27 Dec 3. How comfortable were

Module 03 Written Assignment – Health History

Conduct a health history on a family member or friend. Be sure they give you permission. Using the interviewing techniques learned in Module 2, gather the following information. Use your textbook as your guide.

Individual Health Assessment Form

A response is required for EACH item in EACH category.

Copy this document & record your responses in a text document (e.g.: Word or WordPerfect). That way you can just add the information without retyping the entire document. Please reformat and delete things as appropriate.

Health History

Biographical data: (2 points)

Initals:____________

Age: ______________ Marital status: ____M _____ S _____Sep. ____Cohab.

Birth date: _____________________ Number of dependents: ___________________

Educational level: ________________________ Gender: _____F _____ M _____Other

Occupation: ___________________________________¬¬¬¬_________________________

Ethnicity/nationality: _____________________ Health insurance ____Yes _____No

Source of history/reliability:________________________________________________

Present health history: (2 points)

Current medical conditions/chronic illnesses:

Current medications:

Medication/food/environmental allergies:

Past health history: (8 points)

Childhood illnesses: Ask about mumps, chickenpox, rubella, ear infections, throat infections, pertussis, and asthma.

Hospitalizations/Surgeries: Include reason for hospitalization, year, and surgical procedures.

Accidents/injuries: Include head injuries with loss of consciousness, fractures, motor vehicle accidents, burns, and severe lacerations.

Major diseases or illnesses: Include heart problems, cancer, seizures, and any significant adult illnesses.

Immunizations (dates of known):

Tetanus _______ Diphtheria ________ Pertussis ________ Mumps ________

Rubella _______ Polio _____________ Hepatitis B ______ Influenza _______

Varicella ______ Other ____________________________________________

Recent travel/military services: Include travel within past year and recent and past military service.

Date of last examinations:

Physical examination _________ Vision ___________ Dental ___________

Family History (1 point)

Mother/Father/Siblings/Grandparents: include age (date of birth, if known), any major health issues, and, if indicated, cause and age of death (date of death, if known).

Now answer the questions below: (25 points)

1. Was the person willing to share the information? If they were not, what did you do to encourage them?

2. Was there any part of the interview that was more challenging? If so, what part and how did you deal with it?

3. How comfortable were you taking a health history?

4. What interviewing techniques did you use? Were there any that were difficult and if so, how did you overcome the difficulty?

5. Now that you have taken a health history discuss how this information can assist the nurse in determining the health status of a client.