NUR 2092 Individual Health Assessment Form BLundborg (45 points).

NUR 2092 Individual Health Assessment Form (45 points) Objective: Conduct a General survey and a Health history on a family member or friend (client) over the age of 65 (or someone with major health problems if younger ...

NUR 2092 Individual Health Assessment Form (45 points) Objective: Conduct a General survey and a Health history on a family member or friend (client) over the age of 65 (or someone with major health problems if younger). GENERAL SURVEY: Physical Appearance/Hygiene (3 pts): General appearance: Body Structure (3 pts): Observe general stature: Body Movement (3 pts): Observe the client’s movement. Emotional/Mental Status and Behavior (3 pts): Note the general expression of the client. Following the completion of the General Survey complete a Health History of your client. Using the interviewing techniques learned gather the following information. Use your textbook as your guide. Document responses in each category below. Your assignment must have accurate spelling and grammar. A response is required for EACH item in EACH category. Copy this document & record your responses in a word document. That way you can just add the information without retyping the entire document. Please reformat and delete things as appropriate (such as in review of systems – delete opposite sex when discussing reproductive system). Health History Biographical data: (1 pt.) Initals:____________ Age: ______ Marital status: ____M _____ S _____Sep. ____Cohab. Birth date: ________ Number of dependents: _________ Educational level: ____ __ Gender: _____F _____ M _____Other Occupation: _____ ______________________ Ethnicity/nationality: ____ _____ Health insurance ____Yes _____No Source of history (who gave you the information)/reliability (how reliable is that person): ____ Present health history: (3 points) Current medical conditions/chronic illnesses:. Current medications: Medication/food/environmental allergies: Past health history: (5 points) Childhood illnesses Hospitalizations/Surgeries: Accidents/injuries: Major diseases or illnesses: Immunizations (dates of known Tetanus _______ Diphtheria ________ Pertussis ________ Mumps ________ Rubella _______ Polio _____________ Hepatitis B ______ Influenza _______ Varicella ______ Other ____________________________________________ Recent travel/military services: Include travel within past year and recent and past military service. Date of last examinations: Physical examination ____ Vision _____ Dental ______ Family History (2 points) Mother/Father/Siblings/Grandparents: . Review of Systems (12 points total) Be sure to address ALL items specifically. See page 54 in Jarvis. General health status (1 pt): Integumentary (1 pt): Skin Hair: Nails: HEENT (2 pts): Head: Neck: Eyes: Ears: Nose, Nasopharynx, Sinuses:. Mouth/Oropharynx: Respiratory (1 pt): Cardiovascular (1 pt.): Breasts (1 pt.): Gastrointestinal (1 pt Genitourinary (1 pt.): Female/male reproductive (1 pt.): Musculoskeletal (1 pt.): Neurological (1 pt.): Psychosocial Profile (5 points) Health practices and beliefs/self-care activities: Nutritional patterns: Functional Ability (indicate ability to independently perform following self care activities*): __ Dressing _ Toileting __ Bathing ___ Eating ___Ambulating _____Shopping _____ Cooking _____ Housekeeping *If unable to perform independently, describe: Sleep/rest patterns:. Personal habits (tobacco, alcohol, caffeine, and drugs): Environmental history: Socioeconomic status: Family/social relationships Cultural/religious influences: Mental Health: Now answer the questions below: (5 points) 1. Was the person willing to share the information? If they were not, what did you do to encourage them? 2. Was there any part of the interview that was more challenging? If so, what part and how did you deal with it? 3. What interviewing techniques did you use, e.g. silence, restating, etc 4. Now that you have taken a health history, discuss how this information can assist the nurse in determining the health status of a client. 5. Identify one physical, one cognitive or psychosocial strength and one weakness you believe this person possesses and state why you believe this to be true. What is a weakness?