NRS 434 Week 3 Assignment Health Screening

NRS 434 Week 3 Assignment Health Screening and History of an Adolescent or Young Adult Client

Details:

In this assignment, you will be completing a comprehensive health screening and history on a young adult. To complete this assignment, do the following:

Select an adolescent or young adult client on whom to perform a health screening and history. Students who do not work in an acute setting may “practice” these skills with a patient, community member, neighbor, friend, colleague, or loved one.

Complete the “Health History and Screening of an Adolescent or Young Adult Client” worksheet.

Format the write-up in a manner that is easily read, computer-generated, neat, and without spelling errors.

Complete the assignment as outlined on the worksheet, including:

Biographical Data
Past Health History.
Family History: Obstetrics History (if applicable) and Well Young Adult Behavioral Health History Screening
Review of Systems
Include all components of the health history
Use correct acronyms or abbreviations when indicated
Develop three Nursing Diagnoses for this client based on the health history and screening. Include: one actual nursing diagnosis, one wellness nursing diagnosis, one “Risk For” nursing diagnosis, and your rationale for the choice of each nursing diagnosis for this client.

Collaborative Learning Community: Health Promotion Presentation

1)As a group, develop a 12-15 slide PowerPoint presentation that addresses a childhood disease or illness (infectious, noncontiguous, or congenital) seen in the adult population.

a)Examples of such diseases include:

i)Sickle cell anemia

ii)Cystic fibrosis

iii)Tay Sachs

iv) Juvenile diabetes (Type I)
v) Juvenile rheumatoid arthritis
vi) Hemophilia, congenital heart disease

b)Examples of vaccine preventable adult diseases include:

i)Diphtheria tetanus

ii)Pertussis

iii)Rubella

iv)Measles

v)Mumps

2)Include the following in the presentation:

a)A clinical description and definition of the disease or illness.

b)Pathophysiology and history of the disease or illness.

c)An explanation of the impact of this disease/condition on adults to the health care system and nursing practice.

d)A description of the impact of this disease or illness during childhood.

e)A description of the impact of this disease in adults. Explain why adults live into adulthood with this childhood condition or why adults would contract this childhood illness during adulthood.

f)A validation of the health problem with demographic and health statistics, including citations of sources.

3)Evaluate how this disease or illness impacts the adult client in the following areas:

a)Mentally and emotionally.

b)Physically.

c)Sexually.

d)Economically, specifically as it relates to the ability to access health insurance and health care.

e)Susceptibility to engage in substance abuse.

f)Prenatal care and childbearing.

g)Occupational considerations and hazards.

h)Ability to cope with stress.

4)Develop a care plan that addresses the following:

a)Identify expected outcomes for an adult client living with this childhood condition.

b)Develop health screening, health promotion, health interventions, and education for adults with this condition.

c)Identify a comprehensive set of relevant resources, both community and national, for adults with this condition. Provide description of resources.

5)Post the assignment to the main forum as directed by the instructor.

a)Respond to other learners’ posts in a manner that initiates or contributes to discussion.

b)Each person should make at least three substantive comments.

Adolescent Counselling Process

You are working with Dr. Sattovia today in her general medicine clinic. She asks you to evaluate Judy Pham, an 18-year-old female here for a pre-college physical.

You walk into the exam room and introduce yourself.

Ms. Pham tells you she lives at home with her parents and 15-year-old sister, although next month she will leave home for college and live in a dormitory. She is looking forward to some independence. She has never had a serious illness and feels “fine” now. She has no allergies and takes no medications. Her parents and grandparents are healthy, and the review of systems is negative.

TEACHING POINT

HEEADSSS Approach to Adolescent Counseling

The HEEADSSS approach to adolescent counseling addresses the main categories of Home/health, Education/employment, Eating disorders, Activities, Drugs, Sexuality, Safety/violence, and Suicide/depression. View examples of screening questions for the HEEADSSS history.

One of the nice qualities about the HEEADSSS approach is that it starts with less threatening issues and proceeds to more personal questions, so the interviewer has a chance to establish rapport before exploring sensitive, intrusive topics. Be sure to ask questions in a nonjudgmental way, and avoid questions that can be answered with “Okay” or with a “Yes/No” (i.e., “Do you get along with your mom and dad?”; “How are you doing in school?”; “Do you do drugs?”; “Are you sexually active?”).

Remember to avoid making assumptions about a teen’s behaviors. For example, don’t assume that your patient is heterosexual, sexually active, or even dating.

