HEALTH HISTORY. 3. Refer to list of common medical abbreviations guide for appropriate terminology.
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1 HEALTH HISTORY PURPOSE To provide the student with the opportunity to combine interviewing and documenting skills in one assignment. The student will, for a selected adult patient, complete a health history and perform a health risk assessment and document using a nurse s progress note format. PREPARATION: 1. READ THE ASSESSMENT FORM BEFORE THE EXPERIENCE. 2. Review Lewis, pp Refer to list of common medical abbreviations guide for appropriate terminology. CRITERIA: 1. Respond to each item on the Health History. 2. Document current and accurate information on the assignment form using appropriate medical abbreviations and terminology. 3. Complete Health Risk Assessment page. 4. Write a Nursing Progress Note incorporating identified health risks and nursing plan that addresses the risk behaviors including pertinent information from the interview. Assume that other staff may not have access to this information. ASSIGNMENT AND DUE DATE: One written Health History, Health Risk Assessment and Nursing Progress Note will be submitted to the student s clinical faculty within one week following this clinical experience.
2 HEALTH HISTORY Use both patient interview and medical record for gathering data. Student Name: Date: GENERAL INFORMATION Patient Initials: Sex: M F Age: DOB: Health care insurance: Source(s) of information: History of present condition/illness/surgery: Patient s understanding of current condition: Past health/medical problems: Medications currently prescribed: Nonprescription medications used and frequency: Health maintenance, health promotion practices, healing modalities and home remedies: History of family health/illness (DM, cancer, HTN, CVA, MI, communicable diseases, emotional illness):
3 Allergies (include foods, medications, environmental sources, latex, etc.) SUBSTANCE REACTION Substance use: Number of cigarettes/day: Other tobacco/day: Number of years smoked: Amount of caffeinated beverages/day: Amount/type of alcoholic drinks/day: Other substances: Oxygenation Assessment Chest Pain/Palpitations: (frequency precipitating/alleviating factors) Cough, Sputum or Dyspnea: Distance patient can walk without resting: (Is patient limited by SOB, claudication, fatigue, angina) Number of pillows patient sleeps with at night: Nocturia: Rest/Sleep/Comfort Assessment Hours worked/day: Hours of sleep/night: Rest periods/naps: Yes No Describe:
4 Measures to aid sleep (include medications): Sleep problems: Pain, discomfort: If yes, describe (include if acute or chronic in nature): Activity Assessment Type and amount of activity/exercise: Gait: Muscle Strength: Musculoskeletal discomfort or limitation: Assistive Devices: Ability to care for self: Nutrition Assessment 24 hour recall of typical day. Food Fluid INTAKE BREAKFAST LUNCH DINNER SNACKS Usual times of meals at home
5 Dietary restrictions/dislikes/difficulty: Appetite: Recent weight and/or appetite changes: Ability to feed self: Dentition: Symptoms (nausea, vomiting, pain, emesis, bleeding): Bowel Elimination Assessment Typical bowel elimination pattern: Appearance of stool: Continence: Symptoms (diarrhea, blood, hemorrhoids, pain): Urinary Elimination Assessment Typical daily voiding pattern: Appearance of urine: Continence: Symptoms (dysuria, hematuria, anuria):
6 Safety and Security Assessment Hearing: Sight: Aids: Orientation to: Person: Place: Time: Environmental history (exposure to domestic/occupational/recreational substances; noise, chemicals, infectious agents; financial concerns) Higher Level Needs Educational Level: Occupation: Ability to speak and understand: Type and Place of Residence: Student: Yes No Employed: Yes No / Retired: Yes No Religion: Present emotional state: Usual emotional state: Symptoms (anxiety, stress, depression, grief):
7 Love and Belonging Primary support: Family composition: (do not write down names) Household members relationships Symptoms (adequacy of relationships and social support, domestic violence): Sexuality (partner, STD exposure and protection, contraception): Recognition/Esteem Hobbies: Volunteer work: Other pertinent data:
8 HEALTH RISK ASSESSMENT Based on the data gathered in the Health History, identify: 1. Risk behavior(s): 2. Probable consequences of continuing this behavior for this patient: 3. Circle the patient s stage of readiness for change of this risk behavior, using the information contained in the chronic illness conference guide. 1. Pre-contemplation 2. Contemplation 3. Determination/ Planning 4. Action 5. Maintenance 6.Relapse Support this stage selection with patient information (e.g. patient statements or patient activities r/t the risk behavior): 4. Recommended Plan of Action: EXAMPLE 1. Risk behavior(s): sedentary lifestyle, high sodium, high fat diet, cigarette smoking 2. Probable consequences of continuation of this behavior for this patient: hypertension, coronary artery disease, MI, CVA, cancer 3. Circle the patient s stage of readiness for change of this risk behavior, using the information contained in the chronic illness conference guide. Pre-contemplative /Contemplative / Planning / Action / Maintenance / Relapse 4. Refer to dietician; teach benefits of regular exercise; provide smoking cessation materials.
9 NURSING PROGRESS NOTE
10
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