Pasa - Jannel Reggie - Health Assessment Form PDF

Republic of the Philippines
Cebu Normal University

Osmeña Blvd., Cebu City, 6000, Philippines
College of Nursing
Telephone No.: (+63 32) 254 4837
Email: cn@cnu.edu.ph
Website: www.cnu.edu.ph
Health Assessment Form

Theory-based (Betty Neuman)
Name of Student: Jannel Reggie M. Pasa
Area of Assignment: Ortho-Ward
Name of Clinical Instructor:Mr. Alberich F. Machachon Inclusive Dates: March 22- 24, 2023
I. CLIENT’S PROFILE & CENTRAL CORE

Client’s Initials: Mrs. MS Age : 65 years old Gender: Female Religion:Roman Catholic
Civil Status: Married Allergies: No known allergies
Diet: Diet as tolerated Height: 5’3 Weight: 110 lbs BMI: 19.5
Date & time of Admission: May 2, 2023 at 5:00 AM Mode of Admission: Planned
Impression/Diagnosis: Osteoporosis
Reason for seeking health care (Chief Complaint/s): Upper back pain
Vital Signs: T: 36.4 PR: 80 bpm RR:16 cpm BP:130/80mmHg Pain score:6/10
General Physical Description:

Patient has a small frame, thin, hump like appearance in the upper back (kyphosis), Signs of distress
were noted such as facial grimacing due to pain. She is appropriately dressed. She has limited motor
activity due to her upper back pain.
General Behavior exhibited:

Patient is awake, conscious and coherent. She is oriented to person, place, and time. Manifestations of
pain-depressed behaviors such as locomotor activities were noted. Guarding behavior accompanied
by grimacing, vocalizations of pain, and change in vital signs were also observed.
Impression/Admitting Diagnosis: Osteoporosis

Physician in-charge: Dr. Alex Morales
Nurse-on-Duty: Not specified
II. STRESSORS & REACTIONS TO STRESSORS

A. Client’s Complaints Upon Admission (History of Present Illness):
Upon history taking, the patient reported having upper back pain began approximately 3 weeks
ago when she was getting out of bed in the morning and hasn't changed at all. She confides that
her mother and grandmother were diagnosed with osteoporosis when they were in their early 50s.
B. Stressors as perceived by the client and SO’s:

Emotional- Health: The patient is anxious due to the fact that the maternal side of her family is
known to have osteoporosis.She is also a known smoker and alcoholic drinker with poor
College of Nursing
Telephone No.: (+63 32) 254 4837
nutritional status.
C. Identification and Reactions to Stressors by person variables/subsystems:

1. Intrapersonal
a. Physiological (Head to Toe)
i. Personal health history
Illnesses: None
Surgery: None
History of chronic disease: None
Immunization History: (specify the number of doses received)
1 doses BCG 4 doses DPT 4 doses OPV x AMV
2 doses MMR 2 doses HepB 2 doses TT x HiB
2 doses MMV x Rubella Vaccine / ____ Others(specify)
2 doses Covid-19 Vaccine
Smoking:
1 packs/day x packs/year
Alcoholic Beverages:
N/A Type N/A Amount
N/A Frequency of Use N/A Date of Last Drink
Patient is an alcoholic drinker.
Illicit drugs:
x Type x Amount
x Frequency of Use x Date of Last Use
Patient has no history of drug usage and abuse.
Medication Reconciliation (prescription/OTC)

Medicine Dose Frequency Last Dose Taken Indication
Alendronate 70mg Qweek May 2, 2023 @ For the treatment of osteoporosis

(Fosamax) 6am in postmenopausal women to
increase bone mass, prevent
fractures, including those of the
hip and spine (vertebral
compression fractures).
Calcium plus 1 tab OD May 2, 2023 @ Indicated to help maintain

vitamin D 6am optimum bone function and reduce
College of Nursing
Telephone No.: (+63 32) 254 4837
the risk of osteoporosis later in life.
Ibuprofen 400 mg Q6h,PRN May 2, 2023 @ Indicated for the treatment of mild
for pain 6am pain to moderate pain, including
minor aches and pains associated
with arthralgia, dental pain,
headache, musculoskeletal pain
(including backache), and/or the
common cold.
Fenofibrate 40 mg OD May 2, 2023 @ Indicated as adjunctive therapy to

