Health Assessment Topic Reflection

History taking and conducting a physical exam assessment are opportunities to explore the subjective symptoms and objective signs of a patient. To screen for diseases, and identify risks for future medical issues. Bickley (2017) highlights that despite continuous improvement in the detection of diseases using advanced technology, conducting a comprehensive and skilled physical assessment reduces the number of diagnostic tests to order for the patient and increases patient satisfaction. Recently, I attended several patients in the clinical setting with acute and chronic musculoskeletal disorders, and most patients whom I attended presented with the complaint of pain. The most interesting experience was that of a 60-year-old African American female.Health Assessment Topic Reflection

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The 48-year-old patient presented with complaints of intermittent pain in the right knee joint. The most likely difficulty that can arise when completing a musculoskeletal assessment is making wrong diagnoses. This is particularly in case of a nurses’ inability to determine whether bone pain experienced by a patient is as a result of mechanical injury or an underlying bone pathology when the nurse fails or forgets to use specific diagnostic questions to aid in making appropriate diagnoses. For instance, the patient in this case scenario had risk factors of arthritis (family history of arthritis (mother and father), had a history of previous joint injury secondary to a fall, had a BMI of 33, and was 60 years old). However, it is upon further questioning that the patient disclosed she had sustained an injury while alighting from a car.

One of the most effective and best strategies that can be used to overcome the difficulties encountered when competing for a musculoskeletal assessment is using a specific format in history taking that enables an individual to comprehensively exhaust all dimensions of history taking. Another strategy is using open-ended questions followed by closed-ended questions in history taking and identifying features in a patient’s history to distinguish between inflammatory vs. non-inflammatory symptoms. For instance, for this patient scenario, while writing the HPI, based on the chief complaint (pain), Ball et al (2018) suggest that the nurse can use the mnemonic SOCRATES (site, onset, character, radiation, association, time, exacerbating/relieving factors, and severity). This was a learning point and provided greater insights on how patients end up misdiagnosed due to poor history taking and physical assessments.Health Assessment Topic Reflection

Since pain is a subjective experience with different worldviews, it would be important to determine how the patient views pain from a Christian perspective before proceeding with the musculoskeletal assessment. Generally, African Americans believe that pain is a form of suffering and engage in spiritual and non-spiritual practices to cope with or alleviate pain. Compassion for all will require the use of positive strategies including   the patient’s spirituality as part of the management and intervention plan as a coping strategy.

References

Bickley, L.S. (2017). Bates’ Guide to Physical Examination and History Taking (12th Ed.). Philadelphia, PA: Wolters Kluwer. ISBN 13: 978-1469893419

Ball, J., Dains, J. E., Flynn, J. A., Solomon, B. S., Stewart, R. W., & Ball, J. (2018). Seidel’s guide to physical examination: An interprofessional approach. Health Assessment Topic Reflection