UNIT 7
Wellness Diagnosis
Introduction
Wellness Diagnosis
A wellness nursing diagnosis indicates or shows that the client wants to reach a higher level of
wellness in one or more areas of function. Similar to the risk nursing diagnosis, a wellness diagnosis is
composed of the diagnostic label preceded by the phrase, “readiness for enhanced”. By writing the
response section of the wellness diagnosis in a process format, confusion can be avoided between a
wellness diagnosis and a goal. The response section of the wellness diagnosis is important since it
identifies where the client is in the process and assists in goal development. The process approach is
essential since often the response portion of the diagnosis often cannot be differentiated from the
goal to be achieved or it may lead other nurses to believe that the goal has been achieved.
Content goals
In this module the student will:
1. Review and use phrases and idioms people used when making a wellness diagnosis
2. Identify and demonstrate proper note-taking techniques; take notes of a wellness
diagnosis
3. Listen to an interview with a patient and make a wellness diagnosis
4. Identify the difference between one and two-part wellness statements
5. Review the present and past perfect tense
6. Practice making a wellness nursing diagnosis based on an case
7. Identify ways to improve communication between health care workers and clients.
1
Unit 7
WELLNESS DIAGNOSIS
Terminology/Vocabulary Development
H7:1
A. Read the following words / phrases, their definitions and example of usage.
Idiom/ phrase/word
Meaning
Example
dizzy spells
dizziness/ unsteady
The dizzy spell made the patient lose her balance and
fall.
puffy
swollen
The allergy cause Susan’s face to look puffy.
lower extremity
legs, feet
The diabetic patient suffered numbness on her lower
extremities.
false teeth
dentures
Before any surgery is performed patients must remove
any false teeth they may have.
honey
term of endearment
Many grandmothers call their loved ones ‘honey’.
adhesive
bonding agent/glue
When wearing dentures it is important to use good
denture adhesive.
Atekkdkdk
had
ate
Last night we went out and had lobster for dinner.
consult
discuss
Some patients like to consult with more than one
doctor especially when surgery is recommended.
hay fever
allergic reaction to pollen
Millions of people suffer from hay fever in the spring.
Medicare
U.S public health care for senior
citizens
All senior citizens are covered by Medicare.
can’t afford
to not have enough money for
something
The unemployed man could not afford to buy the car.
B. Read the sentences and choose the best word from the box to complete each sentence.
consult
puffy
Medicare
can’t afford
had
adhesive
1. Julie _____________________to purchase the wheelchair for her son.
2. The US Food and Drug Administration has approved a new medical ____________for use in attaching skin
grafts.
3. The little boy’s face got ______________ after being stung by a bee.
4. Without ___________________, many elderly people would stop receiving any medical care.
5. Six hours after surgery, the patient _____________ some jello.
2
Unit 7
WELLNESS DIAGNOSIS
Listening & Writing
H7:2
A. Listen to and complete the following sentences with the words and expressions from your
vocabulary list.
1. John lost all of his teeth in an accident and had to have _____________________.
2. Unfortunately today many at risk women still ____________________to have a
mammogram done on a regular basis.
3. __________________ will help cover most of the cost of home oxygen equipment and
supplies if you have a breathing condition that it will help improve.
4. Mr. Richards ____________________with both his primary care physician and a specialist
about his condition.
5. The mountain climber who had been exposed to extreme cold suffered from frostbite on
both his upper and ___________________________.
6. Suffering from __________________ is one of the most common symptoms of reduced
blood circulation.
B. Listen to part of a conversation taking place between nurse Joy Adams and an 83 year
old woman who has come to the clinic for an annual wellness visit. You will hear the
conversation twice. The first time just listen, the second time fill in the blanks with the
phrases, letters or numbers you hear. Finally, listen again and recheck your answers.
Nurse Adams: Mrs. James, your hypertension seems to be under control. Are you taking both medications
regularly?
Mrs. James: Yes I am but, I wanted to speak to the doctor and tell him that since he put me on the medication
I’ve been getting dizzy spells and just don’t seem to have any energy to do much. I am not sure, but my legs
also seem to be puffy. As a matter of fact, I could barely get my feet in my shoes today!
Nurse Adams: Yes, I see. Are you taking any other type of medication?
Mrs. James: No.
Nurse Adams: So, the dizzy spells, fatigue and swelling in your lower extremity started since you began taking
medication for your hypertension. Is that correct Mrs. James?
Mrs. James: Yes it is. You know that the doctor has me on two different types, don’t you? Do I have to take
both of them? I don’t like taking all these pills. Never took a pill in my life till now.
