Comprehensive Health Assessment For A Measles Patient

Importance of Health Assessments for Patients

Discuss about the Comprehensive Health Assessment.

For a nurse to gain full understanding of a patient’s health situation, comprehensive health history and physical examination is a crucial exercise to conduct. Results from such exercises provides all the necessary information that a nurse ought to know for him/her to gain a clear understanding of the prevailing patient’s condition (Kozier et al., 2014). There is a huge cluster of patient-provider barriers of communication that necessitates the need of conducting a sensitive, careful and accurate interview of the patient at hand. These barriers mainly arise from the state of status inequity between the patient and the medical officer or discrepancies in the definition of the health problem between the patient and the medical officer. Such interviews are also driven by the fact that the main complaint of a patient is not the primary symptom of a health disorder (Treasure, 2011). Globally medical practitioners are encouraged to use physical examination forms during assessments as these forms ensures comparability and consistency in institutional settings with large numbers of health practitioners trainees

There are various health assessment frameworks available for assessing patients from different scopes. In this case study I implemented the Focused Health Assessment Framework (Guest, Ricciardi, Kawachi, & Lang, 2013). The key areas that are focused by this framework are; neurovascular assessment, mental status, pain, integument and head. Neurovascular assessment is aimed at determining sensory and muscular functions of the limbs and also the peripheral circulation. Under mental status, factors to be considered are; orientation, depression, insight, moods, posture and appropriateness of movements. Assessing the patients experience of pain is also crucial as it aids in provision of appropriate and effective pain management. Integument brings into focus areas such as hair (texture, quantity and distribution), lesions (depth, color of the lesions, location and type) and nails. The head is also assessed while focusing on; scalp, eyes (lacrimal glands, conjunctiva, peripheral vision, acuity, shape, size, pupil reactions, symmetry and eyelids)

Victor, aged 10 years arrives at the medical facility accompanied by his mother. The child looks sickly with rashes all over his face. He seems to suffer from low self-esteem as he has covered his head to hide the clearly visible rashes and lacks courage to face me. His mother’s presence is of much help to his situation as she is currently his only source of comfort. He has a highly evident fever as he is sweating and yet it’s such a chilly morning. He has a harsh dry cough with small white spots inside the mouth. With all the prevailing signs and symptoms, the health disorder that the child could be possibly suffering from is measles and I therefore proceed to conduct all the necessary assessments to ascertain the case.

Focused Health Assessment Framework

The patient’s history is of much significance in determining the real health situation as it brings into the limelight factors such as whether the patient was exposed to the virus that causes measles. Victor confesses of having shared a spoon with a previously sick child at his school. Upon exposure, the incubation period ranges between 7-14 days until the first visible signs and symptom prevails to the infected person (ENA., Hammond & Zimmermann, 2012). However, infected persons are contagious approximately 1-2 days before the onset of the so said symptoms. It is also worth noting that healthy children can also pass the virus to an un-infected person roughly 3-5 days prior to the appearance of the rash and continues being contagious until the fourth day after the onset of the rashes (Messenger, 2012). Individuals who are immunocompromised are considered to be contagious during the entire illness duration.

A high fever of above 104^o F (40^o C) is the first sign of measles. This fever typically last for approximately 4 to 7 days. During this prodromal phase there are occurring instances of anorexia, malaise, classic triad of conjunctivitis and fever (Shmaefsky, 2009). Coryza and coughs are also developed at this stage. The patient admitted to having observed similar symptoms. Other symptoms possibly associable to measles include, myalgias, periorbital edema and photophobia. 2-4 days after the onset of prodrome, there is the appearance of enanthem which lasts for approximately 3-5 days. The mother revealed that she had observed the same. It is also at this early stage that small spots popularly known as Koplik Spots become visible inside the cheeks of the patient. The said spots were clearly visible inside the cheeks of my patient. Mild prirutus is highly associated with the exanthema which generally appears about 1-2 days after the Koplik Spots become visible. (Griffin &Oldstone, 2010)

