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Assessment 

Respond to at least two of your colleagues who selected a different patient than you, using one or more of the following approaches:

· Share additional interview and communication techniques that could be effective with your colleague’s selected patient.

· Suggest additional health-related risks that might be considered.

· Validate an idea with your own experience and additional research.

1 page each response 3 APA/references / citation ( total of 6 for the two responses )

See post below.

Post 1

Case: 14-year-old biracial male living with his grandmother in a high-density public housing complex

“Confidentiality is the cornerstone of the therapeutic relationship between provider and the adolescent” (Sacks, 2018). When developing questions to ask a teenager it is extremely important that they feel comfortable. Many times, teenagers “may be reluctant to talk and have a clear need for confidentiality” (Ball et al, 2019). Knowing this it is important to build a basis of trust with the patient and ensure that whatever they tell you is confidential. The teen may need a lot of reassurance. As the provider it is also important to realize that fourteen-year-old teens are at the stage in their life where taking risks and experimenting with different things will happen. “The risky behavior that adolescents exhibit may lead to lifelong consequences including morbidity and mortality” (Smtih, 2017). Risky behavior could be anything from sexual activity to alcohol and drugs.  Choosing the right risk assessment is crucial in order to determine what the teen is doing, has done, or is planning on doing. With this particular patient I would use the HEEADS assessment. This assessment allows for the provider to assess everything from home life, eating habits, suicide, and safety.

Questions to ask:

1. Can you give me a synopsis of your day-to-day life, starting from when you get up to when you go to sleep?

 

This question allows for the patient to talk about him or herself. It gives the opportunity to gain a better understanding of how the patient lives and many cases it can reveal many things about the patients home life, school life, and extra curricular activities they may engage in.

 

1. What do you like to do in your free time?

This question may open up an opportunity to get a better idea of what the patient does when they are not in school or in the familial home. This can also be a chance to see if the patient is participating in any risky behavior such as drinking, smoking, or partaking in any sexual activities.

 

1. Have you ever had an illness or injury that required a hospital stay?

This question opens up the possibility for the patient to describe to you if there has ever been anything serious that has happened. In some cases the patient may tell you more about certain illnesses that they have had or give you a list of injuries from sports etc that have occurred in detail.

 

1. Are you currently sexually active? If so how many partners and do you use protection?

This question is one that the adolescent may hesitate to answer. Reinforcing that confidentiality is a must between the provider and the patient is a must. If the patient does not want to give an answer the opportunity to give some education arises.

 

1. Have you felt lonely, depressed have you ever thought about hurting yourself? If so what has made you feel that way?

 

This question opens up for the patient to tell you about problems with bullying at school or if there is some type of issue at home.

              

   

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Sacks, D., & Westwood, M. (2018). An approach to interviewing adolescents. Paediatrics & child health8(9), 554–556.

Smith GL, McGuinness TM. Adolescent Psychosocial Assessment: The HEEADSSS. J Psychosoc Nurs Ment Health Serv. 2017 May 1;55(5):24-27. doi: 10.3928/02793695-20170420-03. PMID: 28460146.

Post 2

Assignment 3: 38-year-old Native American pregnant female living on a reservation.

Part 1: Pregnancy-Focused Health History

                Assuming that this patient lives on a reservation, she will be utilizing a federally qualified health center (FQHC) through the Indian Health Service (HIS) program. The Indian Health Services (n. d.) stated that improvements to the HIS program were established in 1992 with amendments to the Indian Health Care Improvement Act. These improvements provide care for Native Americans on and off of reservations to access necessary health services, including those not available in all reservation-based FQHCs. The patient will have access to all essential women’s health tools and options. The interview for building the health history would be pregnancy-focused, including a detailed obstetric and gynecologic history, while including topics important to perinatal health such as nutrition, vaccine history, substance abuse, domestic violence, and a detailed history of any familial genetic disorders. The questions would be asked while avoiding medical terminology whenever possible.

Part 2: Risk Assessment Tool

                A tool I would incorporate into the health history with this patient is the American College of Obstetricians and Gynecologists Antepartum Record and Postpartum Form (American Academy of Pediatrics and American College of Obstetricians and Gynecologists, 2017). The form is presented in a survey format to provide a detailed prenatal history, patient care, management guidelines, and postpartum management tools. I would choose to work through the prenatal history with the patient to translate many of the form’s medical terms and abbreviations and provide patient education during the process, such as completing the vaccination history and providing the patient with the rationale for obtaining needed vaccines during her pregnancy.

Part 3: Health-Related Risks

                The Centers for Disease Control and Prevention (2018) stated that Native Americans have a significantly higher risk for occurrences of:

· Ear defects (anotia/microtia)

· Cleft lip (with or without cleft palate)

· Trisomy 18 (Edwards syndrome)

· Encephalocele

· Limb deficiency

                The ACOG (2022a) stated that these risks for congenital anomalies are more significant in women over 35 years old. Trisomy 21 (Down syndrome) risk increases from an occurrence of one in 1,480 at age 20 to one in 353 at age 35 and increases to one in 35 at age 45.