3
Unit 7
WELLNESS DIAGNOSIS
Listening & Writing
H7:2 (cont.)
Nurse Adams: I understand Mrs. James. I have made notes in your chart for the doctor. I see here on your
chart that at your last visit you complained of constipation and being unable to eat well because of your
dentures. Do you still suffer from constipation? Have you been able to go to your dentist to discuss the
problems you are having with your dentures?
Mrs. James: Honey, I haven’t been able to see the dentist, but my daughter bought me some wonderful
denture adhesive for my false teeth which is much better than the previous one I had been using. So, now I
am eating much better whenever I can. Just last week I had a whole fruit salad and am trying to eat more
vegetables. It seems to be helping because now I am going to the bathroom more regularly than I was before.
Nurse Adams: That’s good news! Remember you need to include at least 5 fruits and vegetables a day in your
diet. Mrs. James, I also see here that at your last visit you were complaining of having difficulty hearing. Were
you able to consult with a hearing specialist?
Mrs. James: Yes, I did. He wants me to go in for some more testing next week, but I just can’t afford them.
The tests are just too expensive for someone my age. The hearing specialist did tell me that some of my
hearing loss may be due to the hay fever that I have suffered with for years! Did you ever hear such a thing?
How could my loss of hearing and hay fever have to do anything with each other? Sometimes, these young
doctors just don’t know what they are saying!
Nurse Adams: Well, Mrs. James I think it would be better if you could go for the hearing test. After all, I see
here that you are covered by medicare. It is very important to find out why you are having difficulty hearing.
Mrs. James: Well, I suppose I should. I’ll talk to my daughter about it.
4
Unit 7
WELLNESS DIAGNOSIS
Note Taking
H7:3
A.Tips for taking notes while making a wellness nursing diagnosis:
Sometimes when writing a wellness diagnosis it can be challenging to identify a particular
condition that contributes to the client’s response, in particular if it has existed for some time.
If conditions cannot be identified, a one-part diagnosis can be used, i.e., the response only. On
the other hand, a two-part diagnosis can be used if a condition can be identified. In most cases,
if a two-part diagnosis is used, the short-term goal relates to the condition and the long-term
goal relates to the response. When deciding which condition to use in writing a wellness
diagnosis, clinical judgments are made. It is important when writing a wellness diagnosis that
the nurse be able to identify certain conditions that the nurse can intervene in. For example, in
the case of a mother whose 3-year old child has died, a diagnosis of ”normal grief response due
to death of a child”, would not be considered to be a helpful wellness diagnosis since the nurse
can do nothing about the fact that the patient’s child has died. However, a diagnosis of
“progressive resolution of grief related to reminiscing about death of child” would be
acceptable because the nurse could encourage the parent to talk about or show pictures of the
child.
B. Listen again to the conversation between Nurse Adams and Mrs. James. Write down a few
possible wellness nursing diagnoses.
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
5
Unit 7
WELLNESS DIAGNOSIS
Listening & Writing
H7:4
Listening:
B. Listen carefully as you read along to a short introduction to a case study for a geriatric
well visit. Pay special attention to the underlined words or phrases. Case provided by Terry
Vaughn,RN.
An 83 year old woman has come to the clinic for an annual wellness visit and to renew her
prescription for blood pressure medicine. She is 5’5” and 121 pounds. She is on Norvasc 5mg
PO qd and Altace 5 mg PO qd for hypertension which is presently well controlled. Her BP is
130/80. Respirations: 17. Temperature 98.4, and pulse of 75. She wears dentures. She
complains that she cannot eat salads because of her dentures. She states that she is having
difficulty hearing. She has consulted with a hearing specialist who verified that she has some
hearing loss and has suggested further testing. The loss of hearing may be due to fluid behind
the eardrum due to chronic allergies. She has allergies to ragweed and pollen. She has refused
to return to the ear specialist for further testing stating that the testing is “too expensive at her
age.” She is covered by private insurance and medicare. She has a history of bronchitis. She has
had cataracts removed from both eyes one year ago. She is able to see with 20/25 in the left
eye and 20/20 in the right. She is still able to drive a car. She reports being active although she
experiences joint pain due to mild rheumatoid arthritis. Her diet is healthy. She watches her
cholesterol carefully. She has been instructed to add more protein to her diet. She states that
she thought red meat was bad for her cholesterol. She has mild bone loss due to osteoporosis.
There is a family history of type 2 diabetes and poor circulation. Her glucose levels are within
normal limits. She reports pain in torso especially in her back. MRI reveals degenerative disk in
her spine. Her heart has a normal sinus rhythm and her lungs sounds are clear bilaterally.
