Holistic Assessment of Patient with Asthma

Introduction

The holistic assessment is an assessment of a person as a whole. It is used in the nursing process and creates a foundation for the patients care. This is done using therapeutic communication and collecting subjective and objective information about the patient. The holistic assessment is made up of physiological, psychological, sociological, developmental, spiritual and cultural needs of the patient ( The importance of holistic assessment – A nursing student perspective) This will help the nurse implement the nursing process of assessment, diagnosis, planning,implementation and evaluation.” Data can be collected through observation, physical assessment and by interviewing the patient (Rennie 2009). A complete assessment produces both subjective and objective findings (Wilkinson 2006). Holland (2008) defines subjective data as information given by the patient. It is obtained from the health history and relates to sensations or symptoms, for example pain. Subjective data also includes biographical data such as the name of the patient, address, next of kin, religion etc. Holland defines objective data as observable data, and relates it to signs of the disease. Objective data is obtained from physical examination, for example of blood pressure or urine.”

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 First, personal details such as name, age, address, nickname, religion, and housing status were recorded. Information was also recorded about any agency involved, along with next of kin and contact details, and details of the general practitioner. Knowing what type of a job the patient does or the type of the house she lives in helps to indicate how the patient is going to cope after discharge. Additionally, identifying a patient’s habits will help in care planning and setting goals.

Health History

The writer started the assessment by introducing self to the patient and stating what will the assessment is all about.During assessment, the nurse needs to use both verbal and non-verbal communication. Using non-verbal communication observing the patient.

The patient JT is a 77 year old female who has a history of asthma and has been admitted for it in the past. She has had wheezing, trouble breathing with exertion, seasonal allergies. She used bronchodilators and corticosteroids since she was ten years old. She lives with her son and grand daughter in a four bedroom house. One other child lives 30 minutes a way in San Francisco, CA. JT has a very active social life and has many friends in the community. She is also a home health nurse and sees many patient each week. She has hypertension and takes amlodipine 10 mg each day, she has no other significant health issues.

Physiological Assessment

During physical assessment, when objective data was collected. Focus was on the respiratory system as the patient has a diagnosis of asthma.  JT demonstrated laboured and audible breath sounds (wheezing) and breathlessness. Use of accessory muscles and nose flaring was also noted. She was agitated and anxious. Her vital signs were: blood pressure 110/70; pulse 102 beats /min; respirations 26/min; temperature 37.4 degrees Celsius; oxygen saturation 95% on RA.

Psychological Assessment

The primary consideration is the health and emotional needs of the patient. Assessment of cognitive function, checking for hallucinations and delusions, evaluating concentration levels, and inquiring into interests and level of activity constitute a mental or emotional health assessment. Asking about how the client feels and their response to those feelings is part of a psychological assessment. Are they agitated, irritable, speaking in loud vocal tones, demanding, depressed, suicidal, unable to talk, have a flat affect, crying, overwhelmed, or are there any signs of substance abuse? The psychological examination may include perceptions, whether justifiable or not, on the part of the patient or client. Religion and cultural beliefs are critical areas to consider. Screening for delirium is essential because symptoms are often subtle and easily overlooked, or explained away as fatigue or depression (Baird & Spiller, 2017).

Social Assessment

Many older adults tend, due to depression to be socially isolated from others.  In the article The Social Connectedness of Older Adults: A National Profile, there are theories that  stated that older adults are less integrated than young adults due to  the marginalization by modernization.” This is due to being forced out of the social roles they had that due to being more selective with the roles and later in life changes that they go through.” The loss of feeling significant to others and loss of function can  make someone feel insignificant to others so they isolate themselves from others. Socially J T is like social butterfly. She is the type of person who would start a conversation with a stranger. She is so very approachable, social, friendly and always has a warm inviting smile on her face for others. She is a very popular person in her community. Many know her, she is a hard person to forget due to her charisma. She is a home health nurse and many of her patients love her and want only her to take care of them due to how up lifting she is to their mental health and healing. She would sometimes give to much of herself to others and often forgets to take care of herself.

Cultural Assessment

Patient is a African woman from Nigeria who has been here in America for  over 30 years.  She very much believes in education and obtained her bachelor's in Nutrition  in California. She speaks english and the yoruba and edo language fluently. She very much identifies with her home country while acclimating well to the American culture. She continues to cook food that are from her country, socialize with others from her country, is apart of a association, the EDO sisters organization that focuses on the community of Edo in the bay area. She is still deeply rooted in the culture and is very proud of where she came from. She is handing down her knowledge of her coulture to her children and grandchild.

Developmental Assessment

In Erikson's developmental assessment, JT is at the ego integrity vs despair  or late adulthood. This the age of 65 years and older. Physically there are changes that include skin that is losing skin turgor, thinning skin, decrease on bone density, loss of cartilage in the joints, decreased metabolic rate, decrease elasticity of blood vessels, renal problems, cardiovascular issues, respiratory issues. There is a decline in function and there is a depression  that sets in doe to the loss of function and self at that age. This is vs a person who tried to stay healthy and active all their life to help slow down the declining process. It is so helpful when the person can reflect back on their younger years and say that they have led a good life. They would be more coming to terms with the aging self when someone is content with their life. JT is a woman that is content with how her life was led and is contine with getting older. Of course she would rather age with the least amount of joint pain as possible but she understands that it is part of the process. JT still goes on walks and is very active. She would be one of the first ones on the dance floor when the music starts to play at nigerian parties.

