A focused assessment is a problem-oriented assessment
DQ-1
A focused assessment is a problem-oriented assessment. It is done on an already established patient and is, therefore, smaller in scope and more targeted than a comprehensive assessment. It is designed to address focused concerns and symptoms and is generally restricted to a specific body system (Bickley & Szilagyi, 2017, p. 5). For example, if I were seeing a hospitalized trauma patient who was a few days post surgery for a femur fracture who was complaining of chest pain, shortness of breath, and anxiety, my history taking and examination would focus primarily on the patient’s respiratory and cardiovascular systems. I would want an ABG done to see if the patient was hypoxemic or hypo/hypercapnic. I would also order lab work that included a CBC, CMP, troponin, and a D-dimer. The troponin will identify stress to the heart muscle while the D-dimer will help rule out a venous thromboembolism (VTE). A D-dimer is a degradation product that is increased in the presence of a VTE (Hadžić et al., 2020). I would also order an EKG to rule out myocardial ischemia or myocardial infarct, and a chest x-ray and chest CT to rule out pulmonary embolism or other pulmonary diseases. A V/Q scan can also be done to detect a mismatch between the patient’s ventilation and perfusion; however, pulmonary angiography is the definitive test for a pulmonary embolus (Toplis & Mortimore, 2020).
References:
Bickley, L. S., & Szilagyi, P. G. (2017). Foundations of clinical proficiency. In Bates’ guide to physical examination and history taking (12th ed., pp. 3-43). Wolters Kluwer.
Hadžić, R., Maksimović, Ž. M., Stajić, M., & Lončar-Stojiljković, D. (2020). D-Dimer: a Role in Ruling out Pulmonary Embolism in an Emergency Care Department. Scripta Medica, 51(1), 28–33. https://doi-org.lopes.idm.oclc.org/10.5937/scriptamed51-25479
Toplis, E., & Mortimore, G. (2020). The diagnosis and management of pulmonary embolism. British Journal of Nursing, 29(1), 22–26. https://doi-org.lopes.idm.oclc.org/10.12968/bjon.2020.29.1.22
DQ-2
The history and physical examination of a patient can inform the healthcare provider of current problems and potential problems. First step is to take the patient health history and survey the patients for event leading to complaint. The second step is to identify the patient age, gender and occupation as well as marital status. The chief complaint, present illness and allergies, past history, family history, personal and social history and review the patient current symptoms. Family health history is essential information in determining patient risk factors and likelihood of the same illness affecting the patient (Ginsburg,Wu,Orlando,2019). A comprehensive physical examination is the next step to begin. This exam is characterized by taking into account of the patients general impression, vital signs, skin presentation, head, eyes, ears, nose, throat, neck, back, posterior thorax, lungs, breast, axillae, epitrochlear nodes, anterior thorax and lungs, cardiovascular system, abdomen, lower extremities, upper extremities and nervous system. This site should be inspected, percussion and palpation. The adequacy of this assessment may influence and guide decision making regarding treatment and patient care management (Donnelly, Martin, 2016). Social and religious practices as well as culture practices may be taken into account. Laboratory orders are dependent on physical findings. I will attempt to get a general understanding on patient general health status by running blood work. I will provide a general assessment of laboratory results such as CBC, CMP, magnesium, phosphorus, TSH, hemoglobin A1c, UA, Xray, CT only if necessary, BNP if indicated by history or physical exam. I selected the indicated laboratory exam because they provided a general impression of the patient cellular and organ status.
Donnelly, M., & Martin, D. (2016). History taking and physical assessment in holistic palliative care. British Journal of Nursing, 25(22), 1250.
Ginsburg, G. S., Wu, R. R., & Orlando, L. A. (2019). Family health history: underused for actionable risk assessment. LANCET, 394(10198), 596–603. https://doi.org/10.1016/S0140-6736(19)31275-9
DQ-3
A focused assessment targets a specific patient problem that involves information gathering and interpretation, which is followed by a list of differential diagnoses and diagnostic tests. .The focused interview includes leading the patient with guided and open-ended questions to assist them in prioritizing their concerns (Bickley & Szilagyi, 2017). For instance, a patient with a chief complaint of productive cough for three weeks would involve collecting a health history, such as whether they have allergies, asthma, or COPD, along with determining if they smoke, have been exposed to any illnesses or environmental toxins. Subjective data would be assessed including whether they experience any shortness of breath, indigestion, congestion, fever, or chills. In addition to assessing vital signs, objective data would be collected, which includes conducting a general survey of their overall appearance to help rule out a variety of other medical issues and then completing a respiratory assessment (Asif, Mohiuddin, Hasan & Pauly, 2017).
Once a list of probable diagnoses is developed, further information is obtained in the diagnostic process, which will help narrow the potential options. According to Bhise et al. (2017), a major factor to consider when ordering a test is the time-dependent nature of the diagnostic process. Some diagnoses may be more important to establish immediately than others, leading to significant patient harm if not recognized, diagnosed, and treated early. For the patient with a productive cough, diagnostic testing would depend on their clinical presentation and history. Coughing accompanied by tachypnea, tachycardia, high fever, and pain on respiration points to pneumonia, which would require a chest x-ray, blood cultures, and a complete blood count. Whereas, if the history and clinical findings are compatible with a cold or bronchitis, neither a chest radiograph nor a chemistry panel would be necessary, if there are no associated abnormal findings.
Asif, T., Mohiuddin, A., Hasan, B., & Pauly, R. R. (2017). Importance Of Thorough Physical Examination: A Lost Art. Cureus, 9(5), e1212. https://doi.org/10.7759/cureus.1212
Bhise, V., Rajan, S. S., Sittig, D. F., Morgan, R. O., Chaudhary, P., & Singh, H. (2018). Defining and Measuring Diagnostic Uncertainty in Medicine: A Systematic Review. Journal of general internal medicine, 33(1), 103–115. https://doi.org/10.1007/s11606-017-4164-1
Bickley, L. S., & Szilagyi, P. G. (2017). Foundations of clinical proficiency. In Bates’ guide to physical examination and history taking (12th ed., pp. 3-43). Wolters Kluwer.
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