Bowel sounds in all 4 quadrants and she reports mild constipation. She is trying to add more
fiber to her diet. She is continent. She just had a mammogram and pap smear 4 months ago.
Both mammogram and pap smear results were normal. She lost her husband 8 years and her
children do not live nearby. Most of her friends are in nursing homes or have died. She is a
member of a church, but is not presently active in her church.
6
Unit 7
WELLNESS DIAGNOSIS
Listening & Writing
H7:5
C. You will here the following case twice. Fill in the blanks with the correct word, phrase or
number.
An 83 year old woman has come to the clinic for an ___________ wellness visit and to renew
her prescription for blood pressure medicine. She is 5’5” and 121 pounds. She is on Norvasc
___________ and Altace ___________for ___________which is presently well controlled. Her
BP is________. Respirations: 17. Temperature_____, and pulse of____. She wears dentures.
She complains that she cannot eat salads because of her dentures. She states that she is having
difficulty hearing. She has consulted with a ________________who verified that she has some
hearing loss and has suggested further testing. The loss of hearing may be due to fluid behind
the eardrum due to __________allergies. She has ___________to ragweed and___________.
She has refused to return to the ear specialist for further testing stating that the testing is “too
expensive at her age.” She is covered by private insurance and medicare. She has a history
of___________. She has had ___________removed from both eyes one year ago. She is able to
see with _______in the left eye and ________in the right. She is still able to drive a car. She
reports being active although she experiences joint pain due to mild_________________. Her
diet is healthy. She watches her ___________carefully. She has been instructed to add more
___________to her diet. She states that she thought red meat was bad for her cholesterol. She
has mild bone loss due to___________. There is a family history of _________________and
poor circulation. Her ___________levels are within normal limits. She reports pain in
___________especially in her back. ________reveals ______________________in her spine.
Her heart has a normal ____________________and her lungs sounds are
clear_______________. Bowel sounds in all __________________and she reports mild
constipation. She is trying to add more fiber to her diet. She is continent. She just had a
___________________and pap smear 4 months ago. Both mammogram and pap smear results
were normal. She lost her husband 8 years and her children do not live nearby. Most of her
friends are in nursing homes or have died. She is a member of a church, but is not presently
active in her church.
7
Unit 7
WELLNESS DIAGNOSIS
Critical Thinking
H7:6
D. Critical thinking: Using the above case write at lease 5 general strength assessment
questions.
1.____________________________________________________________________________
2.____________________________________________________________________________
3.____________________________________________________________________________
4.____________________________________________________________________________
5.____________________________________________________________________________
D. Find the meanings to the following words in the dictionary and write down their definitions.
1. quadrant:_________________________________________________________________
2. rheumatoid arthritis:________________________________________________________
3. annual:___________________________________________________________________
4. degenerative:______________________________________________________________
5. bilaterally:________________________________________________________________
E. Use the following phrases in sentences of your own.
1. hypertension:_____________________________________________________________________
2. chronic:__________________________________________________________________________
___________________________________________________________________________________
3. osteoporosis:______________________________________________________________________
___________________________________________________________________________________
8
Unit 7
WELLNESS DIAGNOSIS
Grammar Review
H7:7
Grammar Note: Present and Past Perfect Tense
Language in context – Present & Past Perfect
Over the last twenty years, the average size of households has fallen dramatically. The number
of one person households has grown, due largely to the ageing of the population, as has the
number of one parent families. Couples having smaller families have also contributed to the fall
in household size.
In 1976, 60% of families were couples with children. By 1996, this had fallen to 51%. Part of this
change can be attributed to the increase in one parent families with dependent children, but
most of the change is due to the increase in the proportion of couple only families. People are
now having children later in life, and are living longer. Therefore, they are spending more time
living in couple-only families, both before they have families and after their children have left
home.
However, children are leaving home later. In 1981, 34% of children aged 20-24 lived with their
parents. By 1991, this had increased to 40%. This increase has, to some extent, countered the
fall in the couples with non-dependent children only.
(Source: ABS Yearbook Australia 1997, Number 79, p. 81)
There are five present perfect verbs in the 'Language in context' passage above. The first present
perfect tense verb is: has fallen
Directions: Find and write the four remaining present perfect verbs and the two past perfect tenses
on the lines below.
1. Second present perfect tense verb: ___________________________
2. Third present perfect tense: _______________________________
3. Fourth present perfect tense verb: ___________________________
4. Fifth present perfect tense verb: ____________________________
5. First past perfect tense verb:________________________________
6. Second past perfect tense verb: _____________________________
9
Unit 7
A.
WELLNESS DIAGNOSIS
Grammar Review/Case Study
H7:8
Past perfect or simple past tense?