6am diet to reduce elevated LDL-C,
Total-C, Triglycerides, and Apo B,
and to increase HDL-C adults with
primary hypercholesterolemia or
mixed dyslipidemia.
Allergies: none Foods none Drugs

- Has no known allergies
Perception of health: x good / fair x poor
Dietary Preferences: Patient has poor nutritional status, dislike with drinking milk
but loves to drink Coke.
ii. Physical Assessment

Central Nervous System
Level of Consciousness:
x Alert / Lethargic x Drowsy
x Obtunded x Stuporous x Comatose
Mood (subjective):
x pleasant x irritable x calm
x happy x euphoric / anxious
/ fearful ________ others(specify)
Affect (objective):
x surprise x anger / sadness
x joy x disgust / fear
x flat x blunted x full
College of Nursing
Telephone No.: (+63 32) 254 4837
Orientation Level:
/ person / place / time
Memory:
/ recent / Intermediate / Remote
Pupils: Right
8 mm size Reactive to light and accommodation Reaction
Left
8 mm size Reactive to light and accommodation Reaction
Reflexes: 2+ grade (describe)

Reflexes are hypoactive.Decreased knee jerk or ankle jerk reflexes, Tenderness in
the spine process T7, Slow movements, Weakened grip strength, No muscle
wasting.
Grasps: Right Left

x Strong / Weak x Strong / Weak
Others:
x Numbness / Tingling x Restless x Mannerism
Pain: None: _____

Provoking/Precipitating factors: Pain is triggered when moving.
Quality/Location: Experiences sharp and knifelike pain on the upper back.
Radiating or non-radiating: Pain is non-radiating.
Severity/intensity: Pain score is 6/10 at its worst and 3/10 at its least. Pain is
provoked when ambulating.
Timing: The pain started 3 weeks ago, it has continuous sharp and knifelike pain,
and gets worse when ambulating,
Visual Acuity:
x Normal x glasses x contacts
x blind (R/L) x Prosthesis: (artificial eye) R/L
Patient has decreased vision.
Hearing:
x Normal / impaired (R/L) x deaf(R/L)
x hearing aid x tinnitus
x drainage from ears
Patient has decreased hearing
College of Nursing
Telephone No.: (+63 32) 254 4837
Touch:
/ Normal x abnormal (specify)
Smell:
/ normal x abnormal
Communication:
x Broca’s Aphasia x Wernicke’s Aphasia
x Global Aphasia
Cardiovascular System
Pulse Rate and Characteristics:
x regular x irregular
x strong / weak
58 bpm Right Upper Extremity 58 bpm Left Upper Extremity
52 bpmRight Lower Extremity 52 bpm Left Lower Extremity
Heart Sounds: / S1 / S2 _____Others (specify)
Blood Pressure: x standing 130/80 mmHglying x sitting
Jugular Vein Distention: / No x Yes (Describe)
Extremities (Temperature):
Upper Extremities / cool x warm
Lower Extremities / cool x warm
Capillary Refill Time: 1 second/s
Homan's Sign: / Negative x Positive
Claudication: / Negative x Positive
Nails: / Normal x Thickened x Clubbing x Other (specify)
Respiratory System
Chest: / symmetrical x asymmetrical (specify)
Respirations: 16 cpm rate
x depth (shallow/deep, abdominal/diaphragmatic)
x regular / irregular (specify)
College of Nursing
Telephone No.: (+63 32) 254 4837
x periods of apnea x orthopnea

x dyspnea at rest / dyspnea on exertion
______others(specify)
Cough: / absent x present (specify)

x dry x soft
x productive x nonproductive
x whooping
x Sputum:
x odor x color x consistency
Breath Sounds:
/ Normal x Adventitious
(specify location) x absent
x crackles
x rhonchi
x friction rub
x wheezing
Respiratory devices: No respiratory devices used or attached.

x CTT: ___________________________________________________________
x Tracheostomy: __________________________________________________
x ETT:___________________________________________________________
x Oxygen Therapy: _________________________________________________
Gastrointestinal System
Prescribed Diet: Diet as tolerated
Appetite: _____Normal / Abnormal (specify)

