Archive for September, 2009

Screening for abuse, comment

September 28, 2009

I think that all nurses and doctors should receive additional training in screening for abuse depending on their specialty area. Patients will present differently depending on whom they are being interviewed by. Many times in the situation of children they are with their abuser when they present and it is difficult to separate the two. The abuser does not want you to have words alone with their child. I worked many years as a school nurse and suspected many cases of abuse that were reported to the appropriate authorities only to find that the child was disbelieved and then years later found to be telling the truth. Adults are very savvy at making a child look like a liar but seldom do these children have the capabilities to make up the horrendous story I heard. Unfortunately the investigators seem to want to believe the abuser. These children were also ones with poor grades (not sleeping at night due to the abuse), behavioral issues (they just wanted someone to listen) and many times documented storytellers (the only way to get attention) so it was very easy for the abuser to discredit them. If we are all trained to look for something other than physical marks we may start to diminish abuse against our children. Part of the assessment should not include where the parents reside in society. Several times the investigators simply found out what the parents did for a living and that in itself ended the investigation.

Original Post:
September 8, 2009
Title: Screening for abuse
Thank you for this important message. It is absolutely imperative that ALL providers know the signs and symptoms of physical, emotional and sexual abuse. Furthermore, it is absolutely necessary that ALL providers screen every patient at EVERY patient encounter for abuse. Providers should incorporate screening for abuse into their health assessment. It is very easy to do. Providers can accomplish this important task by 1. Printing the screening question on the pre-assessment paperwork, 2. Asking the patient during the assessment, "Do you feel safe at home?" 3. Knowing the s/sx and incorporating screening into every pt encounter. So very important.

Original Post
September 2, 2009
Title: Abuse
Child and elder abuse continue to be very under reported making it imperative that doctors and nurses have education on signs of abuse. Nursing home abuse is also very under reported since nursing home pts. are lacking in visitors and seen as demented. Nurses also need to know who to contact should abuse be suspected.

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Exposure to alcohol during pregnancy, comment

September 28, 2009

The drinking of alcohol during pregnancy debate is once again one that brings up many emotions. As a society we have to decide at what point life begins and also how much government interference we want in our lives. Some women may knowingly drink alcohol in spite of being pregnant and have what appears to be a "normal" newborn. You can also have women that drink as they are unaware of their pregnant state. Either newborn could be born with fetal alcohol syndrome or either could be born with no defects at all. Do you only charge those whose newborns are born with defects or do you charge any woman who drinks while pregnant? There is plenty of education available and provided to pregnant women about the dangers of alcohol yet some choose to ignore it. Who knows why? Does it matter why? If a woman smokes during pregnancy should she also be charged with a crime? What if she doesn’t eat a healthy diet? Crime or stupidity?

Original Post
August 19, 2009
Title: Exposure to alcohol during pregnancy
Excessive consumption of alcohol, we know, can harm or negatively effect our bodies cardiovascular system, mental status, respiratory system, liver, stomach, kidney function, pancreas and sexual function. So it’s not surprising that alcohol should harm a fetus if exposed during pregnancy. It is one thing to abuse a substance like alcohol and live with the consequences, and then it’s another thing to drink during pregnancy and harm another human being. New mothers and the general public are more educated today on the effects of alcohol on a fetus, but fetal alcohol spectrum disorder, fetal alcohol syndrome, stillbirths, and spontaneous abortion as a result of alcohol consumption during pregnancy still occur. Although it may not affect the fetus if a few drinks were consumed during the first few months of pregnancy, it is recommended and advised to avoid alcohol all together during the whole pregnancy; but alcohol is just like any drug, and people are addicted to it because of it’s "rewarding effects" on the brain- in these cases, the pregnant women are risking their own lives and their own child’s life for a good night or their own pleasure. It’s selfish and it is murder if the child should not survive. On the other spectrum there are women who have a few drinks during pregnancy when the woman doesn’t know about the pregnancy. In most cases, the pregnant woman can get everything checked and no major abnormalities should result if she should stop drinking after knowing about the pregnancy. Should the mother be held responsible for giving birth to a child with FAS? Can it be proven that the alcohol she consumed was the cause of the abnormality? If so, and the mother was convicted of a crime, what would happen to the child?

