A family health history is a record of health information about a person and his or her close relatives. A complete record includes information from three generations of relatives, including children, brothers and sisters, parents, aunts and uncles, nieces and nephews, grandparents, and cousins. Show
Families have similar genetic backgrounds, and often similar environments and lifestyles. Together, these factors can give clues to conditions that may run in a family. By noticing patterns of disorders among relatives, healthcare professionals can determine whether an individual, family members, or future generations may be at an increased risk of developing a particular condition. A family health history can identify people with a higher-than-usual chance of having common disorders, such as heart disease, high blood pressure, stroke, certain cancers, and type 2 diabetes. These complex disorders are influenced by a combination of genetic factors, environmental conditions, and lifestyle choices. A family history also can provide information about the risk of rarer conditions caused by variants (mutations) in a single gene, such as cystic fibrosis and sickle cell disease. While a family health history provides information about the risk of specific health concerns, having relatives with a condition does not mean that an individual will definitely develop that condition. On the other hand, a person with no family history of a disorder may still be at risk of developing the disorder. Knowing one’s family health history allows a person to take steps to reduce his or her risk. For people at an increased risk of certain cancers, healthcare professionals may recommend more frequent screening (such as mammography or colonoscopy) starting at an earlier age. Healthcare providers may also encourage regular checkups or testing for people with a condition that runs in their family. Additionally, lifestyle changes such as adopting a healthier diet, getting regular exercise, and quitting smoking help many people lower their chances of developing heart disease and other common illnesses. The easiest way to get information about family health history is to talk to relatives about their health. Have they had any health problems, and when did they occur? A family gathering could be a good time to discuss these issues. Additionally, obtaining medical records and other documents (such as obituaries and death certificates) can help complete a family health history. It is important to keep this information up-to-date and to share it with a healthcare professional regularly. Open Resources for Nursing (Open RN) With an understanding of the basic structures and primary functions of the respiratory system, the nurse collects subjective and objective data to perform a focused respiratory assessment. Subjective AssessmentCollect data using interview questions, paying particular attention to what the patient is reporting. The interview should include questions regarding any current and past history of respiratory health conditions or illnesses, medications, and reported symptoms. Consider the patient’s age, gender, family history, race, culture, environmental factors, and current health practices when gathering subjective data. The information discovered during the interview process guides the physical exam and subsequent patient education. See Table 10.3a for sample interview questions to use during a focused respiratory assessment.[1] Table 10.3a Interview Questions for Subjective Assessment of the Respiratory System
Life Span ConsiderationsDepending on the age and capability of the child, subjective data may also need to be retrieved from a parent and/or legal guardian. Pediatric
Older Adult
Objective AssessmentA focused respiratory objective assessment includes interpretation of vital signs; inspection of the patient’s breathing pattern, skin color, and respiratory status; palpation to identify abnormalities; and auscultation of lung sounds using a stethoscope. For more information regarding interpreting vital signs, see the “General Survey” chapter. The nurse must have an understanding of what is expected for the patient’s age, gender, development, race, culture, environmental factors, and current health condition to determine the meaning of the data that is being collected. Evaluate Vital SignsThe vital signs may be taken by the nurse or delegated to unlicensed assistive personnel such as a nursing assistant or medical assistant. Evaluate the respiratory rate and pulse oximetry readings to verify the patient is stable before proceeding with the physical exam. The normal range of a respiratory rate for an adult is 12-20 breaths per minute at rest, and the normal range for oxygen saturation of the blood is 94–98% (SpO₂)[3] is less than 12 breaths per minute, and is greater than 20 breaths per minute. As a general rule of thumb, respiratory rates outside the normal range or oxygen saturation levels less than 95% indicate respiration or ventilation is compromised and requires follow-up. There are disease processes, such as chronic obstructive pulmonary disease (COPD), where patients consistently exhibit below normal oxygen saturations; therefore, trends and deviations from the patient’s baseline normal values should be identified. A change in respiratory rate is an early sign of deterioration in a patient, and failing to recognize such a change can result in poor outcomes. For more information on obtaining and interpreting vital signs, see the “General Survey” chapter.InspectionInspection during a focused respiratory assessment includes observation of level of consciousness, breathing rate, pattern and effort, skin color, chest configuration, and symmetry of expansion.