1.Jack ______________________ (live) in Boston for the past 15 years.
2. Janet ________________________(work) for Smith and Brothers before she came to work for us.
3. Dad ____________________________ (you/finish) reading the paper yet?
4. I would love to visit Prague sometime. Unfortunately, _______________________(be/never)
there.
5. Peter ___________________ (play) Tennis for five years when he ___________(be) at school.
A. Study the following case and be prepared to make a wellness nursing diagnosis based
on the data given. Case provided by Terry Vaughn,RN.
A 15 year old boy comes to the clinic to get a sports physical for participation in football. He
hopes to try out for quarterback. He has never experienced a concussion, never had any
broken bones, and no injuries to report since his last visit. He denies any dizziness. He states
that he has not experienced any shortness of breath, or racing heart. He is 145 lbs. and 5’10”
tall. He does not have any known drug allergies. His eyes turn red, itch, and swell when he is
around cats, dust, or pollen. He assumes that he is allergic to these items, but has never
undergone formal medical allergy testing.
He has sensitivity to peanuts and other nut
products. When he accidentally ingests food with peanuts or other nut products, he will
experience projectile vomiting until the substance is completely purged from his system. He
states that he is healthy and feels well. He exercises by working out 4-5 times per week. He
states that he enjoys school and gets good grades. He is looking forward to going to college at
the University of Texas. He reports that he eats a balanced diet although he does enjoy
ordering pizza on weekends with his friends. He has recently been to the eye doctor and has
10
Unit 7
WELLNESS DIAGNOSIS
Case Study
H7:8 (cont.)
20/20 vision in both eyes. His B/P is 110/70. Respirations 15 per minute, pulse 80,
temperature 98.6. He denies using any recreational/illegal drugs or alcohol. He presently does
not have a girlfriend, although he states that he “hangs out with” groups of girls along with his
friends. His immunizations are up to date. He has not had any surgeries other than wisdom
teeth removal. He wears braces which should be coming off in about 6 months. His heart
sounds are normal and lungs are clear. He does not report any GI problems with diarrhea or
constipation. Reflexes, gait, and balance are normal.
B. Based on what you have read what wellness nursing diagnosis would you make?
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
11
Unit 7
WELLNESS DIAGNOSIS
Summary
H7:9
Reading Comprehension and Note Taking
A. Fill in the blanks with the words you hear.
Sometimes when writing a ______________ diagnosis it can be challenging to identify a
particular condition that contributes to the client’s _______________, in particular if it has
existed for some time. If conditions cannot be identified, a _________________diagnosis can
be used, i.e., the response only. On the other hand, a __________________ diagnosis can be
used if a condition can be identified. In most cases, if a two-part diagnosis is used, the shortterm goal relates to the ______________and the long-term goal relates to the
_________________. When deciding which condition to use in writing a wellness diagnosis,
______________ judgments are made. It is important when writing a wellness diagnosis that
the nurse be able to identify certain conditions that the nurse can __________________ in. For
example, in the case of a mother whose 3-year old child has died, a ________________ of
”normal grief response due to death of a child”, would not be considered to be a helpful
wellness diagnosis since the nurse can do nothing about the fact that the ________________
child has died. However, a diagnosis of “_________________ resolution of grief related to
reminiscing about death of child” would be ___________________ because the nurse could
encourage the parent to talk about or show pictures of the child.
12
Unit 7
WELLNESS DIAGNOSIS
Unit 7 Assessment
H7:10
A. Match the word or phrase to the correct definition.
Word/Phrase
Definition
1.____ can’t afford
a. legs, feet
2.____ dizzy spells
b. bonding agent/glue
3. ____Medicare
c. ate
4. ____ lower extremity
d. allergic reaction to pollen
5. ____ puffy
e. U.S public health care for senior citizens
6. ____had
f. discuss
7. ____adhesive
g. dentures
8. ____hay fever
h. dizziness/ unsteady
9. ____consult
i. to not have enough money for something
10.___ false teeth
j. swollen
B. Fill in the blanks with the words/phrases /numbers you hear.
1. The surgery was a success as the doctor could hear bowl sounds in all four ______________.
2. As it progresses, ________________arthritis symptoms may feel like the flu, with achiness,
muscle aches, and loss of appetite.
3. ______________________ risk factors include obesity, drinking too much alcohol, smoking,
and family history.
4. _____________________disc disease is not really a disease but a term used to describe the
normal changes in your spinal discs as you age.
5. There are over 100 types of ____________________, including osteoarthritis, rheumatoid
arthritis, and gout.
