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Peer 1

Amanda Surujbali

35 year-old white male with history of morbid obesity with disabilities in rural setting:

It is important to take the time to get to know each patient you may come across and develop a rapport with them, helping them feel more comfortable with the care they may receive from you as well as communication amongst both you and the patient. Asking questions that show patient centered care to figure out how to make them feel better is always key as well as showing courtesy, comforting them, connecting, and showing confirmation at the end (Ball et al, 2019). Getting to know them and connecting on a personal level is important in making them feel safe to even continue to answer questions, open up, and speak with you. Communication would differ from patient to patient depending on the factors you may observe with them. Some of them are age, acuity of illness, education level, tradition/ religious beliefs, and ethnicity.

Depending on the patient’s social determinants I would be able to know whether to use task oriented, clinician centered, behavior centered, or patient centered model since there are different levels of information sharing between patients and healthcare professionals (Diamond-Fox, 2021). For my patient, I may target things to help me gather perhaps why he is disabled and what may have caused this, as well as what could have caused him to come in to get seen/ get help. If this patient can speak with me, I would use a patient centered model since Diamond-Fox explains that a clinician centered model is geared toward the disease framework. He discusses the patient centered model is geared toward illness and depending on the situation one would use which ever works more in their benefit (Diamond-Fox, 2021). Since Morbid Obesity is a condition that can stem from lots of different reasons, it made sense to go with the patient centered approach in order to gain knowledge on factors that may be aiding in the illness for this patient.  Asking if he has certain conditions and if he takes medications can also help me to learn if his medication is causing the morbid obesity versus the obesity being a result of a sedentary lifestyle, or something else. According to Sullivan, getting a list of all medications that are prescribed and even over-the-counter medications can also be a crucial part of the medical history (Sullivan, 2018).

With my 35 year-old white male with history of morbid obesity with disabilities in rural setting, the appropriate risk assessment instrument would be the functional assessment since he has disabilities. This assessment will help to determine the variety of disability he has so I would cover all areas of this assessment in order to get a clear picture of how disabled this patient is in order to get proper management plans on board.This can help him with becoming more independent or less disabled/ get the help he needs at home to continue living in conditions that would not make his conditions worse. The Functional assessment covers mobility, upper extremity function, household chores, activities of daily living, and instrumental activities of daily living (Ball et al, 2019). A health related risk this patient has is his morbid obesity that is potentially causing him to have disabilities at the age of 35.

To begin building a health history for this specific patient I would let him know I was going to ask questions regarding his activities of daily living at home/ on a usual basis in order to be able to put a plan together with him to help facilitate the care he may need or for him to have a chance at healing and getting better. Some of the questions I would ask are do you try to take the stairs or use steps and if yes how many can he do, if he has issues walking from his bedroom to the bathroom or one room in the house to another, if he is able to get the mail walking to the mailbox, if he is able to reach things on shelves above him or not, if he takes part in any chores at home and if he does what does he do (in order to gauge if he does heavy or light activities), is he able to eat without gasping for air, how does he transition onto the toilet in order to use the bathroom, who helps him with his medications, are they easy to get to, and if he is able to understand how he should take his medications in case it’s a med he needs to draw up and give himself, cut a pill in half, or mix a solution to drink. There are much more questions that I can ask to help build my health history, but these are some of the pertinent ones that stood out to me from the Functional Assessment tool mentioned above.

References:

Ball, J. W., Dains, J. E., & Flynn, J. A. (2019).  Seidel’s Guide to Physical Examination (9th ed.). Elsevier Health Sciences (US). Retrieved from                        https://mbsdirect.vitalsource.com/books/9780323481953Links to an external site. .

Diamond-Fox, S. (2021). Undertaking consultations and clinical assessments at advanced level.  British Journal of Nursing,  30(4), 238–243.                      Retrieved from  https://doi.org/10.12968/bjon.2021.30.4.238Links to an external site. .

Sullivan, D. D. (2018).  Guide to Clinical Documentation (3rd ed.). F. A. Davis Company. Retrieved from                                                                                     https://mbsdirect.vitalsource.com/books/9780803694194Links to an external site. .

Peer 2

Maricela Leiva

Building a Health History

            Effective patient management is dependent on comprehensive and effective history collection by the healthcare provider. A comprehensive and accurate history collection is specifically crucial in enhancing an accurate diagnosis and enhancing employment of effective treatment interventions (Karaca & Durna, 2019). Effective communication is crucial in enhancing the process of health history collection. Consideration of patient specific factors such as gender, age, environmental setting and ethnicity is also crucial in promoting an individualized care plan (Ebrahimi. et al 2021). This discussion aims to highlight a summary of an interview involving a case scenario of a 35-year-old patient who presents with a history of morbid obesity with difficulty in the rural setting. The targeted questions will also be outlined.

Summary of the interview

            The interview of the 35-year-old patient who presented with the case involves the process of consideration of the patient specific factors to dictate techniques employed. Some of the techniques employed in the case scenario to enhance communication and information collection include practicing active listening, asking open ended questions, demonstrating empathy, and employment of non-verbal cues.

            Through employing open ended questions, the healthcare providers allow for collection of comprehensive information from the healthcare provider. Showing empathy is also crucial in promoting compliance to the interview.

Risk Assessment Instrument

The most applicable risk assessment tool in this case scenario would involve the Framingham Risk Score. The Framingham Risk Score is crucial in investigating for an individual’s risk profile of experiencing a cardiovascular disease within a 10-year timeframe (Petruzzo,.et al, 2021). This risk assessment tool focuses on investigating for potentially underlying risk factors such as smoking, hypertension, sex, age, and cholesterol levels.

Targeted Questions

            The targeted questions that may be employed in the case scenario include:

· Give a description of your daily diet and physical activity

· Describe any significant changes in mental status and mood

· Give a medical history related to the underlying factors as dictated by the Framingham Risk Score.

· Any history of cardiovascular disease.

· Describe your common pain and discomfort management interventions and their efficacy.

Reference

Karaca, A., & Durna, Z. (2019). Patient satisfaction with the quality of nursing care. Nursing

open, 6(2), 535-545.

Petruzzo, M., Reia, A., Maniscalco, G. T., Luiso, F., Lanzillo, R., Russo, C. V., … & Moccia, M.

(2021). The Framingham cardiovascular risk score and 5‐year progression of multiple sclerosis. European Journal of Neurology, 28(3), 893-900.

Ebrahimi, Z., Patel, H., Wijk, H., Ekman, I., & Olaya-Contreras, P. (2021). A systematic review

on implementation of person-centered care interventions for older people in out-of-hospital settings. Geriatric Nursing, 42(1), 213-224.

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