult. I was surprised to find out that a highly specific approachto the condition of Ms. Henderson enabled her to recover quickly, andthe variations in the time of recovery with the specific decisionmade. I was also surprised when I realized that there are specificquestions to ask, and how the answers to these questions affect theprocess of the decision-making process (Estes,2013).

Howmy decisions affected the safety of the patient: My decision offocusing on all the clues enabled me to give great insights thatenabled the doctor to make effective decisions. Through thesedecisions, Dr. Rowling was able to address the condition. Thisdecision further helped the patient to recover quickly withoutfurther complication. The focused assessment enabled quick response,ensuring safety to the patient. I would still make the same decisionagain since it ensures patients quick recovery (Estes,2013).

NursingPractice: The information from the exercise has enabled me to realizethe importance of timely and focused response. In future, I intend toemphasize on more focused approach when practicing nursing (Estes,2013).

Reference

Estes,M. E. Z. (2013). Healthassessment and physical examination.Cengage Learning.

Nettina,S. M., &amp Nettina, S. M. (2013). Lippincottmanual of nursing practice.Lippincott Williams &amp Wilkins.

13.Reflecting Back

Allthese case studies have provided a practical system through which Iwas able to simulate the normal occurrences at the health centers.Through these case studies, I was able to realize the importance ofeffective decision-making in the healthcare set up. The experiencefrom these case studies has enabled me to appreciate the fact thatnurses are faced with a lot of instances of decision-making. In theseinstances, the nurses are often expected to make decisionsimmediately, as time wasted could result to undesirable results aswas shown in the exercise (Nettina&amp Nettina, 2013).

Fromthese case studies, one thing that has stood out is the fact that theprimary interaction between a patient and a nurse is the assessmentof the history of the patient. Assessment of the history of thepatient not only help in providing the right intervention but alsosave on time of diagnostic. The nurse is, therefore, expected to askthe patient certain objective questions that would enable the nurseto understand the nature of the disease. In conclusion, I would saythat these exercises have improved my understanding of the nursingpractice, and this would help me when I begin my actual practice(Nettina&amp Nettina, 2013).

Reference

Nettina,S. M., &amp Nettina, S. M. (2013). Lippincottmanual of nursing practice.Lippincott Williams &amp Wilkins.