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Alcohol addiction is a disease

September 28, 2009

Alcohol is the most commonly used and abused psychoactive drug in the United States. Of those seeking treatment 50% will relapse in the first few months of therapy. Everyone around these patients is effected by this disease. Nursing is on the forefront of the battle these individuals undertake. Alcohol use is broken down into two categories abuse and dependence. Alcohol abuse is characterized as a pattern of use leading to one or more manifestations in a period of a year such as a failure to fulfill major roles or obligations at work, school or home. Recurrent alcohol related legal problems or being in physically hazardous situations and continued use despite problems with relationships caused by or exacerbated by alcohol. Alcohol dependence is a pattern of three or more manifestations in a year such as having a tolerance to alcohol, showing signs of withdrawal, consuming larger amounts or over longer periods than had intended. Continued use of alcohol despite desire or failed attempts to cut down consumption. Drinking and recovering from use takes up more and more time. Continued use despite knowing it is doing damage physically or psychologically, as well as those listed above for abuse. Alcohol not only effects those who are abusing or dependent on the drug, but everyone around them. As a child I remember the late night phone call my mother received that her father, only 49 years old, had passed away after having too much to drink, vomited and aspirated his stomach contents. He was an abuser, a weekend social drinker whose life alcohol had very little impact on until that night, then it had the ultimate impact. A patient I took care of many years ago had a similar experience, he was a young man in his early 30’s, he too aspirated after vomiting, he survived this initially only to be left with damage to his brain from a lack of oxygen. He would live the rest of his life in a coma like state, with a grieving wife and child. Alcohol is a treatable disease, when a patient comes to a hospital or clinic, they have chosen to undertake the battle of their lives. They are not able to do this alone, the attitudes of family and nurses as well as others they may come into contact with are crucial. A compassionate nurse can change the life of a patient, as well as an unsympathetic nurse whose attitude may be "they did this to themselves." Alcohol dependence or abuse should be seen for what it is a real disease that needs real treatment. These patients need all the support they can get from those around them, and education on the subject is paramount to recognizing the signs and symptoms that manifest. Education for healthcare workers so they understand these patients, as well as how to successfully treat them with medications, together with the patient’s desire to enter therapy will hopefully change that 50% to 25% or better 0% relapse in first few months.

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The Correlation between health assessment and forensic nursing, comment

September 17, 2009

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Original Post
September 15, 2009
Title: The Correlation between health assessment and forensic nursing, question

Do you offer financial aid for your online Health Assessment and Forensic Nursing courses?

Original Post
September 8, 2009
Title: The Correlation between health assessment and forensic nursing
Thank you for these great posts related to the correlation between Forensic nursing and health assessment. I am a Sexual Assault Nurse Examiner and a NP student. I never thought about the health assessment as a forensic investigation, but it is so true. Making this correlation has already helped me to complete more thorough health assessments in my graduate NP courses. Thanks!

Original Post
March 21, 2008
Title: The Correlation between health assessment and forensic nursing
I am writing in respond to the article titled “The Correlation between the Health Assessment and Forensics Nursing.” My job is performing assessments on patients for surgery, which in some way is similar to an assessment used in forensics nursing. I am not involved in forensics, but have read materials related to the assessment. I totally agree that as soon as I meet my patient, I start my assessment based on appearance, speech, skin color and facial expressions. Anesthesia assessment involves collecting all types of data that identifies the patient’s physiologic status, risk factors, knowledge and past health and anesthesia history. The most difficult challenge is keeping the patient focused and answering questions completely without omitting details, I can associate this also with a forensic assessment. 
Once the subjective data is obtained, we do gather objective data to be complete. An example would be labs, EKG and x-rays which is also used in an investigation. Subjective and objective data are the two primary components in performing a health assessment, whether it is any type. They both work together, if patient is unresponsive or unable to communicate, it does present a challenge. I than rely on family history or previous medical records. I agree with the last item in the article, “giving our clients a voice”, practicing as a nurse you must always assume the role as a patient advocate. Communication to physicians and other members of the health team is to ensure putting the patient’s best interest first. That is one reason I choice to become a nurse.

Original Post:

November 1, 2007

I think that performing a health assessment is very similar to a forensics investigation. The forensics investigator starts gathering evidence as soon as he enters the scene. The fractioned also gathers evidence as soon as she enters the examination room. Does the client answer questions appropriately, is her posture straight, is she tearful, guarding a certain area of her body. What about hygiene, is well groomed, or wearing stained, mismatched clothing. The forensics investigator uses many senses while investigating a crime scene. Smell, touch, sight, and the 6th sense about what seems to be not quite right. The fractioned doing the assessment uses the same senses. Smell can clue the fractioned into some diseases, for example some malignancies. The sense that something is not quite right is another skill that the fractioned develops. The client that says she is eating, yet losing weight leads the fractioned to follow-up with other questions. Is the client diabetic, bulimic, or an elderly patient unable to afford food? The forensics investigator uses laboratory data to support his theories. Laboratory is a tool that the fractioned also uses. Is the chest pain cardiac with elevated cardiac enzymes and EKG changes? Is weight loss due to a malignancy, diabetes, poor nutrition? Forensics investigation and health assessment share one more very important trait. Forensics investigators give the victim a voice. As health practitioners, our clients too, will often need us to give them a voice. This includes the very young, the very old, the cognitively impaired, and the victims of abuse.