Spiritual Assessment

Spiritually, JT is a devout catholic christian. She grew up in Nigeria and was raised in the Protestantism religion. She was introduced by her mothers mother to the religion when she was very young. According to JT, her father worshiped many Gods and she did not believe in that. She converted to being a catholic when she married her ex husband who was raised in the church all his life. Ever since then she is very involved with the church. She goes to church every Sunday and many time during the week. She volunteers for programs and carnivals. She is a usher in the church and she is very very strong in her believe in Jesus Christ and God.

Breathing

JT has asthma witch is a chronic common disorder of the airway.  Asthma is a chronic inflammatory disorder of the airway. Asthma is the inflammatory cell infiltration. Other physiological findings are changes in the airway structure, gene -by environment interactions,  Atopy, the genetic predisposition for the development of an immunoglobulin E (IgE)-mediated response to common aeroallergens, is the strongest identifiable predisposing factor for developing asthma.”Section 2, Definition, Pathophysiology and Pathogenesis of Asthma, and Natural History of Asthma. How this affects the patient's life is important. JT is an upbeat lady who is very outgoing. She dances and walks and stays moving. She carries around her inhaler and she tries not to let her asthma get the best of her. It is more prevalent during certain season. The spring and summer seasons are the worst times. But she eats right and exercises and tries to stay away from anything that would trigger an asthma attack. She is allergic to smoking, smoke, pollen and dust.

 On assessment, JT’s problem was breathing that resulted in insufficient intake of air, due to asthma. She was wheezing, cyanosed, anxious and had shortness of breath.

The goal statement in this case would be for JT to maintain normal breathing and to increase air intake.

 To look at the problem on a holistic approach, is to look at the person as a whole. JT is a person who suffer from asthma, she knows what to do to stay away from triggles of her asthma. She continues to try and be active and healthy. She visits her doctors on a regular bases and is very active in the community. She still works and volunteers. She takes care of herself and others.

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JT handles coping and stress  well. She puts herself first as often as she can. She leads a very active life. She is always on the go. To handle stress she is enjoys walking, meditating and talking to others who she can truly confide in. She is a little bit of a workaholic so she throws herself int to her work sometimes. JT stated that being alone with her thoughts helps her stress level decrease and is is a soothing coping mechanisms she has been practicing for years. Due to JT taking her health seriously, and making sure that she is take care of herself, not many improvements in seen for her. She is following doctors orders and eating healthy and living a healthy lifestyle, She has cut down on meats, she never smokes or did drugs. She eats green leafy vegetables, she also stays active, has alone time and meditation time . She still works and is active in her community.

As we become older it is a good idea to set goals for ourselves. For JT she has set goals and is maintaining them to keep her life on the right track.

Goals physical is to continue to keep active in her community. Continue to walk as exercise, continue to eat health. For her to reach this goal, she is taught to make being physically active as a priority in her day to day life. Schedule in physical activity each day for at least one hour. Evaluation for this goal is assessing her vital signs and looking at her iwatch tracer for steps each day.

Goal for psychological is to continue her interactions with her patients, family and community while continuing to care for herself by meditating and taking time for clarity of mind. JT is taught to make sure she has time and is balanced in time with her external communication and relationships while making sure that she continues to have a relationship with herself and keep her mind clear. To evaluate this is to monitor for any signs of seclusion and depression. Asking her about a typical day and introducing her to other resources is very helpful. Social requires the same type of intervention and assessment as psychological. JT is continually social with work and family and her Edo group and Nigerian community. She is very involved and that will help her not be secluded. She is well known and well liked in the community. She must continue to foster these relationships with others and stay active in her community. Evaluation of the teaching would see for her interaction with others and not be secluded. Cultural JT is very in tuned with her culture. She is what is know as a monarch and is one of the forefront that is trying to keep the Edo culture alive in the community. JT culture is part of her, embedded in her veins and she will never let go of it. She is a very proud woman and proud of where she came from. Agol for JT is to continue on her interaction with her community and culture. Continue to go and have a good time with others, teach others about her culture. Continue to cook to foods, and wear the clothes and speak the language. This fosters a sense of self and belonging. This also will increase aJT self esteem and find a significant place in the community as an elder. Spiritual JT is very grounded in her faith as a catholic. This in tune has he very connected to Jesus and God. She believes with all things God is on her side. She prays each day and gives thanks always. She tries to follow the bible very closely and live as righteous as possible. She knows who she is. She also is a catechism teacher every Tuesday for children in the 3rd grade. To teach JT is to Developmentally the goal is for her is ego integrity, no despair. Patient is in good spirits and has come to terms with growing old and all that comes with the aging process. The interventions are the patient being social and finding a meaning to life. Not succumb to depression witch it cline for the patient to succumb to illness quicker and asthma being a bridge to other health problems.

• https://www.ncbi.nlm.nih.gov/books/NBK7223/
• https://www.ameritech.edu/blog/6-ways-approach-problems-holistically/
• https://blog.ioaging.org/caregiving/goal-setting-seniors-motivate-elderly-support-progress/
• https://blog.ioaging.org/caregiving/goal-setting-seniors-motivate-elderly-support-progress/