Part 4: Targeted Questions to Ask the Patient

1. Immunizations

                The ACOG (2021) recommends that clinicians assess their pregnant patients’ immunization status. The ACOG recommends the following vaccines during pregnancy:

· Inactivated influenza vaccine (during each pregnancy)

· Tdap (during each pregnancy)

· Hepatitis A, B (if there is an increased risk for exposure)

                The following vaccines are safe to administer during the postpartum period or when breastfeeding:

· Influenza

· Tdap

· Pneumococcal vaccines

· Meningococcal conjugate and serogroup B

· Hepatitis A and B

· HPV

· MMR

· Varicella (ACOG, 2021)

                Albrecht and Arck (2020) stated that the transplacental transfer of antibodies from the mother to the fetus would provide passive immunity to the infant for the first few months.

2. Adequate Nutrition

                Ask if the patient has access and means to obtain adequate, nutritious food, and refer to the WIC program if necessary. The U. S. Department of Agriculture (2019) stated that the Supplemental Nutrition Program for Women, Infants, and Children (WIC) was established in 1974 to assist low-income women, infants, and children up to five years old who do not have access to nutritious food due to various socioeconomic disparities. The program provides nutritious foods to supplement diets, provides nutrition education (including breastfeeding education), and social services referrals as required.

3. Intimate Partner Violence (IPV)

                Ask the patient if she has experienced any forms of IPV, utilizing the HITS screening tool for domestic violence. Heck et al. (2021) stated that lifetime and 12-month prevalence of IPV is consistently high in Native American Women (47.5%); this is the highest reported IPV prevalence of all racial and ethnic groups. American Family Physician (2019) recommends utilizing the IPV screening tool HITS (Hurt/Insult/Threaten/Scream) to detect IPV in women in the past year.

4. Last Menstrual Period (LMP)

                Last menstrual period and pregnancy history (gravidity/parity). The LMP can be used to estimate the due date by adding 280 days (nine months and seven days) to the first day of the last menstrual period. This estimated due date (using the LMP method) can be used until a gestational age is determined by ultrasound (ACOG, 2022b).

5. Sexually transmitted infections (STIs)

                Ask about any history of STIs, including type, date, treatments, and associated complications. According to the CDC (2021), bacterial STIs can safely be treated with antibiotics during pregnancy. Viral STIs can be treated with some antiviral medications safe to take during pregnancy. Other measures to reduce the risk of passing STI infections to the baby during delivery can be taken when medical treatments are contraindicated.

References

Albrecht, M., & Arck, P. C> (2020, March 31). Vertically transferred immunity in neonates: Mothers, Mechanisms and mediators. Frontiers in Immunology, 11(555). 
https://doi.org/10.3389/immu.2929.0555

American Academy of Pediatrics, & American College of Obstetricians and Gynecologists. (2017, September). Guidelines for perinatal care (8th ed.). 
https://www.acog.org/clinical-information/physician-faqs/-/media/3a22e153b67446a6b31fb051e469187c.ashx

American College of Obstetricians and Gynecologists. (2022a). Having a baby after age 35: How aging affects fertility and pregnancy. 
https://www.acog.org/womens-health/faqs/having-a-baby-after-age-35-how-aging-affects-fertility-and-pregnancy

American College of Obstetricians and Gynecologists. (2022b). Methods for estimating the due date
https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/05/methods-for-estimating-the-due-date

American College of Obstetricians and Gynecologists. (2021). Maternal immunizations. 
https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/06/maternal-immunization

American Family Physician. (2019, May 15). U.S. Preventive Services Task Force: Screening for intimate partner violence, elder abuse, and abuse of vulnerable adults: Recommendation statement. American Family Physician, 99(10). 648A-648F. 
https://www.aafp.org/afp/2019/0515/afp20190515od1.pdf

Centers for Disease Control and Prevention. (2021, July 22). Sexually transmitted diseases (STDs). 

https://www.cdc.gov/std/pregnancy/stdfact-pregnancy-detailed.htm

Centers for Disease Control and Prevention. (2018, November 1). Birth defects: Differences in major birth defects. 
https://www.cdc.gov/ncbddd/birthdefects/features/racialethnicdifferences.html

Heck, J. L., Jones, E. J., Bohn, D., McCage, S., Parker, J. G., Parker, M., Pierce, S. L., & Campbell, J. (2021, February 2)., Maternal mortality among American Indian/Alaska Native women: A Scoping review. Journal of Women’s Health, 30(2). 220-229. 
https://doi.org/10.1089/jwh.2020.8890

Indian Health Services. (n. d.) About us. U. S. Department of Health and Human Services. 
https://www.ihs.gov/urban/aboutus

U. S. Department of Agriculture. (2019, February 14). WIC fact sheet. USDA Food and Nutrition Service. 
https://www.fns.usda.gov/wic/wic-fact-sheet

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