Advanced Health Assessment and Diagnostic Reasoning NURS 6512
Main Post Week 1
Scenario: 16-year-old white pregnant teenager living in an inner-city neighborhood
The client interview is a crucial professional skill contributing to quality care by establishing trust. Ball, Dains, Flynn, Solomon, and Stewart (2015) support interviewing a client to develop a therapeutic relationship and understand the client’s unique perspective, which enables the provider to disregard assumptions that could negatively impact care. Fortin, Dwamena, Frankel, and Smith (2013) suggest commencing the interview with a “non-focusing” method (p. 40), in which the provider asks a general open-ended question and allows the client to speak freely while observing nonverbal signals before additional dialogue. In the case of the 16-year-old, this information could help determine how she feels about the pregnancy. As an experienced labor and delivery nurse and obstetrics and gynecologist nurse, I believe the pregnancy was unintended. However, this inner-city youngster may regard her pregnancy as a ticket out of a harsh or even abusive home environment, and she welcomes the pregnancy. Permitting the client to express her emotions will help me deliver caring, nonjudgmental care. Regardless of the client’s age or disease, it is crucial to implement the communication approaches Ball et al. (2015) suggested to establish rapport and ensure the client’s comfort. There are other, more specialized requirements based on the client’s age. In Illinois, unmarried pregnant adolescents must get parental consent for treatment (Illinois Department of Health, 2018). Because adolescents may be reluctant to speak openly in the presence of a parent, the NP should advocate for the client by requesting permission to conduct some interviews without the parent’s presence. Seeing the client alone for at least a portion of the intake interview will enable the screening of abuse in confidence. Ball et al. (2015) describe the vast amount of data obtained from pregnant clients. For a young mother, it may be easier to complete an intake if it is divided up across numerous office visits or if it can be done at home and returned to the office. Risk Assessment Instrument Postpartum depression (PPD) is a serious condition that affects one in five mothers and is more prevalent among adolescents than adults (Illinois Department of Health, 2018).
Therefore, screening for this risk is crucial. The Edinburgh Postnatal Depression Scale is a valid and accurate risk assessment instrument. Intriguingly, the equipment is recommended for usage beginning in the second trimester to provide early detection of PPD (Lydsdottir, Howard, Olafsdottir, Thome, Tyr-fingsson, & Sigurdsson, 2014). The screening instrument consists of ten questions that focus on the client’s emotions throughout the past week. The customer completes the instrument. Question areas include disposition, affect, activity interest, and self-harm. Targeted Inquiries There are numerous questions designed to aid in gaining an understanding of this client and identifying her risks during pregnancy and after.
Five crucial questions to ask include
1. “How has your life changed since you became pregnant?”
2. “What are your hopes and dreams for your child?”
3. “How do you feel about “Have you ever contemplated self-harm?” Who do you confide in while feeling down or overwhelmed?
4. How do the father, your family, and your friends feel about the pregnancy?
5. “Describe the people and animals in your household.” The questions mentioned above were selected because they correspond with The American College of Obstetricians and Gynecologists (ACOG) (2018) and the Edinburg Depression scale, which suggest that maternal anxiety, life stress, unintended pregnancy, and poor relationship quality increase the risk of perinatal depression and allow the practitioner to quickly and efficiently identify at-risk individuals.
Place an order at geniusnursingpapers.com and get 25% discount
American College of Obstetricians and Gynecologists (ACOG). (2018). Screening for Perinatal Depression. Retrieved from https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Screening-for-Perinatal-Depression
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination. St. Louis, MO: Elsevier.
Illinois Department of Health (2018). Trends in teen birth rates: Illinois. Retrieved from: http://dph.illinois.gov/topics-services/life-stages-populations/maternal-child-family-health-services
Lydsdottir, L. B., Howard, L. M., Olafsdottir, H., Thome, M., Tyr-fingsson, P., & Sigurdsson, J. F. (2014). The mental health characteristics of pregnant women with depressive symptoms identified by the Edinburgh Postnatal Depression Scale. Journal of Clinical Psychiatry, 75(4), 393-398. doi: 10.4088/JCP.13m08646.
Smith, R. C., Fortin, A. H., Dwamena, F., & Frankel, R. M. (2013). An evidence-based patient-centered method makes the biopsychosocial model scientific. Patient Education and Counseling, 91(3), 265-270. doi: 10.1016/j.pec.2012.12.010
Health Assessment (NURS 3020 ) – discussion peer response
Hi Stacia, Your discussion thread and the case you chose were enjoyable to read. After analyzing the circumstance, the available information, and the necessary diagnostics, I would also consider Radiculopathy/Sciatica as a differential diagnosis. Patients with radiculopathy or sciatica typically exhibit numbness, weakness in the lower extremities, discomfort radiating to the buttocks and leg (particularly if the pain spreads past the knees), and a unilateral presentation. SPINE-health.com (2018) identifies lumbar disc herniation, degenerative disc disease, spondylolisthesis, and spinal stenosis as common causes of back discomfort. I concur with your primary diagnosis of a herniated disc because it corresponds with the patient’s reported pain location and the occupational risk of heavy lifting!
