Family Health Evaluation

Introduction
Health Assessment is the plan of care that identifies or recognizes particular needs of an individual and how the needs will be addressed and conducted by the health practitioners or health care systems. Health Assessment is the gathering of information by physical assessment or extensive medical questionnaire. The health evaluation is done diagnose diseases early in characters that seem to be in good health condition. The purpose of the health assessment is to establish a plan of care for the patient and family. The health assessment takes into consideration eleven health patters. The interview was conducted using these eleven health care patterns with three open ended family focused questions per health pattern.
A family health assessment is a critical approximation tool used in the healthcare system for the formulation of the family health plan. The research by the health practitioners as in the paper gives detailed information on the role of nurses in the family assessment and how the task can be done. Based on Gordon's principle of functional health pattern, the paper provides a summary of the findings of the health patterns of the involvement of the family with the inclusion of nursing diagnosis of each assessment offered to them. The use of this technique creates a standard systematic approach to collect information and data analysis considering the nurses determine to consider the aspects of health management, sexuality, sleep/rest, values/beliefs, roles/relationship and patterns of elimination.
To complete the health assessment with the patterns provided, I selected Constance Beverly. Constance Beverly is a 52 year old African-American female, born in Camden NJ. Her mother is alive and on hospice, and her father and grandparents deceased. The family of Beverly is active and devoted Catholics. Mrs. Beverly is married for 25 years with one daughter. Mrs. Beverly has one granddaughter by her daughter. Upon the evaluation, Mrs. Beverly has a history of End Stage Renal Disease requiring dialysis three times a week for four hours each treatment, secondary to high blood pressure (HTN) and diabetes type II. She is taking medications for her HTN and diabetes and has them well controlled. Mr. Beverly suffers from High Blood Pressure that is controlled by oral medication. Because Mrs. Beverly does not produce urine she is at risk for imbalanced fluid volume. She can have fluid volume excess, or fluid volume deficit after dialysis (Weber, 2005). Mrs. Beverly’s mother is on hospice for comfort measures due to old age. She resides in a Nursing home. Mrs. Beverly and her family are not able to care for her mother at home. Weber,(2005) would say Mrs. Beverly’s mother is at risk for loneliness.
The Health Perception and Health Management with the data collected by Mrs. Beverly, it is noted that; she has a history of smoking cigarettes for 25 years. This causes a great deal of stress for the family. Besides the financial burden, Mrs. Beverly has been removed from the kidney transplant list due to smoking. She must be smoke free for six months and remain smoke free to stay active on the transplant list. Mrs. Beverly’s brother has offered to donate a kidney to her. He will need to undergo a full extensive medical work up, to see if he is a match. This is scheduled for sometime in May. The family is stressed out and believes Mrs. Beverly’s brother will not be medically cleared to donate the kidney.
Mrs. Beverly is unable to drive to her dialysis treatments due to fluctuations in her blood pressure that cause dizziness, she must relay on family and public transportation. This is a huge burden to her family who want to be able to provide the transportation but do to employment they are not able to. The nursing diagnosis caregiver role and parental role conflict can be used to describe Mrs. Beverly’s daughter who takes her to all her doctor appointments (Weber, 2005). Mrs. Beverly’s daughter wants to keep her in the home and does as much as she can to provide care.
Mrs. Beverly is on a renal diet with high protein and low phosphorus. She also has to limit her salt intake. She takes phosphate binders with every meal. This is difficult for her family who prepares her meals and does the food shopping. The Beverly’s do not have trouble sleeping despite their medical issues. Each one reports getting six to eight hours a night. They also report no issues with bowel movements. Mrs. Beverly reports being depressed occasionally and is self conscious about her fistula. She really wants to receive a transplant, but is unable to quit smoking. She has tried many times and been unsuccessful. The Beverly’s report there medical history does not prevent them from being sexually active.
The Beverly’s are not very active. Mr. and Mrs. Beverly are not working and only make Church functions on Sunday. Mrs. Beverly walks with a cane and the couple does not engage in exercise. This family could benefit from a mild exercise regimen, which is something the nurse could recommend. The Beverly’s are of high average intelligence and do not suffer from any mental or cognitive disabilities. The family reports no hearing or vision problems, just reading glasses.
After the assessment a family health plan can be formulated with good realistic goals and objectives. The Nurse will start with data collection and analysis. The nursing problem can then be diagnosed with goals and objectives. Then a family care plan can be formulated defining the healthcare tasks and responsibilities. The interventions on how and who will be determined. Lastly there will be an evaluation. This will determine if the goals have been met, if not how can we achieve them.
For this family we will use risk for imbalanced fluid volume. Since Mrs. Beverly’s biggest health issue is her dialysis, this is something the whole family can participate in. Due to Mrs. Beverly not making any urine through her kidneys, she needs to be on a fluid restriction. If her fluid restriction is one and a half liters a day, some one needs to be responsible for measuring her fluids. Mrs. Beverly’s family needs a clear picture of what one and a half liters looks like. The nurse needs to also educate the family, and whoever prepares meals the difference between solids and liquids. Jello is a liquid. Episodes of diarrhea or sweating will result in fluid loss and need to be factored into daily intake. Frequent monitoring of blood pressure and checking limbs for swelling can help assess fluid balance.
The goal for this family is to prevent high fluctuations of fluid from over consumption of liquids resulting in more aggressive dialysis. Drastic changes in fluid volume cause the heart to work harder and become enlarged (Edelman & Mandle, 2010). The number one cause of death in dialysis patients is cardiovascular related. A goal populated out of this assessment would be maintain a stable dry weight with no more then a 3 pound fluctuation. A daily record of weights and blood pressures is a way to monitor effectiveness.
During the evaluation the Nurse will determine if the goal was met. If the goal was not met the family will participate in a interdisciplinary team meeting to come up with new strategies to obtain these goals. If the goal was met the current regimen will be continued.

References
Edelman, C., & Mandle, C. L. (2010). Health Promotion Throughout the life span (7th Ed.).St Louis: Mosby.
Weber, J.R. (2005). Nurse's Handbook of Health Assessment, (5th Ed.). Philadelphia: Lippincott Williams & Wilkins