NURS 6512 Wk 11: Health Assessment
A comprehensive history and physical examination is essential for all well-child visits allowing for minor variations based on the patient’s age (Sullivan, 2012). Addressing any new issues if present would be the first step. The child has been coming to the office since birth, past medical, family, and social history would be updated. A review of systems and comprehensive physical exam will also be completed.NURS 6512 Wk 11: Health Assessment
The health assessment includes growth and developmental screenings to determine if the patient is following a healthy growth and developmental trajectory (Sullivan, 2012). Establishing if the patient has received any immunizations from birth until now should also be included particularly due to parental opposition to immunizations and the likelihood that the patient has not received any. Assessment of attention span and ability to separate from parents is important for school readiness (Sullivan, 2012). Patient safety such as seat belts, booster seats, street safety should be determined while discussing anticipatory guidance. Laboratory data is not necessary at this age unless it is required for a new onset issue. Lastly, discussing other topics anticipatory for this age include knowing full name, address, and phone number; sexual curiosity; household chore participation; and no playing with match (Sullivan, 2016).
It is most important to address the parent’s opposition to immunizations. The first step as an advanced practice nurse is to establish why they are opposed to immunizations such as religious or cultural beliefs, lack of understanding for immunizations, fear of pain for their child, or misinformation about the risks of immunizations (Sullivan, 2016). According to Whyte, Whyte, Cormier, and Eccles (2011), perceived risk related to vaccine safety, such as immediate side effects and increased susceptibility to chronic conditions such as autism, is significantly substantial in influencing parents’ decision to immunize. Low immunization rates are also associated with lack of knowledge regarding communicable diseases and the importance of vaccination (Whyte et al., 2011). As advanced practice nurses we should listen carefully and respectfully to the parent’s concerns and be honest about what is known and not known about the risk and benefits of each vaccine (Whyte et al., 2011). We should address any misconceptions or misinformation and attempt to correct it. Concerns regarding multiple vaccines in once visit can also be addressed and remedied by spreading out the vaccines. Lastly, concern about pain related to vaccination administration can also be addressed and prevented with the use of numbing cream or pain medication at least 20 minutes before administration of vaccines. NURS 6512 Wk 11: Health Assessment
As an advanced practice nurse it is important to explain the risks of not being vaccinated. If an unvaccinated child is exposed to a disease germ, the child’s body may not be strong enough to fight the disease. Before vaccines, many children died from diseases that vaccines now prevent, such as whooping cough, measles, and polio. Those same germs exist today, but because babies are protected by vaccines, we don’t see these diseases nearly as often. Immunizing individual children also helps to protect the health of our community, especially those people who cannot be immunized (children who are too young to be vaccinated, or those who can’t receive certain vaccines for medical reasons), and the small proportion of people who don’t respond to a particular vaccine (CDC, 2017). NURS 6512 Wk 11: Health Assessment