Advanced Assessment for Nursing
The course provided instruction on comprehensive assessment and diagnosis of health problems and wellness status for individuals of all ages. The laboratory component provided directed laboratory experiences in advanced assessment of clients of several ages. My clinical experiences included performing Boy Scout physicals, performing physicals for the rural and underserved populations at the Sullivan Center, and performing physical assessments at the Anderson County Health Department.
Total Patients: 15
- 2 adult sports physicals
- 2 adolescent sports physicals
- 5 complete physical exams
- 3 complete breast exams
- 1 pelvic exam
- 4 Pap smears
Dr. Rosanne Pruitt, PhD
Paige Thompson, NP
Daily Patient Logs:
Health Promotion Protocol Synopsis: Eighteen Year Old College Age Female
Developmental Theories: Erikson’s stage: identity vs. role confusion, goal: develop a secure sense of self. Kohlberg’s post-conventional level of moral development, goal: develop behavior that respects universal laws. Piaget’s stage of formal operational thinking, cognitive goal: to think abstractly and logically (Berman, Snyder, Kozier, & Erb, 2008; Townsend, 2008).
Health History: Medical history: family health status of diseases and causes of death, allergies to medications & foods, immunizations, past surgeries & hospitalizations (Swartz, 2006). Physical exam: practice confidentiality, privacy, and aseptic techniques. HEENT: gross vision and hearing eval, note (+) lymphadenopathy due to mononucleosis, obtain CBC and Monospot, note uneven wear of tooth enamel due to eating disorders or grinding (Swartz). Thorax: note unequal rise of chest on inspiration due to spontaneous pneumothorax, anticipate normal S3 or S4 heart sounds, draw fasting lipid panel if (+) family history of CVD. Abdomen: note pain from inflamed appendix or splenomegaly, changes in bowel habits due to irritable bowel syndrome (Swartz). M/S: note undetected spinal curvature or client c/o back pain (USPTF, 2008; SAM, 2008). Skin: note pallor from anemia, draw CBC to assess HgB <12, MCV<80, and MCH <27 (USPTF), note acne & blackhead that may be normal (SAM). Reproductive: breast ultrasound indicated if (+) family history, gonorrhea, Chlamydia, and pregnancy testing if sexually active (SAM), refer to OB/GYN if (+) pregnancy test. Mental health assessment: indicated if family history and/or client reports depression, hopelessness, unexplained somatic problems, substance abuse or chronic pain over the past 2 weeks, refer to mental health counselor (USPTF, 2008).
Health Management: Physical exam recommended every 5 yrs. if asymptomatic (USPTF, 2008). Normal: height 83-86 inches, BMI 17-33, B/P <140/90 (USPTF, Uphold & Graham, 2003, National Center for Health Statistics, 2009). Visual acuity checked every 2 yrs. if asymptomatic, refer if 2 line difference between eyes even with a passing range of 20/20 (American Ophthalmology Assoc., 2005; National Guideline Clearinghouse, 2003). Dental exam every 6 mos along with daily brushing & flossing (Academy of General Dentistry, 2009). Multi-vitamin & folic acid (O.4mg) supplements daily for all women capable of becoming pregnant. Pelvic & Pap yearly if sexually active (USPTF, 2008). Tdap, HPv, and MCV4 immunizations for previously unvaccinated college freshman living in the dorms (CDC, 2009,USPTF).
Anticipatory Guidance: Leading cause of death & disability is unintentional injuries and MVAs associated with alcohol (CDC, 2008, Uphold & Graham, 2003). 18-20 yr olds have the highest illegal drug use, 23% report smoking cigarettes, 14% report smoking cigars, 18% report smokeless tobacco use (ACPM, 2009). 54% of 300,000 rapes in the US are females < 18 yrs. old. At risk for dating violence (Ismail, Berman & Ward-Griffin, 2007). At risk for unhealthy eating habits, 180-230 gm carbs daily, 0.8 gm/kg/day of proteins, 5-9 daily servings of vegetables & fruit (USDA, 2009; Uphold & Graham, 2003). At risk for obesity (BMI >30) (USPTF, 2008). Risk for anorexia & bulimia due to equating thinness and beauty (Choate & Schwitzer, 2009). Refer to behavioral counseling for malnourishment or BMI > 30. At risk for STDs, giving birth before age 20 (ACPM, 2009; CDC Healthy Youth!, 2009), young moms age 18-21 at risk of poor mental health, reduced educational achievement, & unemployment (Boden, Fergusson, & Horwood, 2008; CDC, 2009). Birth control counseling to include method that is easiest to use, store, and remember to take (ACPM, 2009; Uphold & Graham, 2003). Physical activity of 60 mins of aerobic exercise daily (USDHHS, 2008). Mental health risk for anxiety, depression, & suicide (CDC Violence Prevention, 2008; Eberhart & Hammen, 2006; Balkin, Tietjen-Smith, Caldwell, & Shen, 2007), refer suicide ideations & attempts to mental health counselors for follow-up. Need tremendous psychosocial support from family & friends, involve parents & respected non-parent adults in developing problem solving skills through resiliency ,need to develop and enhance a positive self-concept and self-esteem by recognizing & developing special skills & talents (Everall, Altrows, & Paulson, 2006). Delayed maturation due to gonadotropin deficiencies (LH & FSH), Turner syndrome, hypothyroidism, chronic illness, & nutritional deficiencies (SAM, 2008), refer to endocrinologist for 2 standard deviations from the mean development for chronological age (SAM).
Cultural & Ethnic Considerations: African Americans have general distrust of healthcare system, depend on home remedies for curs, and have strong religious beliefs, matriarchal heads of households (Swartz, 2006), higher than average of STDs and pregnancies (USDHHS, 2007), non-A/A APN must work slowly to build trust through thorough explanations of need for all adolescents to have routine health evaluations. Native Americans are a heterogeneous group that live in both rural & urban areas, believe illness is a result of bad behavior or evil spirits (Swartz, 2006), leading cause of death is due to MVAs and poisonings (USDHHS, 2007), at risk for binge drinking, domestic violence, & suicides (USDHHS, 2007), will require a diverse team to provide long-term & counseling support. Latina or Hispanics are a heterogeneous group, Catholic Christians, poverty, close-knit families with patriarchal head, at risk for drinking, smoking, and obesity (USDHHS, 2007). Asian Americans hold obligation, authority, & honor in high esteem, believe in hot-cold remedies to restore health balance (Swartz, 2006), at risk for stomach caner (NCI, 2007). Caucasians are a heterogeneous group of Jewish, European, & mixed ancestry, believe in Western medicine, with religious restrictions (Jehovah Witness) (Swartz, 2006), at risk for melanoma due to fair complexions , educate on sunscreen of SPF >15 and self-skin exam of moles (asymmetry, irregular borders, uneven color, diameter larger than a pencil eraser, elevation of mole above the level of skin, new onset of itching, bleeding or changes in size or color (NCI,2007), refer to dermatologist for biopsy of suspicious moles.
Other Common Health Problems: Lesbian adolescents at risk for poor health care, violence, hate crimes, depression, & substance abuse (USDHHS, 2007), remain neutral, provide routine adolescent examinations, and refer to mental health counselor for depression & substance abuse (LHRC, 2005).
Prepared by Ruth Geide 6/09.