Patient has a decreased appetite.
Gag Reflex: / Present x Absent
GIT problems:
x Nausea x Vomiting
x Dysphagia x Constipation x Diarrhea
x Incontinence x hemorrhoids x Others (specify)
Mouth:
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x pink x inflamed
x moist x dry
x lesions/ulcerations pale__Others(specify)
Oral Prosthesis: No oral prosthesis noted

Defecation Pattern:
Soft _ Consistency Brown Color Moderate Amount 1-2x a day Frequency
Abdomen: / symmetrical _____ asymmetrical
x flat x rounded x obese/flabby
x firm x soft x tender
x ascites x distended
Bowel sounds:
x Hypoactive x Hyperactive
/ Normoactive x____Absent
Bowel Diversions: x Ostomies (specify)
Integumentary System
Pink color: (pallor, ashen, pink, jaundice, cyanotic, ruddy)
Cool temperature: (warm, cool, poikilothermic)
Dry moisture: (dry, moist, clammy, diaphoretic)
Poor skin integrity:
Poor turgor: (good, poor, senile)
Absent edema: (pitting/non-pitting, dependent, bipedal, periorbital, anasarca)
None pruritus
Absent bruises/lesions
Absent decubitus ulcer(describe)
Urinary System
Bladder Patterns:
Yellow Color Moderate Amount
Clear Turbidity 1-2 times during the shift Frequency
Urinary problems:
x Dysuria x Nocturia
x Urgency x Hematuria
x Retention x Burning
x Hesitancy x Incontinence
Patient was able to void freely.
Elimination Assistive Devices: x catheterization (specify)
College of Nursing
Telephone No.: (+63 32) 254 4837
Musculoskeletal System
Self-Care Ability: (0=Independent 1=Assistive device 2=Assistance from others
3=Assistance from person and equipment 4=Dependent/Unable)
Self-care 0 1 2 3 4 Self-care 0 1 2 3 4
Feeding / Transferring /
Bathing / Ambulating /
Dressing / Toileting /
Bed Mobility /
Problems: x tremors x atrophy x swelling

Assistive Devices:
x none x crutches x commode
x walker x cane x splint/brace
x wheelchair x others (specify)
Gait: x normal antalgic gait abnormal (specify)
Range of Motion: x normal / limited (specify)

- Restricted spinal range of motion of L7
Posture: x normal / Kyphosis
x Lordosis x Scoliosis
Deformities: x None x Yes (specify)

Amputation: x None x Yes (specify)
Reproductive System
Sexual concerns: Patient has decreased libido
Female:
N/A LMP N/A GTPAL Score / Menopause (specify)
Family Planning:
x No x Yes (type)
Vaginal bleeding:
/ No x Yes (describe)
History of sexually transmitted disease / None x Yes(specify)
Last Pap Smear: Not recalled
College of Nursing
Telephone No.: (+63 32) 254 4837
Male:
Prostate problems: x No x Yes (type)
Penile discharges: x No x Yes (type
Congenital Problems: x hypospadia x epispadia
History of sexually transmitted disease: x None x Yes(specify)
Last prostate exam: x
b. Psychological
Overt signs of stress: (crying, wringing of hands, clenched fists): Facial grimacing
Coping Strategies: Limiting ambulation to avoid the feelings of pain
Impact of Hospitalization/Illness (financial, self-care, role performance):
Deficient self-care: Patient is not able to perform ambulatory tasks. She currently does
not have the capacity to perform such activities due to fear of doing more complications to
her condition.
Recent Major loss: None as per history taking

Living Arrangement: x Alone / Nuclear x Extended
Number of Children: N/A
Employment Status: x employed / unemployed x unemployed
Occupation: House wife
Social activities: x active / limited x none
c. Spiritual
Religion:
x Protestant / Catholic x Jewish
x Muslim x Buddhist x others(specify)
Religious Practices/Restrictions:
She always goes to church every Sunday and prays for guidance every day. No
restrictions were mentioned.
Concerns related to spiritual or religious customs?
She has no concern about spiritual or religious customs.
d. Developmental
Psychosocial tasks (Erik Erickson’s):
Ego Integrity vs. Despair Ego integrity versus despair is the eighth and final stage of Erik
Erikson’s stage theory of psychosocial development. This stage begins at approximately
age 65 and ends at death. It is during this time that we contemplate our accomplishments
and can develop integrity if we see ourselves as leading a successful life.
College of Nursing
Telephone No.: (+63 32) 254 4837
Psychosexual tasks (Sigmund Freud):

