What are the barriers to interpersonal communication?
As a clinician, interpersonal communication barriers when dealing with a 16-year-old white pregnant teenager are many. They include fatigue, anxiety and embarrassment, age difference between clinician and patient, and the patient’s values and beliefs (Bosworth, 2010). For one, pregnant adolescent patients might have a problem concentrating due to fatigue. Thus, gathering information from such a patient might be a difficult task for any clinician. When patients are not entirely concentrated on giving the correct information, accurately diagnosing and treating them will be a huge ask. Adolescent patients tend to be anxious or embarrassed about their condition, especially if it is an unplanned pregnancy. No one would feel comfortable getting undressed in front of a stranger, much less a teenage mom-to-be. Thus, anticipating embarrassment and finding a way to minimize it can help ease an uncomfortable situation.
Also, everyone has their assumptions based on their culture or beliefs. A 16-year-old white pregnant teenager can genuinely believe that only a female nurse can attend to her and that men would not do a thorough job. The clinician should consider such assumptions before attending to the patient. This goes hand in hand with those adolescent patients who believe that junior staff can properly treat them. The age difference between the clinician and the patient can sometimes be an issue, especially if the patient feels she will not communicate comfortably with an older attendant. Lastly, a 16-year-old white pregnant teenager is most likely to be anxious or embarrassed about her condition. Teenagers may be hesitant to openly discuss their condition in the present of a parent, and my also feel guilty and worried about what their peers might think of them. Thus, the privacy and confidentiality of this interaction will be of utmost importance.
What are the procedures and examination techniques that will be used during the physical exam of your patient?
The 16-year-old white pregnant teenager will be taken through a geriatric assessment. However, since teenagers may hesitate to talk freely in the presence of their parent, the clinician should ask for permission on the patient’s behalf for the parents to be absent while the interview is being conducted. Also, the clinician should avoid any painful or intrusive procedures and do as much as possible with the patient still dressed and seated. The patient should also be asked if they prefer certain things done and whether there are specific movements they feel uncomfortable doing. For this patient, the first step will be to arrange for privacy, quiet, and any special needs since the physical examination will be affected by the environment’s quality. It will also be essential to make sure the patient is calm, relaxed, and adequately draped or gowned. The next step will be to conduct a general inspection and check for vital signs, and an eye and ear examination will follow this. An ophthalmo-otoscopy will then be undertaken before connecting the otoscope to the nasal speculum and examining the nares. A mouth examination will then follow before evaluating the face to examine symmetry and other details concerning motor divisions of the V and VI cranial nerves. For a young mother, a complete examination may be easier if it is divided into multiple sessions rather than taking the patient through hours of exhaustive tasks. The procedure will yield a more relevant and complete list of psychosocial issues, functional problems, or medical problems. Results will be thoughtfully integrated with the patient’s pathophysiology and history (Ball et al., 2015).
Describe the Subjective, Objective, Assessment, Planning (S.O.A.P.) approach for documenting patient data and explain what they are.
The Subjective, Objective, Assessment, and Plan (SOAP) is an acronym used in nursing to document patient’s data in a structured way. It provides clinicians with a framework for evaluating patients’ information. Also, it offers a cognitive outline that aids in clinical reasoning. Using the framework, nurses are able to assess, diagnose, and treat patients in an informed and reasoned manner. This paper aims to discuss S.O.A.P. approach in documenting patients’ data.
The subjective (S) stands for the patent’s experiences, personal views, and feelings. The component included here is chief complaint (CC), history of present illness (H.P.I.), and review of systems (R.O.S.). The patient chief complaint is a short statement of the patient purpose to visit the hospital. History of present illness describes the patient current situation or condition since the time that the symptoms for the disease started showing. It describes the condition in a narrative form. The review of systems compiles the pertinent and negative symptoms (Jenkins &David, 2019).
The Objective assessment (O) entails the documentation of information that the clinician observes from the current patients’ condition. This documentation covers vital signs, physical evaluation findings, imaging results, laboratory information, and other diagnostics data. Simultaneously, the assessment section entails the synthesis of evidence documented in the ‘subjective’ and ‘objective’ sections. This section records the assessment of the patient’s situation, how the problem behaves, and any changes in the condition. It is at this stage that the decision-making process is discussed in more in-depth details (Jenkins & David, 2019). Lastly, the plan (P) section documents what is supposed to address the patient’s concerns. This includes things like doing ordering referrals, additional testing, and consultations with other health care providers. Also, it documents the goals therapy, drugs, and procedures performed on the patient (Jenkins & David, 2019).
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination . St. Louis, MO.
Bosworth, H. (Ed.). (2010). Improving patient treatment adherence: A clinician’s guide. Springer Science & Business Media.
Jenkins, M. L., & Davis, A. (2019). Transforming Nursing Documentation. Studies in health technology and informatics, 264, 625-628.
Why Work with Us
Top Quality and Well-Researched Papers
We always make sure that writers follow all your instructions precisely. You can choose your academic level: high school, college/university or professional, and we will assign a writer who has a respective degree.
Professional and Experienced Academic Writers
We have a team of professional writers with experience in academic and business writing. Many are native speakers and able to perform any task for which you need help.
Free Unlimited Revisions
If you think we missed something, send your order for a free revision. You have 10 days to submit the order for review after you have received the final document. You can do this yourself after logging into your personal account or by contacting our support.
Prompt Delivery and 100% Money-Back-Guarantee
All papers are always delivered on time. In case we need more time to master your paper, we may contact you regarding the deadline extension. In case you cannot provide us with more time, a 100% refund is guaranteed.
Original & Confidential
We use several writing tools checks to ensure that all documents you receive are free from plagiarism. Our editors carefully review all quotations in the text. We also promise maximum confidentiality in all of our services.
24/7 Customer Support
Our support agents are available 24 hours a day 7 days a week and committed to providing you with the best customer experience. Get in touch whenever you need any assistance.
Try it now!
How it works?
Follow these simple steps to get your paper done
Place your order
Fill in the order form and provide all details of your assignment.
Proceed with the payment
Choose the payment system that suits you most.
Receive the final file
Once your paper is ready, we will email it to you.
No need to work on your paper at night. Sleep tight, we will cover your back. We offer all kinds of writing services.
No matter what kind of academic paper you need and how urgent you need it, you are welcome to choose your academic level and the type of your paper at an affordable price. We take care of all your paper needs and give a 24/7 customer care support system.
Admission Essays & Business Writing Help
An admission essay is an essay or other written statement by a candidate, often a potential student enrolling in a college, university, or graduate school. You can be rest assurred that through our service we will write the best admission essay for you.
Our academic writers and editors make the necessary changes to your paper so that it is polished. We also format your document by correctly quoting the sources and creating reference lists in the formats APA, Harvard, MLA, Chicago / Turabian.
If you think your paper could be improved, you can request a review. In this case, your paper will be checked by the writer or assigned to an editor. You can use this option as many times as you see fit. This is free because we want you to be completely satisfied with the service offered.