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Additional Assessment Considerations

Learn about assessing families across the lifespan, cultural considerations, and nutritional assessment in advanced health assessment. Discover theoretical frameworks, family structures, functions, and coping strategies. Understand common family conflicts and psychosocial problems. Gain insights into cultural assessments, beliefs, and practices affecting healthcare.

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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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