Genital stage: In light of her obstetric history, it is safe to presume that the patient has
taken a liking to individuals of the opposite sex. Delving more into the theory, the patient,
in this case, has successfully passed through the previous stages as she now channels
her sexual instinct through heterosexual pleasure rather than self-pleasure
Cognitive level (Jean Piaget):

Formal Operational Stage: She has ability to think in abstract manner, has capacity for
higher-order reasoning. Can deal with hypothetical problems with possible solutions.
Moral Development (Lawrence Kohlberg’s):

Stage 6: Universal Principles: She has already developed her own set of moral
guidelines that influences her perspective around her surroundings and how she lives her
life.
2. Interpersonal (between persons) and Extrapersonal (within the community)

a. Socio-cultural
Community participation:
She is not used to participating in community activities because of her old age and inability
to ambulate independently.
Health cultural beliefs:

Patient believes that it is an individual responsibility for their own health but ultimately
believe that recovery from illness is still uncertain when the individuals itself cannot
change habits and lifestyle.
Political Affiliations:
Denies any political affiliations.
Stressors as perceived by the nurse:

Given her current health status, the patient is anxious knowingly that her maternal side
has a history of osteoporosis.
College of Nursing
Telephone No.: (+63 32) 254 4837
III. DIAGNOSTICS & LABORATORY EXAMINATIONS

Laboratory Exam/Diagnostics Result/s Significance
Complete Blood Count Hemoglobin 11.5 L ● To review overall health

Hematocrit 35 L ● The low RBC count,
Red Blood Cell 4.4 L hematocrit level, and
hemoglobin level can signify
anemia or malnutrition.
Urinalysis Normative values with few ● part of a routine medical

traces of bacteria exam to screen for early
signs of disease.
● If you have signs of diabetes
or kidney disease, or to
monitor you if you are being
treated for these conditions.
● To check for blood in the
urine.
● To diagnose a urinary tract
infection
Blood Chemistry Calcium6.5 mg/dL L ● To know important

Alkaline Phosphatase 150 information about how well a
IU/L H person's kidneys, liver, and
Vit D 15 nmol/L L other organs are working.
● An abnormal amount of a
substance in the blood can
be a sign of disease or side
effect of treatment.
Lipid profile Cholesterol. 240 mg/dl H ● Helps evaluate

LDL 120 mg/dl H cardiovascular health by
Triglycerides 160 mg/dl H analyzing cholesterol in the
blood.
● Too much cholesterol can
build up in the blood vessels
College of Nursing
Telephone No.: (+63 32) 254 4837
and arteries, damaging them

and heightening the risk of
problems like heart disease,
stroke, and heart attack.
Chest x-ray PA view There are no focal areas of ● To aid in diagnosing a range
consolidation. No of acute and chronic
suspicious pulmonary conditions involving all
opacities. The hila and organs of the thoracic cavity
pulmonary vascular
markings are within normal
limits. The heart is not
enlarged. The trachea is
midline.
ECG 12 leads Normal Sinus Rhythm ● Provides more information

on the diagnosis of your
cardiac arrhythmia
X ray thoracic Osteoporotic thoracic ● Used to evaluate the lungs,

kyphosis (80 degrees) heart and chest wall and may
be used to help diagnose
shortness of breath,
persistent cough, fever, chest
pain or injury.
Bone density Bone density T-score of ● An important indicator of how

–2.7. likely bones are to break.
● Identifying osteopenia and
osteoporosis and assessing
the effectiveness of
treatments that aim to
prevent bone loss.
College of Nursing
Telephone No.: (+63 32) 254 4837
IV. NURSING DIAGNOSES (in priority)