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Pediatric medication errors in the PACU (Post Anesthesia Care Unit), comment

September 17, 2009

Thank you for this post… it is a great reminder of the importance of the "5 Rights" of medication administration. Med errors happen more times than we would all like to admit. I have worked in the Neonatal ICU for many years and I will admit I just had a wake-up call. It was an extremely busy day in the unit and I was caring for a set of premature twins with almost identical birth weights, therefore same calculation weights used for dosages. I had a laundry list of meds to give to these patients. After I administered a med and I was tearing the patient label off I realized… the med I just gave was for twin "A" and not "B". It was the Right Medication, the Right Dosage (thankfully being twins of the same size… which does not happen all the time), the Right Route, the Right Time and Right Rationale but not the Right Patient……. the label said "XXXXX, baby-A" and not "XXXXX, baby-B". This was a major wake-up call that thankfully did not cause any harm since both of the patients were to get that exact medication at that exact time but regardless this was a reported Med Error! It really reminded me that no matter how busy you may be….. Take your time when administering medications to your patients… the other tasks can wait!! It can happen to any of us¦ BE CAREFUL!!

Original Post
July 30, 2009
Title: Pediatric medication errors in the PACU (Post Anesthesia Care Unit)

When we, as nurses perform assessments on our patients, in this case, a pediatric patient that will be going for any surgery, we often forget the word beneficence (principal of doing well for our patients) or take it for granted.  We go though the assessment form with the patient and most often the parent assisting, sometimes taking aspects of it as routine or perform a ‘run of the mill assessment’. 

The patient, now has his or her surgery and moves through to the PACU.  We always believe that we will always act in the best interest of our patient, the principal of ‘doing good’.  We always plan on never doing harm to our patients- to do no harm-provide the principal of nonmaleficence. 

‘Medication errors involving pediatric patients in the PACU, may occur as frequently as one in 20 medication orders and more likely to cause harm when compared to medication errors overall.’(AORN 2007, vol 85 page 731)  There have been many instances of late with pediatric medication errors, but the one that is foremost in everyone’s mind is the much published case of the newborn twins of actor Dennis Quaid. A medication(heparin) was administered and the dosage was incorrect.   We as nurses have long been educated and re-educated on the ‘5 rights’ of medication administration.  If we would just take the time to check and re-check the medications, there perhaps would be a decreased number of errors.  Pediatric medication dosages are based on the child’s age, weight and condition. A higher percentage of errors were found of pediatric patients where calculations involving decimals, dosage forms and math related as we have to calculate the proper dosage. Hospitals, pharmacists and nurses are continually trialing and attempting to establish standardized policies, procedures and educating our nurses in the proper handling of our pediatric populations, so errors don’t occur.  Do I think we have the problem solved…no.  But we are well aware of this problem and we have begun the journey to rectify the problems.   I certainly do not want any of our pediatric patients to become statistics and our nurses go through the immense pain and suffering if a negative outcome happens. There are many regulatory bodies that could  get involved.  Not to mention, the family and their worries and concerns for their child, and yes, the lawsuit that may prevail. We must all be very cognizant of not only our pediatric patients, but all our patients.  

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Exposure to Alcohol During Pregnancy, comment

September 17, 2009

This post is an extremely important topic! I agree that despite all of the education that is out there on "what not to do" during pregnancy, we are still seeing a tremendous number of babies born with Fetal Alcohol Syndrome and other drug exposures. In my experience many times the women who are exposing their fetus’ to these toxins claim to be unaware of the pregnancy until they are 3, 4 or even 5 months pregnant. This at times I believe can be true as they probably are not very in-tuned with their body. On the other hand, I feel like this excuse is just that… AN EXCUSE for perhaps denial of the pregnancy! We as healthcare providers can not and should not be judgmental but when you witness an innocent baby suffering from withdrawal or abnormalities, it can be very hard. I do believe these mothers should have consequences for their actions as they are indeed harming another human being! Unfortunately charging the mother may cause the baby to be placed with a new family which obviously has many pros and cons. I feel the best interest of the infant should be the priority not the mother. Fetal exposure will always be an issue but let’s NOT give up on the prenatal education… it is so valuable!