By using the HEEADSSS approach, you learn that Ms. Pham likes to go to movies, baseball games, and sometimes parties with her friends. At these parties there has been beer, and sometimes marijuana, which she tried once. She drinks beer once every few months, and has gotten drunk once. She does not smoke cigarettes. She has not had problems with sadness or depression. You then decide to move on to her sexual history.

“Are you dating anyone right now?”

“Not with any one person. Mostly I hang out with groups of friends. I’ve never had a steady boyfriend, but I’d like to someday. I met a really nice guy at orientation last month, and he’ll be living in the same dorm as me. I’m hoping to get to know him better.”

“Have any of your relationships been sexual relationships?”

“I don’t think I’m ready for sex yet! I’m a little nervous about the whole thing.”

You tell Ms. Pham that when she thinks about becoming sexually active, you would be happy to discuss birth control options, and remind her that hormonal birth control methods are not a substitute for condoms in preventing sexually transmitted infections.

You think about other issues of safety that are important to address during a health maintenance visit.

Question

Which of the following questions are appropriate for addressing the issue of safety? Select all that apply.

The best options are indicated below. Your selections are indicated by the shaded boxes.

Do you always wear a seatbelt in the car, as a driver and a passenger?
Do you ever drink and drive?
Do you feel safe at home and school?
Do you wear a helmet when you go biking, skateboarding, or ride a four-wheeler?
Have you ever been physically abused in a relationship?
Have you ever ridden with a driver that was drunk or on drugs?
Have you ever witnessed violence?

SUBMIT

Answer Comment

> The correct answers are A, B, C, D, E, F, G.

The second “S” in HEADSS is for Safety/Violence. Examples of the types of questions you would ask include those listed in the answer choices above.

TEACHING POINT

Adolescent Interview—Safety

Violence

The leading causes of death in older adolescents are violent: suicide, injuries, and homicide. Bullying, family violence, sexual abuse, date rape, and school violence are all common. Data from the Center for Disease Control (CDC)’s Youth Risk Behavior Surveillance System (YRBSS) survey shows that in 2019, an average of 13% of high school students in the United States carried a weapon to school during the preceding 30 days. Family violence and dating violence cross all economic and social boundaries.

Injuries

For some teens, school violence and guns are the major risks, and in others, sports injuries and injuries from wheeled vehicles are more likely. It is important to address the use of seat belts and bike helmets with every adolescent.

Even though you address the safety issues most prevalent in the patient’s community first, do not skip any part of the history based on assumptions about the patient’s ethnic background or economic status.

Ms. Pham asks if she will need any shots before going away. You review her immunization records.

Ms. Pham has received:

2 doses of hepatitis A vaccines (complete)
3 doses hepatitis B vaccines (complete)
2 doses meningococcal vaccines (complete)
2 doses MMR vaccines (complete)
4 doses of Poliovirus vaccines (complete)
a tetanus-diphtheria (Td) booster (seven years ago)
2 doses of varicella vaccines (complete)

Question

What immunizations should she receive this year? Select all that apply.

The best options are indicated below. Your selections are indicated by the shaded boxes.

COVID-19
Haemophilus influenzae type b
Hepatitis B
Human papillomavirus
Influenza
Meningococcal
Pneumococcal
Tetanus-diphtheria-acellular pertussis
Varicella/chickenpox

SUBMIT

Answer Comment

> The correct answers are A, D, E, H.

CDC recommends everyone 5 years and older should get a COVID-19 vaccination to help protect against COVID-19. Ms. Pham is recommended to get an influenza vaccination on a yearly basis and is also in the right age range for human papillomavirus vaccination.

Since Ms. Pham had a Td vaccine over five years ago, a Tdap is recommended.

Ms. Pham has already been appropriately vaccinated with the Meningococcal, MMR, Varicella, Hepatitis A and B vaccines.

Ms. Pham is not in the age range for Haemophilus Influenzae type b vaccination anymore.

Ms. Pham does not have any risk factors and does not fit the age range for the pneumonia vaccine.

