Knowledge of health screening requires a nurse to combine knowledge of pathophysiology with known risk factors for certain ethnic and/or age groups of patients. Here are the main tests of routine health screening exams and the patient populations in which they are most acutely indicated if applicable.
Blood sugar levels can be checked either fasting or non-fasting. If a patient is fasting (more than 8 hours), a level of greater than 125 mg/dL indicates the need for further testing. A non-fasting patient should have a level less than 199 mg/dL.
Normal blood pressure is defined as anything less than 120/80 mm Hg. While there are several subcategories of hypertension (elevated, stage I, and stage II) severe hypertension is defined as a blood pressure greater than 140/90 mm Hg. Known as the “silent killer,” hypertension even when severe may be completely asymptomatic. Incidence of hypertension is higher in the southeastern U.S. and in African-Americans. Other risk factors for hypertension include age over 60, inactive lifestyle, and hyperlipidemia.
Every adult should have a fasting lipid profile done at least once every 5 years. Total cholesterol should be less than 200 mg/dL, triglycerides or fatty acids should be less than 150 mg/dL, low-density lipoprotein (LDL or “bad” cholesterol) which is closely linked to the development of atherosclerosis should be less than 100 mg/dL, and high-density lipoprotein (HDL or “good” cholesterol) which is cardioprotective should be greater than 40 mg/dL in men and 50 mg/dL in women.
Every adult over the age of 50 should have regular colorectal screening. These tests may include fecal occult blood testing (FOBT), sigmoidoscopy, colonoscopy, double-contrast barium enema (DCBE), and/or digital rectal exam (DRE). In patients with a positive family history of colorectal cancer, screenings should begin at an earlier age and possibly be more frequent.
All men should be screened for prostate cancer starting at the age of 50. A blood test measuring a man’s level of prostate-specific antigen (PSA) along with digital rectal exam (DRE) are the tests that are used.
All women between the age of 40 and 50 should have a baseline mammogram. Annual screenings are generally indicated in most women until the age of 55. They may be done biannually or continued annually. A positive family history of breast cancer may dictate earlier screening mammograms for some women.
Detailed history-taking is essential as some patients may engage in certain high risk behaviors or lifestyles that increase their risk for the development of disease, illness, injury, or death. Many patients may not realize they’re at risk, so identification and education of these is an essential part of comprehensive healthcare.
Unprotected sexual activities (anal, vaginal, or oral) can increase the risk of sexually transmitted diseases (STDs) as well as HIV/AIDs in certain populations. It may also lead to unplanned pregnancy. Using contraception and/or barrier protection methods can take planning and identification of resources for patients who need them. Nurses are often well suited to give this direction and education.
For many age groups, the number one cause of death is unintended injuries. Nurses can provide counseling on ways to reduce risk such as seatbelt use while in the care and the use of helmets or other protective equipment while biking, etc.
Lifestyle choices vary for each patient. They are a set of actions or characteristics that range from habits to thoughtful, intentional decisions. Examples include remaining single or child-free, living in a particular environment (rural versus urban), or engaging in and practicing alternative healthcare (homeopathic, etc.). Each of these can impact a patient’s health negatively or positively depending on his or her particular health circumstances.
Self-care activities are those actions and practices that patients engage in to promote or enhance their own health and well-being. They are not directed or overseen by medical professionals. However, for some patients who have developmental/physical disabilities or the elderly, there may be limited or curtailed ability to perform self-care activities. Nurses need to identify patients in need and utilize professional, institutional, and personal (family/friends) resources to ensure a patient’s ability to live as independently as possible.
Health histories and history of present illness (HPI) are subjective descriptions of a patient’s symptoms and health circumstances. Physical assessment of the patient provides objective information about a patient’s physical condition. The combination of the two helps guide your decision-making and intervention. There are four main physical assessment techniques you will use.
Inspection or purposeful observation can provide you with a wealth of information about a patient’s general health. Posture, body habitus, movements, and speech can tell you about their nutritional status, personal care habits (dental care, exercise, etc.), as well as alert you to deviations from the expected developmental phase. Vital signs are also part of inspection. In some cases, you may need to personalize your assessment technique. For instance, a child will require a small/child-sized blood pressure cuff to obtain accurate information.
Palpation is using both the fingertips and palms to apply light to deep pressure to certain internal structures to gather information regarding their function and state. Palpation is used to assess pulse rate, rhythm, and quality. It is also used to note a cardiac thrill (a palpable heart murmur) as well as tender, swollen, or displaced bones or internal organs such as the liver, spleen, etc. Palpation can also tell you about a patient’s hydration or fluid status by assessing skin turgor and signs of edema.