Original Post
August 19, 2009
Title: Exposure to Alcohol During Pregnancy
Excessive consumption of alcohol, we know, can harm or negatively effect our bodies cardiovascular system, mental status, respiratory system, liver, stomach, kidney function, pancreas and sexual function. So it’s not surprising that alcohol should harm a fetus if exposed during pregnancy. It is one thing to abuse a substance like alcohol and live with the consequences, and then it’s another thing to drink during pregnancy and harm another human being. New mothers and the general public are more educated today on the effects of alcohol on a fetus, but fetal alcohol spectrum disorder, fetal alcohol syndrome, stillbirths, and spontaneous abortion as a result of alcohol consumption during pregnancy still occur. Although it may not affect the fetus if a few drinks were consumed during the first few months of pregnancy, it is recommended and advised to avoid alcohol all together during the whole pregnancy; but alcohol is just like any drug, and people are addicted to it because of it’s "rewarding effects" on the brain- in these cases, the pregnant women are risking their own lives and their own child’s life for a good night or their own pleasure. It’s selfish and it is murder if the child should not survive. On the other spectrum there are women who have a few drinks during pregnancy when the woman doesn’t know about the pregnancy. In most cases, the pregnant woman can get everything checked and no major abnormalities should result if she should stop drinking after knowing about the pregnancy. Should the mother be held responsible for giving birth to a child with FAS? Can it be proven that the alcohol she consumed was the cause of the abnormality? If so, and the mother was convicted of a crime, what would happen to the child?

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The Correlation between health assessment and forensic nursing, question

September 15, 2009

Do you offer financial aid for your online Health Assessment and Forensic Nursing courses?

Original Post
September 8, 2009
Title: The Correlation between health assessment and forensic nursing
Thank you for these great posts related to the correlation between Forensic nursing and health assessment. I am a Sexual Assault Nurse Examiner and a NP student. I never thought about the health assessment as a forensic investigation, but it is so true. Making this correlation has already helped me to complete more thorough health assessments in my graduate NP courses. Thanks!

Original Post
March 21, 2008
Title: The Correlation between health assessment and forensic nursing
I am writing in respond to the article titled “The Correlation between the Health Assessment and Forensics Nursing.” My job is performing assessments on patients for surgery, which in some way is similar to an assessment used in forensics nursing. I am not involved in forensics, but have read materials related to the assessment. I totally agree that as soon as I meet my patient, I start my assessment based on appearance, speech, skin color and facial expressions. Anesthesia assessment involves collecting all types of data that identifies the patient’s physiologic status, risk factors, knowledge and past health and anesthesia history. The most difficult challenge is keeping the patient focused and answering questions completely without omitting details, I can associate this also with a forensic assessment. 
Once the subjective data is obtained, we do gather objective data to be complete. An example would be labs, EKG and x-rays which is also used in an investigation. Subjective and objective data are the two primary components in performing a health assessment, whether it is any type. They both work together, if patient is unresponsive or unable to communicate, it does present a challenge. I than rely on family history or previous medical records. I agree with the last item in the article, “giving our clients a voice”, practicing as a nurse you must always assume the role as a patient advocate. Communication to physicians and other members of the health team is to ensure putting the patient’s best interest first. That is one reason I choice to become a nurse.

Original Post:

November 1, 2007

I think that performing a health assessment is very similar to a forensics investigation. The forensics investigator starts gathering evidence as soon as he enters the scene. The fractioned also gathers evidence as soon as she enters the examination room. Does the client answer questions appropriately, is her posture straight, is she tearful, guarding a certain area of her body. What about hygiene, is well groomed, or wearing stained, mismatched clothing. The forensics investigator uses many senses while investigating a crime scene. Smell, touch, sight, and the 6th sense about what seems to be not quite right. The fractioned doing the assessment uses the same senses. Smell can clue the fractioned into some diseases, for example some malignancies. The sense that something is not quite right is another skill that the fractioned develops. The client that says she is eating, yet losing weight leads the fractioned to follow-up with other questions. Is the client diabetic, bulimic, or an elderly patient unable to afford food? The forensics investigator uses laboratory data to support his theories. Laboratory is a tool that the fractioned also uses. Is the chest pain cardiac with elevated cardiac enzymes and EKG changes? Is weight loss due to a malignancy, diabetes, poor nutrition? Forensics investigation and health assessment share one more very important trait. Forensics investigators give the victim a voice. As health practitioners, our clients too, will often need us to give them a voice. This includes the very young, the very old, the cognitively impaired, and the victims of abuse.

