Consider how you would build a health history for the patient.

Consider how you would build a health history for the patient.

Consider how you would build a health history for the patient. 150 150 Nyagu

TJ, a 32-year-old pregnant lesbian NURS 6512

TJ, a 32-year-old pregnant lesbian, is being seen for an annual physical exam and has been having vaginal discharge. Her pregnancy has been without complication thus far. She has been receiving prenatal care from an obstetrician. She received sperm from a local sperm bank. She is currently taking prenatal vitamins and takes over the counter Tylenol for aches and pains on occasion. She has a strong family history of diabetes. Gravida 1; Para 0; Abortion 0

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Shadow Health: Please be sure to follow the course announcements to assist with your troubleshooting of this tool. As I receive information, I will be posting it there.

Discussion: Diversity and Health Assessments
May 2012, Alice Randall wrote an article for The New York Times on the cultural factors that encouraged black women to maintain a weight above what is considered healthy. Randall explained—from her observations and her personal experience as a black woman—that many African-American communities and cultures consider women who are overweight to be more beautiful and desirable than women at a healthier weight. As she put it, “Many black women are fat because we want to be” (Randall, 2012).

Photo Credit: Getty Images

Randall’s statements sparked a great deal of controversy and debate; however, they emphasize an underlying reality in the healthcare field: different populations, cultures, and groups have diverse beliefs and practices that impact their health. Nurses and healthcare professionals should be aware of this reality and adapt their health assessment techniques and recommendations to accommodate diversity.

In this Discussion, you will consider different socioeconomic, spiritual, lifestyle, and other cultural factors that should be taken into considerations when building a health history for patients with diverse backgrounds. Your Instructor will assign a case study to you for this Discussion.

To prepare:

Reflect on your experiences as a nurse and on the information provided in this week’s Learning Resources on diversity issues in health assessments.
By Day 1 of this week, you will be assigned a case study by your Instructor. Note: Please see the “Course Announcements” section of the classroom for your case study assignment.
Reflect on the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient assigned to you.
Consider how you would build a health history for the patient. What questions would you ask, and how would you frame them to be sensitive to the patient’s background, lifestyle, and culture? Develop five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.
Think about the challenges associated with communicating with patients from a variety of specific populations. What strategies can you as a nurse employ to be sensitive to different cultural factors while gathering the pertinent information?
By Day 3 of Week 2
Post an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you were assigned. Explain the issues that you would need to be sensitive to when interacting with the patient, and why. Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Read a selection of your colleagues’ responses. TJ, a 32-year-old pregnant lesbian NURS 6512

By Day 6 of Week 2
Respond on or before Day 6 on 2 different days to at least two of your colleagues who were assigned a different patient than you. Critique your colleague’s targeted questions, and explain how the patient might interpret these questions. Explain whether any of the questions would apply to your patient, and why.

Submission and Grading Information
Grading Criteria
To access your rubric:

Week 2 Discussion Rubric

Post by Day 3 of Week 2 and Respond by Day 6 of Week 2
To Participate in this Discussion:

Week 2 Discussion

What’s Coming Up in Week 3?
Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

Next week, you examine assessment techniques, health risks and concerns, and recommendations for care related to patient growth, weight, and nutrition. You will also begin your first DCE: Health History Assessment which will be due in Week 4. Plan your time accordingly.

Overview of Digital Clinical Experiences (DCE) and Lab Components
Throughout this course, you are required to not only complete your standard course assignments and discussions, but you will also complete DCE and Lab Components that are either structured as optional or required assignment submissions. Please take the time to review your DCEand Lab Components for this course that are required submissions. See the table below and the attached table for specific DCE and Lab Components for the course.

Note: Each Shadow Health Assessment may be attempted and reopened as many times as necessary prior to the due date to achieve a total score of 80% or better, but you must take all attempts by the Day 7 deadline. You must pass BOTH the Health History and Comprehensive (head-to-toe) Physical Exam of at least a total score of 80% in order to pass the course.

