Health Assessment Introduction

Health assessment is the process through which the clinician builds an understanding of the patient’s current state of health, identifies illness, disease and risks for disease, as well as what these conditions and/or risks mean to the patient within the context of the patient’s life. The process of health assessment includes an interview and physical examination of the patient. In some cases, laboratory and/or radiographic studies are needed in addition to the examination and interview.

Health assessment is a particularly important aspect of care for nurse practitioners (NPs) because it is the mechanism through which the NP comes to know the patient and through which a relationship with the patient is built.

Barbara Carper described the four patterns of “knowing” in nursing as: (1) empirical, (2) esthetic, (3) personal, and (4) ethical. The health assessment process encompasses all four of these patterns of knowing. The NP applies empirical knowledge of what physical exam techniques, interview questions, or laboratory or radiographical studies are needed based on the patient’s presentation and risk factors. The NP accesses esthetic knowing when they perceive something about the patient or the situation that has not been and cannot be discursively expressed. In this case, the health assessment process is the growth medium from which this ineffable knowledge can emerge. Personal knowing is the relationship between the patient and the NP, in which both parties are authentically present, accepted and transformed by the experience. Through the understanding and relationships of the first three patterns of knowing, the NP is able to access ethical knowing which informs what ethical questions and principles are relevant to the specific context (Carper, 1978).

In this section, you will read a variety of patient presentations and be guided through questions about the relevant health assessment components. Sometimes, the case studies will present more information than is strictly necessary to “make the diagnosis.” However, this will also be the case in clinical practice. Patients will come to you with complex arrays of symptoms and complicated histories. They will come with the emotional baggage of their previous interactions within the healthcare system. They will be battle-weary from whatever type of familial or socioeconomic stressors they are currently confronted with. As the NP, you will need to perceive all of this, be able to synthesize and organize the information and develop a plan that is aligned with your obligation to care for the patient. It is important to remember that as an NP, you are tasked with more than diagnosing problems; your job is to care for the patient.

Cases Included in This Section

• Back Pain
• Unilateral Face Numbness
• Blurred Vision
• Erectile Dysfunction
• Evaluating Cough
• Trouble Sleeping
• Stomach Pain
• Iron Deficiency
• Polycystic Ovarian Syndrome
• Syphilis
• Lyme Disease
• Tanner Stages

Health assessment is a complex skill which requires contextual awareness, inquisitiveness, flexibility, logical reasoning, reflection, and perseverance. Honing such a complex skill takes time and practice. These case studies provide a playground for you to test and strengthen your skills.

References