The study presents a holistic health assessment of a friend, Nancy, to establish if she suffers from any chronic illness. The holistic assessment involves a thorough study of the patient's cultural, social, physiological, spiritual, developmental, and psychological status. The assessment is essential in facilitating creation of a complete health care plan that will enable Nancy to live a comfortable and healthy life. Besides, it is a requirement that nurses provide holistic care to their patients. Therefore, through the assessment, I am confident that I will have the right skills to carry out similar comprehensive evaluations on my patients successfully. After reviewing the patient, the following information was obtained.
Part 1: Holistic health assessment
Health History
The holistic health assessment began with a brief view of Nancy's health history. Nancy is a 21-year-old female nursing student with a history of asthma that she controls using bronchodilators. She has never been admitted to a hospital but has received outpatient health care on numerous occasions due to minor illnesses and management of her asthma. She suffers from allergies, occasional sneezing, and a stuffy nose; she can hardly manage without using a handkerchief or blowing her nose. Apart from asthma and the running nose, the patient denies suffering from many ailments. Nancy does not smoke, nor does she drink alcoholic beverages. However, in her family lineage, there is a long history of asthma. She gets asthma attacks mostly in the evenings or after engaging in strenuous activities (Fawcett & Rhynas, 2012). Nancy denies having chest pains. She manages her asthmatic condition using a salbutamol inhaler.
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Physiological Assessment
Physiological assessments are well carried out in a clinical setting (Esmaeel & Aly, 2019). In the case of Nancy, the physiological evaluation comprised of a review of the patient's appearance, that is, any difficulty in talking or breathing. The heart and respiratory rates were measured (Beasley et al., 2016). While Nancy’s appearance was generally good, her heart rate was low since she had used a bronchodilator an hour before. She regularly uses long-acting B2 agonist or inhaled corticosteroids to manage her asthma. However, she complained that the medication was not effective in managing her condition. The previous day, she had taken over 15 doses of the inhaler within 24 hours.
Psychological Assessment
I carried out a psychological assessment on Nancy using the Taylor manifest anxiety scale test and the mini-mental state examination. From the tests, I conclusively established that Nancy suffers from mild depression. I suspected that the mild depression had caused the increased hospital visits, and the shame associated with using an inhaler in public might have contributed to the depression.
Social Assessment
A social assessment of Nancy's background revealed crucial details. For instance, Nancy comes from a middle-class single-parent family and is the firstborn of among two siblings. Occasionally, she acts as the parent of her younger brother when the father is not around. Nancy carries out most of the house chores, that is, laundry, dishes, and cleaning. Currently, she is a full-time student but works part-time at a restaurant. Nancy is not yet married but has a boyfriend. She is financially stable, and her neighborhood is free of any stressors.
Cultural Assessment
A cultural assessment of the patient classifies Nancy as an ethic minority since she is African-American. She lives in an urban setting and is a practicing Christian. She believes that the environment does not in any way interfere with her asthma treatment and management. However, she uses specific home-made remedies in an attempt to cure her asthma.
Developmental Assessment
Developmental assessment investigates the manner with which cognitive and psychosocial practices influence the physiological disorder (Cabana et al., 2014). Presently, Nancy does not undergo any developmental assessment to assist with management of her asthma. However, she practices her coping strategies, which play a developmental role in handling of her asthma. For instance, Nancy does not take any drinks, not even a glass of water after 5 pm. She believes that by doing so, it is less likely for her get asthma attacks.
Spiritual Assessment
A spiritual assessment indicated that the patient has a high religious preference. She prayed daily, went to church regularly, and believed that spirituality goes together with medical practices. Nancy stated that spirituality helps her find meaning during periods of hardships and enables her cope with asthma. However, Nancy also believes in negative religious coping, that is, God uses asthma to punish her sins. Thus, when suffering from severe asthma attacks, she requests her family, friends, and church members to pray for the forgiveness of her sins so that she can recover.
Part 2: Interpret the findings of the assessment
Physiologic abnormality and possible pathophysiologic reasons for the abnormality and the abnormality on a holistic basis
An interpretation of Nancy's holistic health assessment shows that she suffers from acute asthma. However, on certain occasions, she suffers from severe asthma attacks. Asthma is a chronic disorder characterized by the inflammation of an individual’s airway disorder, leading to shortness of breath, tightness of the chest, wheezing and coughing (Cabana et al., 2014). The obstruction of airflow is reversed using treatment or spontaneously. The disorder is claimed to originate from various environmental or host factors.
Several pathophysiologic reasons observed in the holistic assessment are responsible for Nancy's asthma attacks. Host factors and environmental exposure are the most likely reasons. Some of the host factors that lead to Nancy's asthma include sex genetics and innate immunity. According to Fawcett and Rhynas (2012), amongst children, prevalence of asthma is higher among boys than girls. However, after puberty, sex ratio changes course and higher incidences of asthma are reported among females than males. Genetics is the other likely course of asthma.
Clinical studies show existence of a link between asthma prevalence and specific phenotypic characteristics. Thus, Nancy might have inherited asthma from her family lineage since her relatives also suffer from the disorder. An individual's innate immunity is the other likely cause of asthma. Innate immunity involves a balance between Th1 and Th2 cytokine profiles. People such as Nancy who have asthma have more of Th2 than Th1. While the Th1 cells provide defense against infections, the Th2 cells generate allergic inflammation (Cabana et al., 2014). Therefore, asthmatic individuals have an immune system that is skewed towards the generation of Th2 cytokines instead of Th1.
