Preventative Treatments and Examinations

Assessing for other preventive treatments and examinations includes gathering data on medications, examination and diagnostic tests, and vaccinations. See Table 2.7 for sample questions and statements, along with specific considerations. You might begin this section by asking the client, “What are the ways that are most important for you to optimize your health?” (you may have already discussed this as part of the functional health section).

It is important to ask the client about their current, past, and known future medication regime, examinations, and immunizations to form a profile of the treatment that the client has received and plans to receive. This information will tell you a lot about the client’s current health status based on the care they have and will receive.

Note: The client may refer to items that have already been discussed as part of the functional assessment or other items not yet discussed. You may need to probe with statements such as, “Tell me more,” and “How does that affect you?”

Items Questions and Statements Considerations
 

Medications

Name, dose, frequency, reason for taking it, when they first started taking it, and whether they take it as prescribed. This applies to both prescribed and over-the-counter medications, such as vitamins, pain relievers, homeopathic medicines, and cannabis.

Take action

Medication misuse refers to taking medications outside their prescribed purpose. It can include snorting or injecting medications or taking excessive (large) non-prescribed dosages of medications such as opioids, sedatives, stimulants, and hypnotics. Assess further if you suspect medication misuse.

  • Do you have the most current list of your medications?
  • Do you have your medications with you? (If not, you should ask them to list each medication they are prescribed and if they know the dose and frequency.)
  • Can you tell me why you take this medication?
  • How long have you been taking this medication?
  • Do you take the medications as prescribed? (If they answer “no” or “sometimes,” ask them to tell you the reasons for not taking the medications as prescribed.)
 

Some clients and their care partners are active in their care and will be able to answer all these questions. Other clients may not be able to answer all these questions particularly in the context of multimorbidity and polypharmacy.

Sometimes, clients do not take the medications as prescribed because they are experiencing adverse effects, have insufficient income to purchase the medications, and/or have received insufficient health promotion education and discussions when the medication was prescribed.

 

 

Examination and diagnostic dates

Primary care provider (physician or nurse practitioner), specialists, blood pressure, blood tests, chest radiographic, electrocardiogram, dental, vision or hearing. (See Appendix A for a list of links to screening recommendations.)

Take action

Assess further if the client is an older adult who has never received any screening such as blood pressure. It is important to explore with the client the reasons they have not received prior screening.

  • When was the last time you saw [name the primary care provider, nurse or specialist]?
  • Can you share with me why you saw them?
  • When was the last time you had your [name screening] tested?
  • Do you know what the results were?
 

This is an opportune time for health promotion, particularly if you identify that examinations such as dental or vision have not been completed based on screening recommendations.

Genetic screening during pregnancy is optional. In collaboration with their health professionals, some parents choose to screen for any abnormalities and others do not. A finding of an abnormal result can be extremely difficult for some parents to experience, and some will decide not to act on such a result.

 

 

Vaccinations

Type, date received, and any significant reactions (check the provincial or territorial immunization schedule). Immunization schedules for Ontario and immunization requirements for school attendance in Ontario can be found at Immunizations.

Schedules for other provinces and territories are also available on the Internet. 

Take action

Follow up on clients whose immunizations are not up-to-date.

  • Can you tell me about your immunization status?
  • Can you tell me what immunizations you have had, the dates you received them, and any significant reactions?
  • Do you have your immunization record?
  • When was your last flu vaccine?

If the client’s immunizations are not up-to-date or you noted vaccination hesitancy, you may ask:

  • Can you tell me the reasons that your immunizations are not up-to-date?
  • Can you tell me why you are hesitant to receive immunizations? (You may need to explore this further.)

Depending on the client’s age and main health needs/reasons for seeking care, you may ask about specific immunizations such as:

  • Tetanus if they have an injury or wound in which the skin is not intact.
  • Childhood vaccinations and adult boosters.

Vaccines for older adults such as influenza, pneumococcal, and shingles.

 

 

Vaccine hesitancy is a current global issue referring to the delay or refusal of vaccinations. Nurses and other health professionals play a vital role in addressing this issue. You should use a non-judgmental approach and work in partnership with your client to better understand their concerns. Using a relational inquiry approach will allow you to understand what is important to the client and, thus, be able to address existing knowledge gaps.

Some clients who are immune-compromised cannot receive vaccinations. During times of outbreaks, they are at risk for exposure.

 

Table 2.7: Preventative treatments and examinations

Test Yourself

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The Complete Subjective Health Assessment by jlapum; Oona St-Amant; Michelle Hughes; Paul Petrie; Sherry Morrell; and Sita Mistry is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License, except where otherwise noted.

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