Palpation
AuscultationUsing the diaphragm of the stethoscope, listen to the movement of air through the airways during inspiration and expiration. Instruct the patient to take deep breaths through their mouth. Listen through the entire respiratory cycle because different sounds may be heard on inspiration and expiration. As you move across the different lung fields, the sounds produced by airflow vary depending on the area you are auscultating because the size of the airways change. Listen to normal breath sounds on inspiration and expiration. Correct placement of the stethoscope during auscultation of lung sounds is important to obtain a quality assessment. The stethoscope should not be performed over clothes or hair because these may create inaccurate sounds from friction. The best position to listen to lung sounds is with the patient sitting upright; however, if the patient is acutely ill or unable to sit upright, turn them side to side in a lying position. Avoid listening over bones, such as the scapulae or clavicles or over the female breasts to ensure you are hearing adequate sound transmission. Listen to sounds from side to side rather than down one side and then down the other side. This side-to-side pattern allows you to compare sounds in symmetrical lung fields. See Figures 10.5[7] and 10.6[8] for landmarks of stethoscope placement over the anterior and posterior chest wall. Figure 10.5 Anterior Auscultation AreasFigure 10.6 Posterior Auscultation AreasWhen assessing patients who are experiencing shortness of breath (or fatigue easily), it may be helpful to begin auscultation in the bases and progress upward to other lung fields as tolerated by the patient. This ensures that assessment of the vulnerable lower lobes is achieved prior to patient fatigue. Expected Breath SoundsIt is important upon auscultation to have awareness of expected breath sounds in various anatomical locations.
Adventitious Lung SoundsAdventitious lung sounds are sounds heard in addition to normal breath sounds. They most often indicate an airway problem or disease, such as accumulation of mucus or fluids in the airways, obstruction, inflammation, or infection. These sounds include rales/crackles, rhonchi/wheezes, stridor, and pleural rub:
Life Span ConsiderationsChildrenThere are various respiratory assessment considerations that should be noted with assessment of children.
Older AdultsAs the adult person ages, the cartilage and muscle support of the thorax becomes weakened and less flexible, resulting in a decrease in chest expansion. Older adults may also have weakened respiratory muscles, and breathing may become more shallow. The anteroposterior-transverse ratio may be 1:1 if there is significant curvature of the spine (kyphosis). PercussionPercussion is an advanced respiratory assessment technique that is used by advanced practice nurses and other health care providers to gather additional data in the underlying lung tissue. By striking the fingers of one hand over the fingers of the other hand, a sound is produced over the lung fields that helps determine if fluid is present. Dull sounds are heard with high-density areas, such as pneumonia or , whereas clear, low-pitched, hollow sounds are heard in normal lung tissue.
Expected Versus Unexpected FindingsSee Table 10.3b for a comparison of expected versus unexpected findings when assessing the respiratory system.[12] Table 10.3b Expected Versus Unexpected Respiratory Assessment Findings
What is considered relevant medical history?Include information on major medical conditions, causes of death, age at disease diagnosis, age at death, and ethnic background. Be sure to update the information regularly and share what you've learned with your family and with your doctor.
How is it important to get the past medical history of the client?A patient's medical history can identify the chances of their probability of having lifestyle diseases like diabetes, heart attacks etc which are the main cause of serious health conditions. It helps doctors and care giver's to minutely assess and give the best of medical facilities to the patient.
What should you consider before conducting a health history?Personal status (e.g. education, occupation, etc.). The patient's important family / social relationships. The patient's diet / nutrition and exercise status. The patient's functional ability and mental health.
Why is it important to know a patient's previous medical history when treating them?Knowing your medical history gives your primary care physician a better understanding of your overall health. An accurate medical history can also improve the quality of health care that you receive.
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