Week Digital Clinical Experiences Lab Components
Module 1: Comprehensive Health History
Week 1: Building a Comprehensive Health History
Module 2: Functional Assessments and Assessment Tools
Week 2: Functional Assessments and Cultural and Diversity Awareness in Health Assessment
Week 3: Assessment Tools, Diagnostics, Growth, Measurement, and Nutrition in Adults and Children DCE: Health History Assessment (assigned in Week 3, due in Week 4) Case Study Assignment: Assessment Tools and Diagnostic Tests in Adults and Children
Module 3: Approach to System Focused Advanced Health Assessments
Week 4: Assessment of the Skin, Hair, and Nails DCE: Health History Assessment Lab Assignment: Differential Diagnosis for Skin Conditions (SOAP Note for differential diagnosis)
Week 5: Assessment of Head, Neck, Eyes, Ears, Nose, and Throat DCE: Focused Exam: Cough Case Study Assignment: Assessing the Head, Eyes, Ears, Nose, and Throat (Episodic SOAP Note)
Week 6: Assessment of the Abdomen and Gastrointestinal System Lab Assignment: Assessing the Abdomen (Analyze SOAP Note)
Week 7: Assessment of the Heart, Lungs, and Peripheral Vascular System DCE: Focused Exam: Chest Pain
Week 8: Assessment of the Musculoskeletal System Discussion: Assessing Musculoskeletal Pain (Episodic SOAP Note)
Week 9: Assessment of Cognition and the Neurologic System DCE: Comprehensive (head-to-toe) Physical Assessment Case Study Assignment: Assessing Neurological Symptoms (Episodic SOAP Note)
Week 10: Special Examinations—Breast, Genital, Prostate, and Rectal Lab Assignment: Assessing the Genitalia and Rectum (analyze SOAP Note)
Module 4: Ethics in Assessment
Week 11: The Ethics Behind Assessment Lab Assignment: Ethical Concerns
Next Week
To go to the next week:

Week 3

Week 2: Functional Assessments and Cultural and Diversity Awareness in Health Assessment
Diversity is not about how we differ. Diversity is about embracing one another’s uniqueness.

—Ola Joseph

Countless assessments can be conducted on patients, but they may not be useful. In order to ensure that health assessments result in the necessary care, health assessments should take into account the impact of factors such as cultures and developmental circumstances. TJ, a 32-year-old pregnant lesbian NURS 6512

Learning Objectives
Students will:

Analyze diversity considerations in health assessments
Apply concepts, theories, and principles related to examination techniques, functional assessments, and cultural and diversity awareness in health assessment
Learning Resources
Required Readings (click to expand/reduce)
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.

Chapter 1, “The History and Interviewing Process” (Previously read in Week 1)
This chapter highlights history and interviewing processes. The authors explore a variety of communication techniques, professionalism, and functional assessment concepts when developing relationships with patients.

Chapter 2, “Cultural Competency”
This chapter highlights the importance of cultural awareness when conducting health assessments. The authors explore the impact of culture on health beliefs and practices.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.

Chapter 2, “Evidenced-Based Clinical Practice Guidelines”
Melton, C., Graff, C., Holmes, G., Brown, L., & Bailey, J. (2014). Health literacy and asthma management among African-American adults: An interpretative phenomenological analysis. Journal of Asthma, 51(7), 703–713. doi:10.3109/02770903.2014.906605

Credit Line: Health literacy and asthma management among African-American adults: An interpretative phenomenological analysis by Melton, C., Graff, C., Holmes, G., Brown, L., & Bailey, J., in Journal of Asthma, Vol. 51/Issue 7. Copyright 2014 by Taylor & Francis, Inc. Reprinted by permission of Taylor & Francis, Inc. via the Copyright Clearance Center.

The authors of this study discuss the relationship between health literacy and health outcomes in African American patients with asthma.

Centers for Disease Control and Prevention. (2015). Cultural competence. Retrieved from https://npin.cdc.gov/pages/cultural-competence

This website discusses cultural competence as defined by the Centers for Disease Control and Prevention (CDC). Understanding the difference between cultural competence, awareness, and sensitivity can be obtained on this website.

United States Department of Human & Health Services. Office of Minority Health. (n.d.). A physician’s practical guide to culturally competent care. Retrieved June 10, 2019, from https://cccm.thinkculturalhealth.hhs.gov/

From the Office of Minority Health, this website offers CME and CEU credit and equips healthcare professionals with awareness, knowledge, and skills to better treat the increasingly diverse U.S. population they serve.