Towards the end of the prodrome, there was appearance of Koplik spots visible on the buccal mucosa right opposite the second molars as confirmed by the boy’s mother. Generally, Koplik spots are first seen roughly 1-2 days prior to the appearance of the rash and are persistent until the second day after appearing of the rashes. Sloughing of this enanthem commences as the rashes appear. It is however worth noting that though this is the pathognomonic enanthem of measles, diagnosis should not be excluded once its absence prevails. (Cox, 2009)

Onset of Erythematous macules, blanching and papules begin behind the ears, on the neck sides and at the hairline on the face. The boy admits to sighting strange and unusual developments on his neck. Within a duration of 48 hours, the pre-mentioned starts coalescing resulting to formation of plagues and patches that begin spreading from the head downwards including to palms and soles. Simultaneously they begin to regress starting from the head and neck. Lesions intensify above the shoulders whereby eruptions could either adopt a petechial or acchymotic nature (Sawyer, 2012). The mother confirmed that the child appeared ill the most during the first and second day after the onset of the rash. The mother also confirmed that Exanthem had been predominantly persistent for about 5-7 days before being succeeded coppery-brown patches that are hyper-pigmented in nature which later on fell off like scales or flakes.

Symptoms and Diagnosis of Measles

Illness brings about a significant number of psychological implications with it to the life of the infected individual. Some of these can be easily eradicated with passage of minimal time whereas it proves difficult to eradicate the impact of others from the lives of such individuals. Pain is one implication of an illness (Marini & Stebnicki, 2012). Victor complained of intense pain that had developed over time since the onset of the illness. He pointed out that he was suffering from chest pains which could have possibly emanated from straining of the chest muscles as a result of consistent coughs. He also mentioned that he was having recurrent headaches especially during sunny days. He also complained of general discomfort, a condition known as malaise.

Fatigue was another concern raised by the patient. Fatigue is a state of awareness that describes a considerably wide range of afflictions and is characterized by mental and/or physical weakness (Bienvenu, Jones & Hopkins, 2017). Physical fatigue is a condition where one cannot function at the normal levels of physical activeness. Though it’s a common phenomenon in every day running, it becomes more noticeable during heavy exercises or during states of health disorders. Mental fatigue on the other hand expresses itself mostly through increased sleepiness or somnolence. victor admitted that it was proving quite a hard task for him to concentrate in class or even participate in any gamming activity. His mother also pointed out that he was consuming considerably higher amounts of time in completing basic home chores than he had been spending before the onset of his illness.

Victors mother complained that his son’s self-confidence had gone down significantly. This is the attitude that allows one to have realistic views that are positive about themselves and the situations that revolve around their lives. She further pointed out that in the recent past since the onset of the disease, her son had could no longer trust his abilities and had lost the general sense of control of his life (Orto & Power, 2007). Things that he previously did with ease were again proving hard for him to accomplish. He exclusively depended on the approval of his parents or elder siblings for him to get down to performing tasks that required no approval. Most are the times that he even doubted his success in accomplished tasks.

Another significant psychological impact of illness that manifested itself fully in Victor was low mood and depression (Smith, Eriksen & Bor, 2015). His mother stated that she had received complaints from Victor’s teachers and schoolmates pointing out that he had developed a habit of excluding himself from others and made minimal interactions at school. Victor also admitted to having problems in catching sleep, this being an evident sign of depression. In conclusion, it had become quite hard for victor to eat. His appetite had reduced significantly since the onset of measles. His mother complained that the amount of food that he used to eat had halved within eight days. 

