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Additional Assessment Considerations

Additional Assessment Considerations. Advanced Health Assessment Lesson #2. Review Items. Topics listed are for general review purposes & to serve as a reminder that each of these components are significant aspects of the assessment.

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Additional Assessment Considerations

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  1. Additional Assessment Considerations Advanced Health Assessment Lesson #2

  2. Review Items • Topics listed are for general review purposes & to serve as a reminder that each of these components are significant aspects of the assessment. • Notes included in pediatric growth & development notes include lifespan & family dynamics information also

  3. Relevant Topics • Assessment across the lifespan • Family Assessment • Cultural Assessment • Nutritional Assessment • Sleep Assessment • Sexual Assessment • Vital Signs & Lab Values

  4. Assessment Across the Lifespan • Erickson’s psychosocial theory of development serves as an excellent framework • Other theories are addressed for pediatrics in the handout

  5. General guidelines for Dealing with Children • Infants • Young Child • School Age Child • Adolescent

  6. General Guidelines for Dealing with Adults • Young Adult • Middle Age Adult • Aging Adult

  7. Family Assessment • The family can be assessed in a variety of ways: • Biologic • Economic • Educational • Psychological • Sociocultural

  8. Family: Definition • Any group of people related biologically, emotionally or legally. • It’s function is to help its family members satisfy their needs for physical & emotional survival

  9. Family Provides for its Members • Esteem • Relief • Buffering & mediation • Emotional life & bonding force • Support system for meeting basic needs • Raising of children, preparing for adulthood

  10. Family Function & Coping • Family Strengths • Family Coping Success • Meeting Developmental Tasks

  11. Basic Areas of Family Assessment • Structure: Composition & significant influences • Family Function: How families interact

  12. Family Composition • Nuclear • Nuclear Dyad • Kin Network (Extended Family) • Single Parent • Blended (Reconstituted) • Binuclear (Joint Custody of Children)

  13. Family Composition • Homosexual • 3-Generation • Co-Habitating Couples • Single Adult (Living Alone)

  14. Significant Family Influences • Home Conditions & Community Environment • Occupation & Education of Family Members • Cultural & Religious Traditions

  15. Family Functional Assessment • Family Interactions & Roles • Power, Decision Making & Problem Solving • Communication • Expression of Feelings & Individuality

  16. Theoretical Framework for Evaluating Families • Systems Theory • Development Theory • Structural-Functional • Interactional

  17. Strong Families • Sense of Commitment • Sharing Traditions • Active Expression of Appreciation • Effective Communication • Spending Time Together

  18. Strong Families • Shared Values • Solving Problems & Coping • Sense of Humor

  19. Difficult Family Issues • Missing support: the less support, the more morbidity • Enmeshment - Disengagement • If connected by strong emotion, may resist change in roles & behaviors of individuals • Change is disequalibriating & disquieting

  20. Difficult Family Issues • Paying attention to how change affects the family is better tolerated • Conflict arises when emotions & attitudes are too far out of synchrony • Needs unmet: dissatisfactions arise

  21. Some Common Family Conflicts • Dominance vs. Submission • Closeness vs. Autonomy • Emotion vs. rationality • Over involvement vs. distancing • Health vs. Disease

  22. Common Family Conflicts • Adequacy vs. Mismanagement • Responsibility vs. irresponsibility • Sharing vs. Nonsharing

  23. Common Psychosocial Problems • Domestic conflict & sexual difficulties • Substance abuse & dependence • Domestic violence • Physical, emotional or sexual abuse of women & children • Divorce • Financial: management - mismanagement

  24. Cultural Assessment • Culture • Subculture • Race • Ethnic Group • Minority Group • Customs & Rituals • Values & Cultural Norms

  25. Values Affecting Health Care • Time Orientation • Activity Orientation • Human Nature Orientations • Human-Nature Orientation • Relational Orientations

  26. Beliefs & Practices • Folk Illness • Naturalistic Illness • Personalistic Illness • Specific Practices

  27. Some Specific Issues • Coining or Moxa • Distant vs. close space • Eye contact (direct or indirect) • Family Authority • Dietary Customs • Ethnic Predisposition to illness

  28. Nutritional Assessment • Major component of health maintenance • Identify nutritional risk • Over nutrition • Under nutrition

  29. Nutritional Screening • Health history • Lifestyle habits, food choices & exercise • Medications & supplements • Diet History • 24 hour diet re-call • 3-4 day food recall records • food frequency questionnaires (6 months)

  30. Comprehensive Nutritional Screening • Weight is <80% or 120% of ideal weight • Unintended weight loss of >4.5kg • Low serum albumin level • Low total lymphocyte count • History or physical exam indications

  31. Subjective History Information • Unusual weight changes • Changes in appetite, taste, smell, dentition, chewing, swallowing • Recent illness, surgery, trauma, burns, infection, chronic illness • Vomiting, diarrhea, constipation • Food allergies or intolerances

  32. Diet Evaluation & Comparisons • Food Pyramid: 6 food groups • Guideline: 5 servings or fruits or vegetables per day

  33. Age Related Considerations • Infants • Young Children • Adolescents • Pregnancy & Breast Feeding Female • Older Adult

  34. Objective Data: Clinical Assessment • Skin, Hair & Nails • Mouth • Musculoskeletal System • Cardiovascular System • Gastrointestinal System • Neurological System

  35. Body Measurements • Height • Weight • BMI: Nomogram • Skin Fold Thickness (TSF) • Mid-upper arm circumference • Waist-to-hip ratio

  36. Laboratory Studies • Hemoglobin & Hematocrit • Total Lymphocyte Count • Serum Albumin • Fasting Blood Sugar • Serum Lipids

  37. Sleep Assessment • Sleep has restorative function • Sleep deprivation may cause changes in mood & performance: fatigue, irritability, anxiety, depression, feelings of persecution, poor concentration, feelings of depersonalization & increased aggression

  38. Sleep Assessment • Identify Sleep Problems • Evaluate quantity & quality of sleep • Identify circumstances that promote or inhibit sleep • Identify psychological or physiological factors affecting sleep

  39. Sleep Categories • Non-REM: Non rapid eye movement sleep, consisting of 4 stages, during which no dreaming occurs • REM: Rapid eye movement sleep, during which dreaming occurs • Both types of sleep occur during the 4-6 cycles of sleep occurring during an8-hour sleep period

  40. Sleep Patterns with Age:Hours of Sleep per Day • Infants: 14-18 • Young Children: 10-14 • Older Children: 8-10 • Adolescents: Increase • Adults: 7-9 • Older Adults: Awake frequently, nap

  41. Common Sleep Problems • Sleep Apnea • Insomnia • Sleepwalking • Sleep terrors • Nocturnal enuresis

  42. Sexual Assessment • Interviewer’s personal attitudes important • Issues different in various age groups • Straight forward approach useful • Chronic illness influence • Advancing age

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