Espey , D. K., Jim, M. A., Cobb, N., Bartholomew, M., Becker, T., Haverkamp, D., & Plescia, M. (2014). Leading causes of death and all-cause mortality in American Indians and Alaska Natives. American Journal of Public Health, 104(Suppl 3), S303–S311.

The authors of this article present patterns and trends in all-cause mortality and leading cause of death in American Indians and Alaskan Natives.

Wannasirikul, P., Termsirikulchai, L., Sujirarat, D., Benjakul, S., & Tanasugarn, C. (2016). Health literacy, medication adherence, and blood pressure level among hypertension older adults treated at primary health care centers. Southeast Asian Journal of Tropical Medicine and Public Health, 47(1), 109–120.

The authors of this study explore the causal relationships between health literacy, individual characteristics, literacy, culture and society, cognitive ability, medication adherence, and the blood pressure levels of hypertensive older adults receiving healthcare services at primary healthcare centers.

Required Media (click to expand/reduce)
Module 2 Introduction
Dr. Tara Harris reviews the overall expectations for Module 2. Consider how you will manage your time as you review your media and Learning Resources for your Discussion, Case Study Lab Assignment, and your DCE Assignment (3m).

Functional Assessments and Cultural and Diversity Awareness in Health Assessment – Week 2 (10m)

Paulson-Main Post Week 2:
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Paulson-Main post week 2; Case study assigned: TJ, a 32-year-old pregnant lesbian, is being seen for an annual physical exam and has been having vaginal discharge. Her pregnancy has been without complication thus far. She has been receiving prenatal care from an obstetrician. She received sperm from a local sperm bank. She is currently taking prenatal vitamins and takes over the counter Tylenol for aches and pains on occasion. She has a strong family history of diabetes. Gravida 1; Para 0; Abortion 0

Patient TJ appears to be a young, healthy, pregnant lesbian female who presents to the clinic for her annual exam with a chief complaint of vaginal discharge. Although it is important to acknowledge her sexual orientation and circumstance of pregnancy – artificial insemination, these are questions that are best interjected into the health and social history with respect, dignity, and a non-judgmental manner. This is likely something that has taken a lot of consideration, consultation, and potential expense on her part and is something to be proud and excited about and should not be taken lightly in terms of the effort and commitment involved. Starting out the interview with a simple greeting, asking the patient how she would like to be addressed, and what brings her to the clinic is a relative first step in developing a trusting relationship with the client. Additionally, practicing cultural competence and cultural humility by remaining sensitive to her sexual orientation by avoiding non-heteronormative language, using affirming pronouns, and remaining open to different perspectives in lifestyle and preferred differences will also further develop a trusting relationship (Ball et al., 2019).

The specific socioeconomic, cultural, and lifestyle factors associated with TJ are important to assess to determine how she defines her current situation and beliefs on medical care, including vaccinations and medications, and her support inside and out of her home. It is equally important to address social networking support, challenges she has faced to this point, and identify any barriers to care. According to Pharris et al. (2016), first time parents, specifically lesbian couples or individuals benefit from a network of professionals who provide a safe, inclusive, and supportive environment to ask difficult questions and connect them with community resources during and after their pregnancy.

There are often misconceptions or assumptions surrounding parenting a child or motherhood, specifically that the child is associated with a heterosexual family and a man and a woman will be raising the child. Lesbians and the LGBTQ community is not unfamiliar with these stereotypes and are often affected by the discrimination and social isolation often experienced by lesbian mothers and same sex families that choose to raise a child, let alone conceive and birth one. According to Holland (2019), when lesbian women choose to get pregnant and transition to motherhood, their social status changes, their medical decision making and navigation of a system strongly set up for heterosexual women, becomes increasingly more challenging and complex, and physical and psychological stress can often ensue. By providing a safe environment rich with support and community resources, the provider can ensure they are doing their part in an already unsteady and potentially unfamiliar environment for the client.

