Additional Assessment Considerations

1
Additional Assessment Considerations

• Advanced Health Assessment
• Lesson 2

2
Review Items

• Topics listed are for general review purposes
  to serve as a reminder that each of these
  components are significant aspects of the
  assessment.
• Notes included in pediatric growth development
  notes include lifespan family dynamics
  information also

3
Relevant Topics

• Assessment across the lifespan
• Family Assessment
• Cultural Assessment
• Nutritional Assessment
• Sleep Assessment
• Sexual Assessment
• Vital Signs Lab Values

4
Assessment Across the Lifespan

• Ericksons psychosocial theory of development
  serves as an excellent framework
• Other theories are addressed for pediatrics in
  the handout

5
General guidelines for Dealing with Children

• Infants
• Young Child
• School Age Child
• Adolescent

6
General Guidelines for Dealing with Adults

• Young Adult
• Middle Age Adult
• Aging Adult

7
Family Assessment

• The family can be assessed in a variety of ways
• Biologic
• Economic
• Educational
• Psychological
• Sociocultural

8
Family Definition

• Any group of people related biologically,
  emotionally or legally.
• Its function is to help its family members
  satisfy their needs for physical emotional
  survival

9
Family Provides for its Members

• Esteem
• Relief
• Buffering mediation
• Emotional life bonding force
• Support system for meeting basic needs
• Raising of children, preparing for adulthood

10
Family Function Coping

• Family Strengths
• Family Coping Success
• Meeting Developmental Tasks

11
Basic Areas of Family Assessment

• Structure Composition significant influences
• Family Function How families interact

12
Family Composition

• Nuclear
• Nuclear Dyad
• Kin Network (Extended Family)
• Single Parent
• Blended (Reconstituted)
• Binuclear (Joint Custody of Children)

13
Family Composition

• Homosexual
• 3-Generation
• Co-Habitating Couples
• Single Adult (Living Alone)

14
Significant Family Influences

• Home Conditions Community Environment
• Occupation Education of Family Members
• Cultural Religious Traditions

15
Family Functional Assessment

• Family Interactions Roles
• Power, Decision Making Problem Solving
• Communication
• Expression of Feelings Individuality

16
Theoretical Framework for Evaluating Families

• Systems Theory
• Development Theory
• Structural-Functional
• Interactional

17
Strong Families

• Sense of Commitment
• Sharing Traditions
• Active Expression of Appreciation
• Effective Communication
• Spending Time Together

18
Strong Families

• Shared Values
• Solving Problems Coping
• Sense of Humor

19
Difficult Family Issues

• Missing support the less support, the more
  morbidity
• Enmeshment - Disengagement
• If connected by strong emotion, may resist change
  in roles behaviors of individuals
• Change is disequalibriating disquieting

20
Difficult Family Issues

• Paying attention to how change affects the family
  is better tolerated
• Conflict arises when emotions attitudes are too
  far out of synchrony
• Needs unmet dissatisfactions arise

21
Some Common Family Conflicts

• Dominance vs. Submission
• Closeness vs. Autonomy
• Emotion vs. rationality
• Over involvement vs. distancing
• Health vs. Disease

22
Common Family Conflicts

• Adequacy vs. Mismanagement
• Responsibility vs. irresponsibility
• Sharing vs. Nonsharing

23
Common Psychosocial Problems

• Domestic conflict sexual difficulties
• Substance abuse dependence
• Domestic violence
• Physical, emotional or sexual abuse of women
  children
• Divorce
• Financial management - mismanagement

24
Cultural Assessment

• Culture
• Subculture
• Race
• Ethnic Group
• Minority Group
• Customs Rituals
• Values Cultural Norms

25
Values Affecting Health Care

• Time Orientation
• Activity Orientation
• Human Nature Orientations
• Human-Nature Orientation
• Relational Orientations

26
Beliefs Practices

• Folk Illness
• Naturalistic Illness
• Personalistic Illness
• Specific Practices

27
Some Specific Issues

• Coining or Moxa
• Distant vs. close space
• Eye contact (direct or indirect)
• Family Authority
• Dietary Customs
• Ethnic Predisposition to illness

28
Nutritional Assessment

• Major component of health maintenance
• Identify nutritional risk
• Over nutrition
• Under nutrition

29
Nutritional Screening

• Health history
• Lifestyle habits, food choices exercise
• Medications supplements
• Diet History
• 24 hour diet re-call
• 3-4 day food recall records
• food frequency questionnaires (6 months)

30
Comprehensive Nutritional Screening

• Weight is lt80 or 120 of ideal weight
• Unintended weight loss of gt4.5kg
• Low serum albumin level
• Low total lymphocyte count
• History or physical exam indications

31
Subjective History Information

• Unusual weight changes
• Changes in appetite, taste, smell, dentition,
  chewing, swallowing
• Recent illness, surgery, trauma, burns,
  infection, chronic illness
• Vomiting, diarrhea, constipation
• Food allergies or intolerances

32
Diet Evaluation Comparisons

• Food Pyramid 6 food groups
• Guideline 5 servings or fruits or vegetables per
  day

33
Age Related Considerations

• Infants
• Young Children
• Adolescents
• Pregnancy Breast Feeding Female
• Older Adult

34
Objective Data Clinical Assessment

• Skin, Hair Nails
• Mouth
• Musculoskeletal System
• Cardiovascular System
• Gastrointestinal System
• Neurological System

35
Body Measurements

• Height
• Weight
• BMI Nomogram
• Skin Fold Thickness (TSF)
• Mid-upper arm circumference
• Waist-to-hip ratio

36
Laboratory Studies

• Hemoglobin Hematocrit
• Total Lymphocyte Count
• Serum Albumin
• Fasting Blood Sugar
• Serum Lipids

37
Sleep Assessment

• Sleep has restorative function
• Sleep deprivation may cause changes in mood
  performance fatigue, irritability, anxiety,
  depression, feelings of persecution, poor
  concentration, feelings of depersonalization
  increased aggression

38
Sleep Assessment

• Identify Sleep Problems
• Evaluate quantity quality of sleep
• Identify circumstances that promote or inhibit
  sleep
• Identify psychological or physiological factors
  affecting sleep

39
Sleep Categories

• Non-REM Non rapid eye movement sleep, consisting
  of 4 stages, during which no dreaming occurs
• REM Rapid eye movement sleep, during which
  dreaming occurs
• Both types of sleep occur during the 4-6 cycles
  of sleep occurring during an8-hour sleep period

40
Sleep Patterns with AgeHours of Sleep per Day

• Infants 14-18
• Young Children 10-14
• Older Children 8-10
• Adolescents Increase
• Adults 7-9
• Older Adults Awake frequently, nap

41
Common Sleep Problems

• Sleep Apnea
• Insomnia
• Sleepwalking
• Sleep terrors
• Nocturnal enuresis

42
Sexual Assessment

• Interviewers personal attitudes important
• Issues different in various age groups
• Straight forward approach useful
• Chronic illness influence
• Advancing age