4.2.3: FRAME 3- Prioritize Hypothesis

After completing the community and home assessment, the home health nurse notices Stanley is moderately dyspneic with audible wheezing and appears anxious. He is positioned in a tripod position while sitting at the kitchen table. The nurse asks Stanley how he is doing, and he says... “really well, just got back from my truck.”

The nurse sits down at the table with Stanley and records the following data.

Prioritize Hypotheses

QUESTION: Matrix Multiple Choice

Scoring Rule: 0/1

What interventions are relevant in Stanley’s initial pulmonary assessment?

Each row should include a single choice.

Intervention	Relevant	Not Relevant
Assess Stanley for additional signs of hypoxia
Ask Stanley to apply oxygen via nasal cannula
Inquire when Stanley last used his inhaler and nebulizer
Call the provider to report symptoms
Encourage Stanley to walk across the room to assess if he has increased shortness of breath upon exertion
Assess for signs of confusion and restlessness
Review medication lists
Observe self-administration of inhaler and nebulizer treatments
Assess psychosocial support
Inquire about immunizations

Putting It All Together

DEBRIEF

An initial pulmonary assessment should begin with a detailed history of chronic respiratory conditions, acute respiratory illnesses, hospitalizations, cardiovascular health, and immunization history. The nurse should assess for respiratory cues such as rate, rhythm, audible wheezing, dyspnea, pulse, pulse ox, and blood pressure. The nurse should observe for abnormalities in the shape of the client’s chest, posture, and signs of hypoxia, confusion, or restlessness. The nurse should perform a physical examination with auscultation and percussion of lung and heart sounds.

A holistic assessment includes an evaluation of the client’s medications list, self-management of symptoms, ADLs, medication and treatment administration, and the client’s psychosocial support system.

Home health nurses have autonomy in practice and would not be required to report symptoms unless they were concerned about a change and requests consultation. The nurse would not ask Stanley to walk across the room to assess if he has increased shortness of breath upon exertion.

Being familiar with resources in your community that can bridge the healthcare gap and inequities will decrease disparities for uninsured individuals. Community options to consider are community or free clinics, sliding fee clinics, shelter-based care, and veteran services.

Encourage clients to look into federal and state programs (Medicaid and Medicare). There are also specialty federal programs such as the National Breast and Cervical Cancer Early Detection Program, which provides screening and diagnostic services for women in every state, and children’s health insurance programs. 211 is a local resource hub to get information and referrals on mental health resources and financial assistance programs to help pay for prescriptions and medical emergencies.

RECOGNIZING SOCIAL DETERMINANTS OF HEALTH (SDOH)

A primary goal of home health care is to discharge the client to self or family care and avoid subsequent hospitalizations. This goal aligns with the SDOH domain, Health Care Access and Quality, by decreasing unplanned and recurrent admissions to the hospital. Unplanned admission to the hospital is an undesirable outcome of home health care that causes problems for clients, caregivers, providers, and payers. Unplanned hospital admissions are associated with complications, morbidity, patient and family stress, and increased costs (Ellenbecker et al., 2008).

The Centers for Disease Control and Prevention (CDC) (2022) reports that 12.2 percent of adults ages 18-64 were uninsured. In 2022, among adults aged 18–64, the percentage who were uninsured was highest among those with family incomes less than 100% Federal Poverty Level (FPL) (22.7%).

What Do You Think About?

1. Describe how living in poverty contributes to health disparities.
2. Compare and contrast how living in poverty, residing in a rural community, and age influences health outcomes.
3. Identify health care sources in your local community who serve individuals that are uninsured.