Topics

• History Components
• Pediatric Variations
• Geriatric Variations
• Clinical Reasoning Frameworks

NDNP 819 - Advanced Health Assessment Across Lifespan

Module: History Data, Clinical Reasoning

Geriatric Variations

There are potential challenges in taking a health history with an older adult that may need to be overcome by the APN. They can include sensory impairment (hearing, vision, etc.), restricted mobility, slowed response time/communication difficulties (aphasia), cognitive impairment, tendency to underreport or minimize symptoms, lengthy medical histories and disease presentation in an atypical fashion.

Strategies to help in getting information include: Schedule more than one session for the initial patient history, Bring medications and supplements in a brown bag, Get collateral history from family/caregiver, Attempt to minimize the impact of sensory deficits (adequate lighting, minimize ambient noise), Structure the interview to overcome patient disability (ex. Yes or no questions for an aphasic patient, attention to non-verbal cues).

For immunizations, make sure to ask about influenza, pneumococcal, tetanus and herpes zoster. Older adults health screening includes colon cancer (fecal occult blood, sigmoidoscopy, or colonoscopy), breast cancer for women (mammograms), depression, blood pressure, and alcohol misuse.