Huether, S. E., & McCance, K. L. (2017). Disorder of the joints. In alterations of musculoskeletal function (6th ed., pp. 991-1038).SPINE-health (2018). What You Need to Know About Sciatica. Retrieved October 14, 2018from: https://www.spine-health.com
Advanced Health Assessment and Diagnostic Reasoning NURS 6512 – Main Post Week 3
Health Issues and Risks of Children’s Weight
For a 5-year-old girl of normal weight with obese parents, BMIParental obesity is a risk factor for childhood obesity (Fuemmeler, Lovelady, Zucker, & stbye, 2013); hence, it is vital to evaluate familial features regarding weight issues. According to Sahoo et al. (2015), body mass index (BMI) is inheritable to 25 to 40 percent. It is one of the leading causes of obesity, placing a 5-year-old girl of normal weight at a greater risk for obesity than a kid whose parents have a normal BMI. Childhood obesity is associated with poor physical health, including an increased risk of developing sleep apnea, Type II diabetes, asthma, cardiovascular disease, high cholesterol, insulin resistance, and menstrual abnormalities, as well as social and emotional issues associated with low self-esteem and the stigmatization of bullying (Sahoo et al., 2015). This increased social isolation might increase sedentary behavior and weight gain (Sahoo et al., 2015).
Additionally, excessive school absences can severely impact academic achievement, particularly when a chronic disease occurs (Sahoo et al., 2015). Information Required for Weight Evaluation To determine the possible dangers linked with childhood obesity, a complete medical history of the parents is required. If parental obesity is associated with a disease process, the child may be at risk of having the disease. In addition, information regarding the mother’s health during pregnancy, particularly a history of gestational diabetes, would be relevant because it might cause metabolic abnormalities in kids (Lehnen, Zechner, & Haas, 2013). The following questions would be good for this patient:
Was there a history of pregnancy-related problems, such as Gestational Diabetes?
Does she (the youngster) engage in at least one hour of daily physical activity? What types of foods and beverages does she consume and have access to at home? How many hours of television (TV) does she watch each day? 5. How does the child engage with their peers? Does she love playing with other children, or is she aware that she’s alone? Strategies for Healthier Conduct Family has a crucial influence in developing and maintaining good kid behaviors (Faith et al., 2018). Weight-related conversations can be delicate; therefore, shifting this patient’s/discourse family towards improving general health rather than focusing simply on weight loss or maintenance could be beneficial. It is good to discuss a healthy diet with the parents, focusing on foods that boost health and are nutritionally sound and adequate hydration that excludes sugary and caffeinated beverages. A debate on restricting television viewing and embracing other activities, such as unstructured and social play, enhances critical thinking abilities (Hill et al., 2016). A healthy lifestyle for the mind and body can be promoted by promoting physical exercise over television.
Anderson PM, Butcher KE. (2018) Childhood obesity: Trends and potential causes. Future Child, 16(1). Retrieved from http://files.eric.ed.gov/fulltext/EJ795889.pdf
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.
Faith, M. S., Van Horn, L., Appel, L. J., Burke, L. E., Carson, J. A., Franch, H. A., & Kral, T. (2018). Physical activity and metabolism; Council on clinical cardiology, cardiovascular disease. Retrieved from https://professional.heart.org/professional/ScienceNews/UCM_455052_Severe-Obesity-in-Children-and-Adolescents.jsp
Fuemmeler, B. F., Lovelady, C. A., Zucker, N. L., & Østbye, T. (2013). Parental obesity moderates the relationship between childhood appetitive traits and weight. Obesity (Silver Spring, Md.), 21(4), 815–823. http://doi.org/10.1002/oby.20144
Hill, D., Ameenuddin, N., Chassiakos, Y. L. R., Cross, C., Hutchinson, J., Levine, A., … & Swanson, W. S. (2016). Media and Young Minds. Pediatrics, e20162591. Retrieved from http://pediatrics.aappublications.org/content/early/2016/10/19/peds.2016-2591
Lehnen, H., Zechner, U., & Haaf, T. (2013). Epigenetics of gestational diabetes mellitus and offspring health: the time for action is in early stages of life. Molecular human reproduction, 19(7). doi: 10.1093/molehr/gat020
Sahoo, K., Sahoo, B., Choudhury, A. K., Sofi, N. Y., Kumar, R., & Bhadoria, A. S. (2015). Childhood obesity: causes and consequences. Journal of Family Medicine and Primary Care, 4(2), 187–192. http://doi.org/10.4103/2249-4863.154628
Djohnsonfolmar Financial Analysis methods – Health Assessment
The horizontal analysis enables investors and analysts to determine what has been driving a company’s financial performance over several years and identify trends and growth patterns, such as seasonality. It allows analysts to evaluate and project relative changes in line items across time. By simultaneously examining the income statement, balance sheet, and cash flow statement, one may generate a comprehensive picture of operational outcomes and determine what has been driving a company’s success and whether it is functioning profitably and efficiently. Vertical analysis is a method for analyzing financial statements in which each line is listed as a percentage of the statement’s base figure. Thus, income statement line items can be expressed as a percentage of total revenue.
In contrast, balance sheet line items can be expressed as a proportion of total assets or liabilities. A cash flow statement’s vertical analysis depicts each cash inflow or outflow as a percentage of the total cash inflows. The vertical analysis makes it considerably simpler to compare the financial statements of different companies and industries. This is because the balanced proportions of account balances are visible. It also makes it easy to compare past periods for time series analysis, which compares quarterly and annual numbers over several years to evaluate if performance indicators are improving or degrading.
In contrast to horizontal analysis, which examines how the dollar amounts in a company’s financial statements have changed over time, the vertical analysis examines each line item as a percentage of the statement’s base figure. My opinion is that one cannot exist without the other. Unlike horizontal, which is used to calculate throughout a time, vertical is used to calculate each item. Whether annual or monthly, all financial ratios are quite crucial for a financial organization. The horizontal dimension represents an extended period, and the vertical dimension represents a single object.