TEACHING POINT

Vaccination Recommendations for Adolescents and Teenagers

Vaccine	Information
COVID-19	There are multiple manufacturers of COVID-19 vaccinations. Some are given in a two-shot series and some have approval for a third booster dose. They are highly effective at preventing COVID-19 and in preventing severe disease.
Haemophilus influenzae type b	Haemophilus influenzae type b vaccine protects against meningitis, pneumonia, epiglottitis, and bacteremia in infants and young children, but it is not recommended after the age of five years.
Hepatitis A	Hepatitis A vaccination is effective in preventing hepatitis A virus infection. The series of two to three injections (depending on the type of vaccine) is recommended for adolescents if they did not receive them when younger.
Hepatitis B	Hepatitis B vaccination is effective in preventing hepatitis B virus infection and its sequelae of cirrhosis and hepatic carcinoma. The series of three injections is recommended for adolescents if they did not receive them when younger.
Human papillomavirus	There are two different human papillomavirus vaccines available. They vary in the number of strains of HPV they protect against, ranging from four to nine, and can prevent most cases of cervical cancer and genital warts. It is recommended for girls and females 9-26 years old.‎The Advisory Committee on Immunization Practices (ACIP) recommends the use of the HPV vaccine in males 11 or 12 years of age. ACIP also recommends vaccination in males ages 13-21 who have not been vaccinated previously or who have not completed the three-dose series. ACIP states that males aged 22-26 years may be vaccinated, but does not recommend routine vaccination in this age group.
Influenza	The influenza vaccine is recommended for everyone who is at least six months old. It is usually administered in September through December when the influenza season is imminent.‎The H1N1 strain, or “swine” influenza, the predominant strain circulating in the U.S. since 2009, has high rates of morbidity and mortality among children and adolescents.
Meningococcal	The meningococcal vaccine is given to prevent meningococcal meningitis. It is commonly given once at age 11-12 years during the routine preadolescent immunization visit with a booster dose at age 16 and is recommended for all previously unvaccinated adolescents aged 11-18 years.
MMR	MMR is recommended in adults who have not been previously vaccinated as children. An exception to this recommendation is the case of pregnant females, given concern for fetal transmission from a live virus vaccine.
Pneumococcal	The pneumococcal vaccine is indicated for adolescents with certain chronic health conditions, including immunocompromised state (including HIV, transplant status, and cancer), functional or anatomic asplenia, CSF leaks or cochlear implants, diabetes, and conditions of the heart, lung, and liver.
Tetanus-diphtheria-acellular pertussis	The tetanus, diphtheria, acellular pertussis (Tdap) vaccine protects against tetanus, diphtheria, and pertussis. It contains acellular pertussis vaccine (ap), which is less reactogenic than the older whole-cell pertussis vaccine that caused high fever and neurologic symptoms when given to older children and adults. Tdap, which was licensed in 2005, is the first vaccine for adolescents and adults that protects against all three diseases.‎Adolescents should receive a single dose of Tdap as a booster between the ages of 11 and 18, with the preferred timing between 11 and 12 years. If a patient has received a Td booster, then waiting at least five years between Td and Tdap is encouraged because the incidence of side effects is lower. ‎ The exception to this rule is the case of type III hypersensitivity reactions*, where one should wait 10 years between booster doses.
Varicella/chickenpox	The varicella vaccine series, which is a live virus vaccine, should be given to adolescents who have never had chickenpox or have not received the vaccine.‎Two doses are required, with the first administered at 12-15 months of age and the second at 4-6 years of age. There is also a combination measles, mumps, rubella, and varicella vaccine (MMRV) available.

*Type III hypersensitivity reactions (Arthus reactions), which are characterized by immune complex deposition in blood vessels, can rarely be seen following receipt of vaccines containing tetanus toxoid or diphtheria toxoid. These reactions are characterized by severe pain, swelling, and sometimes necrosis at the injection site and occur between 4 and 12 hours following vaccination. It is recommended that patients who have had such a type III hypersensitivity reaction avoid receiving a tetanus toxoid-containing vaccine more frequently than every 10 years.

Dr. Sattovia and you review Ms. Pham’s immunization record.

You step out of the room to present Ms. Pham’s history to Dr. Sattovia.

You and Dr. Sattovia then return to the exam room and advise Ms. Pham that she should receive the Tdap booster and the influenza vaccine when it is available. Dr. Sattovia tells Ms. Pham about the HPV vaccine and gives her some information on the HPV vaccine to read.

Dr. Sattovia and you review Ms. Pham’s immunization record.

You step out of the room to present Ms. Pham’s history to Dr. Sattovia.

You review your history and physical with Dr. Sattovia, ask Ms. Pham if she has any questions (she does not), and wish her well. She says she will return for the HPV vaccine after she speaks with her mother. You remind her that it is a series of three injections and let her know that she can receive the vaccine here or at her university’s health service.

REVISIT THREE MONTHS LATER

Also Read: NRS-434 Week 2 Developmental Assessment and the School-Aged Child

NRS 434 Week 3 Assignment Health Screening