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Medication Errors

September 11, 2009

You are so correct! Providers must be advocates for our patients. We need to LISTEN to what they are saying to avoid critical medication errors. We are our patients’ voices. We must not be so hurried that we simply dismiss information that our patients’ tell us.

Original Post
September 7, 2009
Title: Biological, Radiological and Chemical Terrorism
With September 11th soon approaching, a very sad and emotionally draining memory of that tragic day remains in people’s minds around the world. Sophisticated security measures have evolved because of this specific devastation in order to protect our citizens in a more diligent and effective manner. Understanding the detrimental physiological and psychological dynamics of such violence has also become a much greater concern for health care professionals in the event of another terrorist attack. How to respond and treat patients if or when a crisis of this magnitude arises requires further educational focus. Within this chapter, Lehne (2007) discussed inhalation and cutaneous anthrax, francisella tularensis (tularemia), yersinia pestis (pneumonic plague), variola virus (smallpox), botulism toxin, ricin, sulfur mustard (mustard gas) as well as various nuclear bombs and radiation emergencies (Pgs 1252-1257). Recognizing and comprehending the clinical manifestations/medical treatments of these deadly toxins are essential for nurses in order to save lives engulfed in catastrophic conditions. Lehne (2007) noted that with regard to inhalation anthrax, “Even with treatment, the mortality rate can be high: In the U.S. outbreak in 2001, 45% of victims died” (Pg. 1252). Lehne (2007) further stated such statistics with cutaneous anthrax, “In the absence of antibiotic therapy, about 20% of people with cutaneous anthrax die” (Pg. 1252). The availability and proper use of antibiotics early would likely reduce the number of fatalities. The variola virus (smallpox) is also a very deadly and highly contagious disease that can cause a fatality rate of 30%. Because of the serious outbreak of this disease in the 1940’s, global vaccination measures were implemented, resulting in the last case of smallpox worldwide occurring in 1977. Lehne (2007) stated, “The successful elimination of smallpox has set the stage for its potential return as a weapon of terrorism. If we hadn’t eradicated natural smallpox, then vaccination would still be ongoing. As a result, the population would have immunity, making smallpox useless as a weapon” (Pg. 1254). Reinstating the smallpox vaccination presents risk including possible death, though statistics are relatively low for a terminal reaction. Receiving a smallpox vaccination versus contracting this disease still suggests that the benefits may outweigh the risks, particularly for health care professionals. The most deadly biological threat mentioned in this chapter was the use of botulism toxin. Lehne (2007) noted, “Just 1 gram, if evenly dispersed and inhaled, could kill more than 1 million people” (Pg. 1256). Because of strict drug regulations by the CDC, the only method of treatment is the use of botulism antitoxin at a dosage of 10 mL, administrated by slow IV infusion. With such statistics, it would be highly difficult to properly prepare for this type of devastation. Chemical and radiologic weapons also continue to represent serious terrorist threats worldwide creating a heightened concern and greater need for advanced education for nursing and health care professionals. References Lehne, R.A. (2007). Pharmacology for Nursing Care (Sixth Edition). Pgs. 1252-1257.

Original Post
June 17, 2009
Title: Medication Errors
Medication errors are a major problem in hospitals, nursing homes, and clinics everywhere. There are many steps taken to avoid these errors, but they still happen. It can be an accident which could cost a person their life. Nurses need to be sure and follow the steps to avoid making errors and listen to the patients concerns about a medication. I have had a first hand experience with being given a wrong medication. I have a severe allergy to penicillins. I repeatedly told the nurse and the doctor about it and even witnessed the nurse close the medication allergy alert that popped up on the computer screen. When I questioned the nurse about the medication she told me that it was not in the penicillin "family." I went home, took the medication and ended up in the emergency room. If the nurse and doctor would have taken the time to listen to what I was saying my trip to the ER could have be avoided. The nurse always should be an advocate for the patient and always check whatever it is the patient is questioning.

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Critical Stress, comment

September 11, 2009

It is absolutely imperative that professionals who treat/witness trauma undergo ongoing debriefings/CISMs. As a combat Iraqi veteran RN, I personally know how very important this issue is. We must have an outlet to process, reflect and deal with the trauma that we witness. We need a safe place to discuss our experiences. If we neglect ourselves, we are unable to effectively care for others. Thanks for discussing this important issue.

