Health Assessment for Mother & Newborn

1. Health Assessment for Mother & Newborn Chapter –1

2. Introduction • As long ago as the beginning of the civil war an article was published recommending periodic health examinations in the interest of early detection of diseases. This concept was depoted by American medical association in (1992) in the form of a resolution advocating periodic health assessment. • In (1995) the declaration that health care is a basic human right was made at a white house conference on aging. The general public has expressed with increasing frequency the expectation that preventive health care constitutes a fundamental part of this care. Preventive health care is defined in three categories, primary, secondary and tertiary prevention. Each level of prevention is based on a thorough assessment of the client's health as status.

3. The health assessment is frequently the mechanism of entry into the health care system. Since accessibility has been shown to be an important factor in determining whether a client will seek health care, alternates mode of providing health care to greater numbers of people has been explored. • *recent studies have indicated that although periodic health assessment have proved beneficial , they may not necessarily need to be performed by a physician, but also performed by nurses.

4. **controlled studies comparing physician's and nurses problem lists after they have examined the same clients show no appreciable differences . The examinations are certainly less costly to the client when they done by nurse other than physicians.

5. Objectives and types of assessment: • The purposes of health assessment include surveillance of health status, the identification of latent or occult disease, screening for specific type of disease, and follow-up care. • The periodic assessment, on other hand, is regarded as occurring at regular intervals.

6. A return or follow up visit is one that is scheduled to assess the progress or an abatement أنحسار of diagnosed dysfunction. • Increasing client participation in health care. • The health assessment should accurately define the health and risk care needs for individual at that specific point in time. • The information obtained in the interview and health assessment is used to formulate the exchanges of responsibility in defining the contract.

7. The findings of the health assessment are shared with the client in a clearly and understandable manner. In many cases this may mean educating him to the anatomy and physiology of his diseased tissues, so that he can fully understand the meaning and level of his dysfunction. • Only with clear definition of his problem is the client capable off assuming active involvement in decision making for his own care.

8. ** the world health organization (W.H.O) has defined health education as" the active mechanism of facilitating an optimal state of social, emotional, & physical functioning that should be available to all people . Client education is implicit ضمنin preventive care.

9. ** Frequency of assessment: • There is considerable controversy surrounding the issue of how often the periodic health assessment should be performed on the ostensibly ظاهرياhealthy client. • Early recommendations suggested that the health assessment should be done each year .but one recommendation suggested that the health assessment for the persons under (35) years of age must be every (4 – 5) years, and persons from (35 – 45) years of age must be every (2 – 3) years. And that any person over (45) years of age undergo a thorough health assessment every year.

10. **Importance of nursing health assessment: • Assessment is "the systematic and continuous collection validation and communication of client data". • ** The collection of client data is a vital step in the nursing process, because the remaining steps depend on complete, accurate, relevant, and factual data which obtained from the client.

11. When nurses make health assessment they don’t duplicate medical assessments. The primary purpose of the nursing assessment is not to gather data that define underlying pathology & medical problems but it focus on client responses to health problems.

12. Through health assessment the nurse carefully examine the client’s body parts to review their integrity & to determine if abnormalities exist. • The nurse relies on data from a variety of sources to reveal patterns of abnormalities which when validated with health assessment findings can indicate significant clinical problems. • Health assessment provides abase line, measurement of the client’s existing function abilities, successive examinations used to plan the clients care.

13. Health assessment helps the nurse to diagnose client’s problem & determine the best nursing measures & their management. • A complete health assessment involves a more detailed review of client’s condition. • Accuracy of health assessment influence, the choice of therapies a client receives & the determination of response to those therapies.

15. Purposes of health assessment:- • To gather base line data about the client's health. • To supplement, confirm, or refute data obtained in the health history. • To confirm identify nursing diagnoses. • to make clinical judgments about client's changing health status and management • To evaluate the bio-psycho-social and spiritual outcomes of care.

16. **Nursing diagnosis and medical diagnosis • Nursing diagnosis represent the independent role of the nurse. The nurse can use this model to decide whether the identified problem can be treated independent by as a nursing diagnosis, or whether the nurse will monitor and use both medical and nursing interventions to treat or prevent the problem, if medical and nursing interventions are not needed, the problem is discharged from nursing care referred to medicine and /or dentistry.

17. ** The medical diagnoses depend on clinical picture and laboratory findings, but the nursing diagnoses depend on the client's problems associated with specific disorder. And any problem must notice from a holistic view e.g. bio-psycho-social and spiritual relations which play major roles in disease process of the client. • *the difference between medical diagnosis, a collaborative problem, and nursing diagnosis is explained with the following examples:-

18. Medical diagnosisCollaborative problemNursing diagnosis-fractured jaw Potential Complication:Aspiration *altered oral mucous membrane related to difficultly with hygienic secondary to fixation devices *chronic pain related to tissue trauma. Diabetes mellitusPotential Complication: Hyperglycemia Hypoglycemia *impaired skin integrity related to poor circulation to lower extremities. *know ledge deficit: effects of exercise on need for insulin. Pneumonia Potential Complication Hypoxemia *ineffective airway clearance related to presence of excessive mucus. *fluid volume deficit related to poor fluid intake.