Classification Nursing Problems (at least 5)
Physiological Acute pain r/t osteoporotic thoracic kyphosis as evidenced by reports

of sharp and knife-like pain in the upper back lasting more than 3
weeks with a pain score of 6/10, loss of height, and spine
malformations such as hunched posture secondary to osteoporosis.
Impaired Physical Mobility r/t to upper back pain as evidenced by

reluctance to attempt movement.
Imbalanced Nutrition: Less Than Body Requirements r/t inadequate

calcium and vitamin D.
Psychological Anxiety r/t to a recent medical diagnosis and fear of the unknown as
evidenced by reports of restlessness, fear, and worry.
Deficient knowledge r/t lack of exposure to information regarding

medications, dietary modifications, or safe activity programs as
evidenced by presence of preventable complications.
Socio-cultural Impaired social interaction r/t severe anxiety
Spiritual Spiritual distress r/t pain.
Developmental Readiness for enhanced knowledge.

College of Nursing
Telephone No.: (+63 32) 254 4837
V. Discharge Planning
Client’s Initials: M.S.
Diagnosis: Osteoporosis
Probable Date: May 4, 2023
Destination: Going home
Transportation: Own transportation
Medications Encourage the patient to take her medications exactly as

prescribed, and explain the following details: prescribed
dosage and to never change the dose without the doctor's
inputs, frequency of taking the medication as well as when to
stop taking the medication, indications, and any potential
adverse effects to look out for. The patient should continue
taking the prescribed drugs as directed:
● Alendronate (Fosamax) 70mg/week p.o.
● Calcium plus vitamin D OD p.o.
● Ibuprofen 400 mg every 6 hrs p.o. prn for pain
● Finofibrate 40 mg OD p.o
Environment & Exercise Encourage the patient to do low-impact weight- bearing

exercises such as walking to strengthen bones as well as to
participate in a range of motion exercises to avoid muscle
atrophy caused by immobility. Physiotherapist-guided exercise
is recommended for pain reduction and improvement of daily
function. Advised to have a well-ventilated room as to avoid
exposure to air pollution which increases the risk of
osteoporosis
Treatments Explain to the patient the goal of the next and ongoing physical
therapies at home.
Encourage the patient to continue undergoing a diagnostic test
to make sure she's not experiencing any problems along the
first few weeks after discharge.
Advice to implement measures to prevent falls (eg installing
grab bars/handrails, non slip flooring, adequate lighting,
removing loose wires, keeping things within reach)
Remind the patient to follow the advice of their doctor.
College of Nursing
Telephone No.: (+63 32) 254 4837
Health Education Educate patients on how to reduce the risk of fragility fractures
and encourage adherence to drug treatment. Avoid cigarette
smoking and excessive alcohol consumption as both are
associated with increased risk of osteoporotic fractures. .
Educate the patient on fall prevention, especially that the
patient is an elderly and has a risk of falls, and on ways to
reduce risk of falls.
Observable symptoms Instruct the patient to have a regular follow-up checkup since
there might be changes especially in the medications she has
to take. This is also to check her status by observing symptoms
of her progressing osteoporosis that might occur in a few
weeks after discharge. Remind patients to seek medical
attention if the following symptoms occur: sudden limitation in
movement and increased pain with movement.
Dietary Prescription Instruct the patient to eat a healthy diet rich in essential
nutrients such as calcium, vitamin D, and protein can help
reduce the risk of osteoporosis. In addition, limiting caffeine
and alcohol intake may be beneficial for bone health, especially
among older adults.
Spirituality Encourage the patient to uphold her religious habits unless

they pose a risk to her health.
Jannel Reggie M. Pasa March 22, 2020

Name/Signature of Student Date
College of Nursing
Telephone No.: (+63 32) 254 4837
Health Assessment Form Rubric