Once trust is established through active listening, respectful conversation, and inclusion, the remainder of the interview and physical exam should take place. After a review of her medications, allergies, family and social history, and history of present illness (HPI) – vaginal discharge. I would explain to the patient that vaginal discharge during pregnancy is expected and may increase as she gets further along in her pregnancy. However, it is important to explore further to determine if there is an infection or a potential rupture of membranes. I would gather some additional information through a review of systems (ROS) and focus on her chief complaint as well as addressing any high risk areas of concern, such as her strong family history of diabetes and relative findings during exam. The five focused questions that I would include in the interview to build the remainder of the HPI, PMH, and risk assessment, include: 1) first, I would ask the client if she was comfortable with a male provider performing an interview and exam or if she preferred a female provider and if she had any other preferences related to her medical care or treatment before we continued. I would also inform her that I would be including a nurse or assistant during the exam as a chaperon, 2) I would inquire about her goals of the pregnancy and post-partum care, 3) last menstrual period (LMP) and determine her estimated date of confinement (EDC), if she is experiencing any Braxton Hicks / contractions, and feeling the baby move, 4) onset of symptoms, including frequency, odor, consistency, color, itching, burning, history of yeast infections current sexual history and vaginal penetration, and if there is a history of sexual transmitted infections (STI’s), dysuria, frequency, hematuria, or other signs or symptoms of infection, 5) Signs or symptoms of hyperglycemia, including polydipsia, excessive hunger, weight loss, diet, nausea, vomiting, diarrhea, abdominal pain, other medications or reactions to medications.

There are multiple social and medical topics to discuss with this patient, however, the high risk topics and sensitive areas of the assessment needed to coincide for timely care. Depending on the results of the exam, I would order lab work, perform a wet mount, assess for amniotic fluid, urinalysis for infection, hydration status, ketonuria, glucose, fetal heart tones, and further investigate and monitor for gestational diabetes with glucose tolerance testing as needed, and refer back to OB and possibly neonatology and endocrinology if positive. Additionally, I would treat any infection such as yeast, UTI, or otherwise, and refer her to community resources, social, and LGBTQ support groups and have her follow back up with the clinic as needed or indicated based on treatment plan.

References
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.

Holland, S. (2019). Constructing queer mother-knowledge and negotiating medical authority in online lesbian pregnancy journals. Sociology of Health & Illness, 41(1), 52-66. doi:10.1111/1467-9566.12782

Pharris, A., Bucchio, J., Dotson, C., & Davidson, W. (2016). Supporting Lesbian Couples During Pregnancy. International Journal of Childbirth Education, 31(3), 23-24.

RE: Paulson-Response #2 Henderson
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Avery,

Thank you for your discussion, it was very interesting and informative. You addressed every topic very clearly and precisely. I found some other interesting information regarding gestational diabetes, sleep quality, age and how they can increase TJ’s risk factors for her already strong family history of diabetes. According to Zhong et al., (2018), there is evidence from observational and experimental studies demonstrating the associations between poor sleep quality and the risk of impaired glucose metabolism. During her health history questioning, I would ask how she has been sleeping. Do you have difficulty falling asleep? Do you sleep all night? How many hours of sleep do you think you get in a night? Do you consider it restful?

As the patient already stated, she has a strong family history of diabetes. According to Lin et al., (2016), among all risk factors, family history of diabetes is the strongest predictor of gestational diabetes mellitus. TJ has reported that she received the sperm from a sperm bank, was she able to find out the medical history associated with the sperm donor? From my understanding, sperm donors have the right to confidentiality. I am not completely sure on what is kept confidential and what is shared with the receiver.

Becki

Reference

Zhong, C., Chen, R., Zhou, X., Xu, S., Li, Q., Cui, W., Wang, W., Li, X., Wu, J., Liu, C., Xiao, M., Sun, G., Yang, X., Hao, L., & Yang, N. (2018). Poor sleep during early pregnancy increases subsequent risk of gestational diabetes mellitus. Sleep Medicine, 46, 20–25. https://doi-org.ezp.waldenulibrary.org/10.1016/j.sleep.2018.02.014

Lin, P.-C., Hung, C.-H., Chan, T.-F., Lin, K.-C., Hsu, Y.-Y., & Ya-Ling Tzeng. (2016). The risk factors for gestational diabetes mellitus: A retrospective study. Midwifery, 42, 16–20. https://doi-