19. Chapter 2 • Health history • Health history "a holistic approach" done by:- • The interview • Psychosocial assessment • Nutritional assessment • Assessment of sleep-wakefulness patterns • The health history.

20. Interview • The major purpose of interview conducted before physical examination is to obtain health history and to elicit symptoms and the time course of their development. • The interview is defined as "a communication process that focuses on the client's development, psychological, physiological, socio cultural , and spiritual responses , that can be treated with nursing & collaborative interventions ,"

21. Phases of the Interview Process • Pre-interaction Phase • Before meeting with the patient, the nurse collects data from the medical record and reviews the patient’s history of medical illnesses or surgeries, current medication list, and problem list.

22. Beginning Phase • The nurse initially introduces herself or himself by name, states the purpose of the interview, and asks the patient his or her preferred name ,The nurse shakes hands if that seems comfortable with the patient and is appropriate for culture and setting. • The beginning phase may continue with discussion of neutral topics (eg, the weather) if the patient seems anxious.

23. Ensuring privacy within the specific health care setting by pulling drapes, closing doors, or moving to a remote area before proceeding is essential, especially considering confidentiality guidelines.

24. Working Phase • The nurse asks specific questions, two types of which are closed ended and open ended. Each has a purpose, which the nurse chooses to elicit appropriate responses: • Closed-ended (direct) questions yield “yes” or “no” answers. Anexample is “Do you have a family history of heart disease?” They are important in emergencies or when a nurse needs to establish basic facts.

27. Open-ended questions require patients to elaborate.توضيح • They arebroad and provide responses in the patient’s own words. They are key to understanding symptoms, health practices, and areas requiring intervention. • Closing Phase • The nurse ends the interview by summarizing and stating what the two to three most important patterns or problems might be, as well as asking patients if they would like to mention or need anything else. The nurse also thanks patients and family members for taking the time to provide information.

29. Interviewing and Therapeutic Communication • All nursing practice revolves around the nurse–patient relation-ship. • Unlike personal and social relationships, the nurse–patientrelationship is based on the therapeutic use of self through verbal and nonverbal communication skills. • The nurse has a privileged role as a respected care provider. In some situations, patients disclose information to nurses not even shared with family members. • Within the nurse–patient relationship, the nurse learns wide-ranging things about patients from minute physical details to deep-seated feelings about spirituality, culture, and psychosocial concerns.

30. Therapeutic communication is a basic nursing tool in whichthe nurse ensures that the interaction focuses on the patient and the patient’s concerns. Key elements include caring and empathy. • Caring is the ability to connect with the patient and demonstrate compassion,التعاطف sensitivity, and patient-centered care. • Empathy means the ability to perceive, reason, and communicate understanding of another person’s feelings without criticism. It is being able to see and feel the situation from the patient’s perspective, not the nurse’s

32. Nonverbal Communication Skill During interviewing and history taking with patients, nonverbal communication is equally as, if not more, important than verbal communication. • The nurse’s physical appearance, facial expression, posture and positioning in relation to the patient, gestures, eye contact, voice, and use of touch are all important components. • The nurse should not assume that touch is culturally acceptable. Permission to touch the patient is a courtesy.

36. Verbal Communication Skills • Effective interviewing skills evolve through practice and repetition. They encourage patients to further expand initial brief answers and also help redirect patients who wander from topic. • Active listening is the ability to focus on patients and their perspectives. It requires the nurse to constantly decode messages, including thoughts, words, opinions, and emotions.

37. Restatement relates to the content of communication. The nursemakes a simple statement, usually using the same words of patients. The purpose is to ask patients to elaborate. • Reflection is similar to restatement; however, instead of simplyechoingرد the patient’s comments, the nurse summarizes the main themes.مواضيع Patients, thus, gain a better understanding of underlying issues, which helps to identify their feelings.

38. Encouraging elaboration (facilitation) assists patients to morecompletely describe problems. Responses encourage patients to say more, continue the conversation, and show patients that the nurse is interested. • Purposeful silence allows patients time to gather their thoughtsand provide accurate answers. Silence can be therapeutic, communicating nonverbal concern. It gives patients a chance to decide how much information to disclose.

39. Focusing helps when patients stray from topic and need redirection. It allows the nurse to address areas of concern related to current problems. • Clarification is important when the patient’s word choice or ideasare unclear. • Summarizing happens at the end of the interview, when the nursereviews and condenses important information into two or three of the most important findings. Doing so also helps to reassure the patient that he or she has been heard accurately.