Original Post:
December 30, 2008
Title: Critical Stress
I personally feel this is an important issue that is frequently swept aside in many critical incident situations. I have been both an EMT and an RN for many years, but have had very few debriefing sessions. Several occasions were warranted, such as a when an entire family perished in an MVC on Christmas Day, co-workers who were killed on their way into work, a colleague who successfully overdosed; to name just a few. The emotional and behavioral keynotes were especially noteworthy. It is no wonder that so many of my colleagues have turned to substance abuse and psychotropics to seek refuge. As for myself and a few others, we have turned to a higher power; after all there has to be more and a “better place.” I pray that is not a hollow promise. I and my co-workers have experienced many of the emotional stress responses: a. Agitation b. Anger c. Anxiety d. Apprehension e. Depression f. Fear g. Feeling abandoned h. Feeling isolated i. Feeling lost j. Feeling numb k. Feeling overwhelmed l. Greif m. Guilt n. Irritability o. Limiting contact with others (I found I withdrew and cuddled up with my Lab and quilting) p. Panic (what if I can’t make it through this shift?) q. Sadness r. Shock s. Startled t. Suspiciousness u. Uncertainty (constantly checking and rechecking your work, documentation, etc.) v. Wanting to hide (that never happened to me) w. Worry about others (BIG TIME!!). References Lynch, Virginia A. and Duval, Janet Barber. (2006). Forensic Nursing. St. Louis: Elsevier Mosby

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The Correlation between health assessment and forensic nursing

September 8, 2009

Thank you for these great posts related to the correlation between Forensic nursing and health assessment. I am a Sexual Assault Nurse Examiner and a NP student. I never thought about the health assessment as a forensic investigation, but it is so true. Making this correlation has already helped me to complete more thorough health assessments in my graduate NP courses. Thanks!

Original Post
March 21, 2008
Title: The Correlation between health assessment and forensic nursing
I am writing in respond to the article titled “The Correlation between the Health Assessment and Forensics Nursing.” My job is performing assessments on patients for surgery, which in some way is similar to an assessment used in forensics nursing. I am not involved in forensics, but have read materials related to the assessment. I totally agree that as soon as I meet my patient, I start my assessment based on appearance, speech, skin color and facial expressions. Anesthesia assessment involves collecting all types of data that identifies the patient’s physiologic status, risk factors, knowledge and past health and anesthesia history. The most difficult challenge is keeping the patient focused and answering questions completely without omitting details, I can associate this also with a forensic assessment. 
Once the subjective data is obtained, we do gather objective data to be complete. An example would be labs, EKG and x-rays which is also used in an investigation. Subjective and objective data are the two primary components in performing a health assessment, whether it is any type. They both work together, if patient is unresponsive or unable to communicate, it does present a challenge. I than rely on family history or previous medical records. I agree with the last item in the article, “giving our clients a voice”, practicing as a nurse you must always assume the role as a patient advocate. Communication to physicians and other members of the health team is to ensure putting the patient’s best interest first. That is one reason I choice to become a nurse.

Original Post:

November 1, 2007

I think that performing a health assessment is very similar to a forensics investigation. The forensics investigator starts gathering evidence as soon as he enters the scene. The fractioned also gathers evidence as soon as she enters the examination room. Does the client answer questions appropriately, is her posture straight, is she tearful, guarding a certain area of her body. What about hygiene, is well groomed, or wearing stained, mismatched clothing. The forensics investigator uses many senses while investigating a crime scene. Smell, touch, sight, and the 6th sense about what seems to be not quite right. The fractioned doing the assessment uses the same senses. Smell can clue the fractioned into some diseases, for example some malignancies. The sense that something is not quite right is another skill that the fractioned develops. The client that says she is eating, yet losing weight leads the fractioned to follow-up with other questions. Is the client diabetic, bulimic, or an elderly patient unable to afford food? The forensics investigator uses laboratory data to support his theories. Laboratory is a tool that the fractioned also uses. Is the chest pain cardiac with elevated cardiac enzymes and EKG changes? Is weight loss due to a malignancy, diabetes, poor nutrition? Forensics investigation and health assessment share one more very important trait. Forensics investigators give the victim a voice. As health practitioners, our clients too, will often need us to give them a voice. This includes the very young, the very old, the cognitively impaired, and the victims of abuse.

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