Percussion techniques can tell you about the levels of air and fluid within an organ or body cavity. The middle finger of one hand is pressed over the structure while the index and middle finger of the other hand lightly taps on the pressed finger. The returned sound will be dull (soft) if there is fluid/exudate present and hollow (loud) if there is air. Percussion is most used to assess conditions of the chest cavity (i.e., lungs) and the abdomen.
Auscultation is the technique of using a stethoscope to listen to the movement of air and fluid inside of the body. The stethoscope has two sides that are useful for the assessment of different sounds: the bell (smaller, hollow cup) picks up very low frequency sounds (heart murmurs, some bowel sounds, arterial bruits, etc.) while the diaphragm (larger, flat) is better for high frequency sounds (breath sounds, normal heart sounds, blood pressure, etc.).
Nurses are invaluable sources of information and education for the patients that they care for. As a nurse, you have been preparing for this role throughout your entire education and training. However prepared you are, though, you will need to understand the principles of teaching and learning to effectively communicate this information with your patients.
Take the time to learn more about your patients and assess their ability and readiness to learn. Ask about and identify how a patient likes to learn or learns best and make accomodations for this to help ensure that your information is received, processed, and understood. It is helpful to have a consistent, organized approach to clearly deliver medical information.
Age and development— Consider the age and development of your patient. Tailor your message as appropriate. Examples would be using small, simple words for younger patients, and allowing older/adolescent patients learn more independently through the use of trusted Internet-based websites.
Living situation— A patient who is socially isolated due to physical limitations (decreased sight or hearing) or geographically isolated from family and friends will likely need special accommodations for the learning process to be effective.
Learning preference— Different people learn differently. Visual learners may prefer diagrams, handouts, or pamphlets. Auditory learners will prefer face-to-face discussions or group meetings. Tactile (kinesthetic) learners will want to touch, feel, and move a model or device to better “experience” what they are learning.
A critical part of effective teaching is ensuring that the material is received and understood. A nurse must identify any potential barriers to learning prior to teaching to ensure that the process is effective and produces the desired effect.
Physical condition— Consider a patient’s ability to hear and see during your communication. Adjust your tone and rate of speech or use materials with enlarged print or braille if indicated.
Financial concerns— Consider a patient’s financial ability to pay for a procedure, surgery, medication, or other treatment. Discussing strategies or resources to help ease these concerns will help build rapport and trust with patients.
Absence of support systems— Patients may feel isolated and alone if they lack the proper support systems. Be available to these patients and guide them to the proper resources to help them find the support they need.
Literacy skills and comprehension— Patients with low literacy skills and decreased ability to comprehend will need special accomodation. A balance of proper tone and delivery is necessary to avoid sounding condescending or belittling.
Cultural background— Cultural beliefs need to be considered when teaching patients. Be sensitive to and respectful of certain ethnic traditions and practices.
Language barriers— Language barriers need to be identified and translators should be used whenever possible.
Attitude and motivation— An unmotivated patient is unlikely to put forth the effort required to learn. Identify the reasons behind a poor attitude and make efforts to remedy them whenever possible.
Acceptance of responsibility— Patients must recognize and accept personal responsibility over their health and circumstances and take initiative to make the necessary changes to get better.
Environment— Patients need the proper environment to receive information and learn effectively. Minimize distractions and ensure proper measures are taken to respect the patient’s privacy.
A nurse can use many teaching techniques and strategies to ensure patients have the medical information they need and understand what they have learned or been instructed to do. You may employ one or all of these when you work with your patients.
Let the patient help establish and evaluate own goals.— Encourage your patients to take an active part in getting better. Helping them establish and evaluate their own goals makes them part of the treatment team and motivates them to adhere to a treatment regimen. In this way, patients take more ownership over their condition, healing, and wellness.
Have patient demonstrate understanding.— Asking a patient if they understand or have any questions gives them an opportunity to identify gaps in learning. If a patient seems reluctant to ask questions, you can also ask them to repeat back to you what they understood in their own words. For procedures or self-care that necessitate learning a new skill, ask the patient to perform the task to ensure they understand.
Evaluate and modify the plan.— Despite your best efforts, effective patient education can sometimes be difficult. Be flexible and ready to try multiple strategies if your teaching efforts are not producing the intended results.