Psychological Implications of Illness

Performance of diagnostic tests is crucial to establish the real cause of the disease and all the implication it is having on the life of the infected person (Domino, 2010). The first diagnostic test that was conducted on Victor was ‘Impaired Social Interaction.’ The primary aim of this test is to establish and provide substantial advice for any case of self-exclusion or stigmatization from friends and family members. With victor’s condition as a measles patient, it was obvious that he would succumb to the pre-mentioned situations more so due to his prevailing physical appearance. Victor himself admitted to at one point considering himself as an outcast from the rest of his school members after receiving open discrimination at a past class exercise.

The other diagnostic test conducted was to determine ‘Risk for Impaired Skin Integrity (Pagana & Pagana, 2014). The skin and the mucosal membrane, which are the most affected by measles, provides physical barrier for prevention against penetrations from the external environment. Victors skin had been greatly affected as there were even evident lesions that could provide entry points for harmful disease causing micro-organisms into the body. This diagnostic provided the basis of the kind of skin therapy to give to victor in attempt to heal his impaired skin.

Diagnoses was also conducted for high risk of infection relating to the infectious agents prevailing to victor and also by the fact of him being a host (Malarkey & McMorrow, 2011). It emerged clearly that he had already contracted the measles virus. This rendered him highly infectious to an uninfected person. He was also on the verge of contracting more infections as his prevailing state of having skin lesions rendered him more susceptible to other infections. The aim of this diagnostic was to initiate the relevant precautionary measures against spreading the measles virus and also against contracting new infection emanating from his current status.

The last diagnose was on ‘acute pain’ which was directly attributable to irritated mucosal membrane and skin lesions (Fischbach & Dunning, 2009). Pain is the unappealing experience that could be sensory and/or emotional and arises from potential or actual damage of the tissues. Victor was a victim of active pain that entirely compromised his comfort. He came to a point that he completely stopped attending school as pain became more intense.

The whole assessment process was a great success. It provided a very resourceful and interactive session with real a case and thus I had the privilege to get the real touch of being a practicing nurse. I was able to learn the various techniques of handling patients and the various ways of helping them overcome mental suffering emanating from their conditions. The main challenge however was on how to begin an interactive session with the patient who had been overcome by grief as a result of his state of health. The status of nurse- patient situation between me and the client also resulted to a communication barrier hindering outsourcing of information relevant for diagnosing the patient. (Longe, 2006)

 Age difference between me and the patient was another challenge that prevailed itself. Although I tried my level best to ensure the patient that age mattered no more, he found it difficult to open up and talk freely about his situation and thus much of the talking was done by the mother. The last challenge that I encountered was time limit. There were several more patients waiting to be diagnosed as hence the whole assessment process was undertaken under limited time.

The whole process provided a wide range of opportunities. I was able to work under close supervision of experienced medical practitioners who did not hesitate to offer guidance on how to go about the whole process. It was also an educative process that offered practical knowledge to top up on theoretical knowhow. The assessment process also provided a first-hand interactive forum with clients and thus I was able to learn on how to handle such clients. Working from a medical facility setting also boosted interaction opportunities with experienced practitioners.

A change is like a rest and is considered as the most effective transformational tool. First, I would consider changing the mode of outsourcing information from patients. I would consider offering small gifts such as candies to children clients in order to create a free atmosphere (Thompson & Dowding,2009). Such gifts will ease the tension of the child and lure them to speaking up their whole experience since the onset of the disease they could be suffering from. This will enable me perform clear and more informed diagnostics.

While interviewing victor, I learnt that he left the task of answering the questions answered to his mother. In future, I would consider interviewing my minor clients in the absence of their parents (Potter, 2013). This will leave them no option but to speak up as there will be no one liable to answer queries meant for them.

Conclusion

After conducting the comprehensive health assessment, I was able to gain a vivid understanding on the essence of the same. I also gained the relevant skills necessary for me to handle patients in future. The prevailing case that I was handling necessitated me to expound more on measles and I therefore gained more knowledge on the disease that will be of help in future while handling similar cases. I can conclude that were it not for comprehensive assessment tests, no medical practitioner would be able to diagnose their patients accordingly.

Reference list

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