How the abnormality impact the other areas of the patient’s life
Nancy's asthmatic condition has an impact on other areas of her life. In an attempt to control her asthma, Nancy has dramatically changed her lifestyle. For instance, she does not go out in the evening or very early in the morning since she fears getting an attack. She must have an inhaler everywhere she goes, sometimes she forgets to carry it and has to go back home. Her life is one of the constant fears that she might get an attack any time. She cannot engage in strenuous activities unless she has adequately planned.
Client’s stress and coping mechanisms
Analysis of the Nancy’s stress and coping methods revealed she follows the avoidance coping strategy. Her denial is illustrated by the fact that Nancy visits hospital emergency rooms after asthmatic attacks. Her preference for reliever medication over preventer medication is further proof of her denial (Beasley et al., 2016). She is currently not a member of any social support group and hardly involves her family in management of her condition. Nancy should try to integrate her disorder into her concept of self to gain more control over her asthma.
Are they healthy?
Apart from asthma, Nancy does not have any other ailment. She is healthy and physically fit. Sometimes, she goes for over a month without getting an asthmatic attack. Nancy comfortably engages in physical activities such as running and going to the gym. However, she must have a bronchodilator to prevent her from suffering from a severe asthma attack.
Improvements that could be made
Specific improvements on the patient's quality of life should be undertaken for better management of the condition. The patient should learn to accept her asthmatic condition rather than live in denial. For instance, the patient should build quality relationships with her family members, thereby leading to better psychological outcomes and management of asthma. Dysfunction within families is a barrier to the active management of asthma and leads to increased stress (Cotton et al., 2014). Joining a social support group would play a crucial role in the patient's coping process since it acts as a sufficient stress buffer.
Part 3: A teaching plan/client goals
At least one client goal for each of the categories (physical, psychological, social, cultural, developmental, and spiritual)
From the assessment data obtained, the following client goals are prescribed. From the physical assessment, one of the client goals is to reduce the number of acute asthma attacks and, subsequently, the amount of inhaled doses within 24 hours. A significant symptom of deteriorating asthma is characterized by increased use of inhalers, which leads to a drop in the heart rate. The second client goal regards the patient psychological status, and it aims to eliminate the mild depression associated with asthma. It is recommended that the patient be referred to psychiatric personnel (Esmaeel & Aly, 2019). The third client goal addresses the patient social status and suggests that the patient ought to avoid engaging in tasks that aggravate her asthma. From the cultural assessment conducted, a valid client goal is to ensure that her beliefs do not influence the use of asthma medication (Koinis-Mitchell et al., 2010). A developmental client goal involves adoption of effective cognitive and psychosocial practices. A spiritual client's goal is to rid the patient of all negative religious coping and subsequently encourage positive religious coping.
How will you teach the client about the goal?
I will teach the patient about the above goals by discussing with the patient how to avoid asthma triggers, that is, reduced use of deodorants and less time in the gym. I will also describe all the signs of acute asthma attacks and advise the patient about the best time to seek medical assistance (Laher et al., 2016). However, much of my teaching will be on the prevention of asthma attacks.
Evaluating the teaching
To evaluate my teaching plan, I will ask the patient questions about what I have taught and repeat instructions that require reinforcement. I will request the patient to repeat the instructions according to her understanding. I will reach out to the patient’s family to measure how well the patient is following the guidance I provided. Finally, I will describe hypothetical situations that might affect an asthma patient and ask the patient to solve them.
Conclusion
The study proves that a holistic assessment is critical for management of physiological conditions such as asthma. The benefit of the evaluation is its ability to address multiple issues that might be contributing to a patient's deteriorated health condition. At the end of the assessment, client goals are prescribed to assist with management of the situation. However, before discharging the patient, one must prove that the patient has understood all the instructions by evaluating the teaching plan.
References
Beasley, R., Hancox, R. J., Harwood, M., Perrin, K., Poot, B., Pilcher, J., ... & Thayabaran, D. (2016). Asthma and Respiratory Foundation NZ adult asthma guidelines: a quick reference guide.
Cabana, M. D., Slish, K. K., Evans, D., Mellins, R. B., Brown, R. W., Lin, X., ... & Clark, N. M. (2014). Impact of physician asthma care education on patient outcomes. Health Education & Behavior , 41 (5), 509-517.
Cotton, S., Grossoehme, D. H., Bignall, W. R., & Weekes-Kanu, J. C. (2014). Should my provider pray with me? Perspectives of urban adolescents with asthma on addressing religious and spiritual issues in hypothetical clinical settings. Journal of religion and health , 53 (2), 604-613.
Esmaeel, H. M., & Aly, H. Y. (2019). Psychological assessment of patients with bronchial asthma: focus on some predictors of abnormalities. Egyptian Journal of Bronchology , 13 (1), 35.
Fawcett, T., & Rhynas, S. (2012). Taking a patient history: the role of the nurse. Nursing Standard (through 2013) , 26 (24), 41.
Koinis-Mitchell, D., McQuaid, E. L., Kopel, S. J., Esteban, C. A., Ortega, A. N., Seifer, R., ... & Fritz, G. K. (2010). Cultural-related, contextual, and asthma-specific risks associated with asthma morbidity in urban children. Journal of Clinical Psychology in Medical Settings , 17 (1), 38-48.
Laher, A. E., Motara, F., Moolla, M., & White, D. A. (2016). Asthma in the emergency department: strategies beyond acute management protocols: guest review. Current Allergy & Clinical Immunology , 29 (4), 240-246.