Criteria Competent Advance Beginner Novice
Completeness All sections of the health There are 3-5 missing details There are more than 5
(10%) assessment forms were or information missing details or information (3)
properly filled out. (7)
(10)
Comprehensiv Provides descriptions of the Missed to elaborate 3-5 Missed to elaborate 6 or more
eness of assessment findings (not just assessment findings assessment findings
Content (10%) limited to documenting (7) (3)
normal, abnormal, present,
absent etc.) as applicable
(10)
Accuracy (25%) Documents the correct Committed 3-5 errors in Committed 6 or more errors in
assessment findings or documenting the assessment documenting the assessment findings
health data of the findings of the client/case. of the client/case. (10)
client/case. (18)
(25)
Clarity of All data presented is clear Documented data includes 3- Documented data includes 6 or
information and easily understood. 5 ambiguous and/or non more ambiguous and/or
(25%) (25) specific information. non-specific information
(18) (10)
Relevance (25%) All data in the nursing Documented nursing Documented nursing
diagnoses and discharge diagnoses and discharge diagnoses and discharge
planning are appropriate and planning include 3-5 health planning include 6 or more health
related to the patient’s case data that are inappropriate data that are
or case scenario as and unrelated to the patient’s inappropriate and unrelated to the
supported by case or case scenario. The patient’s case or case scenario. The
the documented information is not supported information is not supported by
assessment findings by assessment findings. assessment findings
(25) (18) (10)
Timeliness (5%) Submits the completed Submits the completed health Submits the completed health
health assessment form on assessment form within the assessment form after the agreed
the agreed date, beyond the date of submission (2)
agreed date and time of specific time of submission (4)
submission
(5)
Total Score ___/100 points
Mr. Alberich F. Machachon

Name and Signature of Faculty

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Republic of the Philippines

Cebu Normal University

Health Assessment Form

Name of Student: Jannel Reggie M. Pasa

Area of Assignment: Ortho-Ward

I. CLIENT’S PROFILE & CENTRAL CORE

General Physical Description:

General Behavior exhibited:

Impression/Admitting Diagnosis: Osteoporosis

II. STRESSORS & REACTIONS TO STRESSORS

B. Stressors as perceived by the client and SO’s:

C. Identification and Reactions to Stressors by person variables/subsystems:

Medication Reconciliation (prescription/OTC)

Alendronate 70mg Qweek May 2, 2023 @ For the treatment of osteoporosis

Calcium plus 1 tab OD May 2, 2023 @ Indicated to help maintain

the risk of osteoporosis later in life.

Fenofibrate 40 mg OD May 2, 2023 @ Indicated as adjunctive therapy to

Allergies: none Foods none Drugs

ii. Physical Assessment

Reflexes: 2+ grade (describe)

Grasps: Right Left

Pain: None: _____

Heart Sounds: / S1 / S2 _____Others (specify)

Blood Pressure: x standing 130/80 mmHglying x sitting

Jugular Vein Distention: / No x Yes (Describe)

Capillary Refill Time: 1 second/s

Homan's Sign: / Negative x Positive

Claudication: / Negative x Positive

Nails: / Normal x Thickened x Clubbing x Other (specify)

x periods of apnea x orthopnea

Cough: / absent x present (specify)

Respiratory devices: No respiratory devices used or attached.

Appetite: _____Normal / Abnormal (specify)

Gag Reflex: / Present x Absent

Oral Prosthesis: No oral prosthesis noted

Bowel Diversions: x Ostomies (specify)

Problems: x tremors x atrophy x swelling

Range of Motion: x normal / limited (specify)

Deformities: x None x Yes (specify)

Recent Major loss: None as per history taking

Psychosexual tasks (Sigmund Freud):

Cognitive level (Jean Piaget):

Moral Development (Lawrence Kohlberg’s):

2. Interpersonal (between persons) and Extrapersonal (within the community)

Health cultural beliefs:

Stressors as perceived by the nurse:

III. DIAGNOSTICS & LABORATORY EXAMINATIONS

Complete Blood Count Hemoglobin 11.5 L ● To review overall health

Urinalysis Normative values with few ● part of a routine medical

Blood Chemistry Calcium6.5 mg/dL L ● To know important

Lipid profile Cholesterol. 240 mg/dl H ● Helps evaluate

and arteries, damaging them

ECG 12 leads Normal Sinus Rhythm ● Provides more information

X ray thoracic Osteoporotic thoracic ● Used to evaluate the lungs,

Bone density Bone density T-score of ● An important indicator of how

IV. NURSING DIAGNOSES (in priority)

Physiological Acute pain r/t osteoporotic thoracic kyphosis as evidenced by reports

Impaired Physical Mobility r/t to upper back pain as evidenced by

Imbalanced Nutrition: Less Than Body Requirements r/t inadequate

Deficient knowledge r/t lack of exposure to information regarding

Socio-cultural Impaired social interaction r/t severe anxiety

Spiritual Spiritual distress r/t pain.