6. The bone loss with _____________________ occurs over many years and is severe.
7. Effective medications and psychotherapy can help relieve the depression and make _________________ pain more tolerable.
8. An ___________________ physical exam is a tradition for many U.S. adults, but it is not always
necessary, according to a new study.
13
Unit 7
WELLNESS DIAGNOSIS
Unit 7 Assessment
H7:9 (cont)
9. Rheumatoid arthritis affects the joints _____________________, but not always at the same
time.
10. ______________________ occurs when the airways in your lungs are inflamed and make too
much mucus.
C. Fill in the blanks using the words in the box.
drugs
vomiting
balanced
immunizations
experienced
sensitivity
gait
physical
swell
Johnny comes to the clinic to get a sports _______________for participation in football. He
hopes to try out for quarterback. He has never experienced a concussion, never had any broken
bones, and no injuries to report since his last visit. He denies any dizziness. He states that he has
not ________________any shortness of breath, or racing heart. He is 145 lbs. and 5’10” tall.
He does not have any known drug allergies. His eyes turn red, itch, and _____________when he
is around cats, dust, or pollen. He assumes that he is allergic to these items, but has never
undergone formal medical allergy testing. He has _________________to peanuts and other nut
products. When he accidentally ingests food with peanuts or other nut products, he will
experience projectile ________________until the substance is completely purged from his
system. He states that he is healthy and feels well. He exercises by working out 4-5 times per
week. He states that he enjoys school and gets good grades. He is looking forward to going to
college at the University of Texas. He reports that he eats a ________________diet although he
does enjoy ordering pizza on weekends with his friends. He has recently been to the eye doctor
and has 20/20 vision in both eyes. He denies using any recreational/illegal __________or
alcohol. His_________________are up to date. He has not had any surgeries other than
wisdom teeth removal. He wears braces which should be coming off in about 6 months. His
heart sounds are normal and lungs are clear. He does not report any GI problems with diarrhea
or constipation. Reflexes, ___________, and balance are normal.
14
Unit 7
Answer Key / Wellness Diagnosis
Terminology/Vocabulary Development
H7:1
A. Read the following words / phrases, their definitions and example of usage.
Idiom/ phrase/word
Meaning
Example
dizzy spells
dizziness/ unsteady
The dizzy spell made the patient lose her balance and
fall.
puffy
swollen
The allergy cause Susan’s face to look puffy.
lower extremity
legs, feet
The diabetic patient suffered numbness on her lower
extremities.
false teeth
dentures
Before any surgery is performed patients must remove
any false teeth they may have.
honey
term of endearment
Many grandmothers call their loved ones ‘honey’.
adhesive
bonding agent/glue
When wearing dentures it is important to use good
denture adhesive.
Atekkdkdk
had
ate
Last night we went out and had lobster for dinner.
consult
discuss
Some patients like to consult with more than one
doctor especially when surgery is recommended.
hay fever
allergic reaction to pollen
Millions of people suffer from hay fever in the spring.
Medicare
U.S public health care for senior
citizens
All senior citizens are covered by Medicare.
can’t afford
to not have enough money for
something
The unemployed man could not afford to buy the car.
B. Read the sentences and choose the best word from the box to complete each sentence.
consult
puffy
Medicare
can’t afford
had
adhesive
1. Julie can’t afford to purchase the wheelchair for her son.
2. The US Food and Drug Administration has approved a new medical adhesive for use in attaching skin grafts.
3. The little boy’s face got puffy after being stung by a bee.
4. Without Medicare, many elderly people would stop receiving any medical care.
5. Six hours after surgery, the patient had some jello.
15
Unit 7
Answer Key / Wellness Diagnosis
Listening & Writing
H7:2
A. Read each sentence twice. Read at a regular pace the first time and then slower the second time.
1. John lost all of his teeth in an accident and had to have false teeth.
2. Unfortunately today many at risk women still can’t afford to have a mammogram done on a
regular basis.
3. Medicare will help cover most of the cost of home oxygen equipment and supplies if you
have a breathing condition that it will help improve.
4. Mr. Richards consulted with both his primary care physician and a specialist about his
condition.
5. The mountain climber who had been exposed to extreme cold suffered from frostbite on
both his upper and lower extremities.
6. Suffering from dizzy spells is one of the most common symptoms of reduced blood
circulation.
B. Read the following passage twice. The first time read at a normal speed, and on the second time
read at a slower speed.
Nurse Adams: Mrs. James, your hypertension seems to be under control. Are you taking both medications
regularly?
Mrs. James: Yes I am but, I wanted to speak to the doctor and tell him that since he put me on the medication
I’ve been getting dizzy spells and just don’t seem to have any energy to do much. I am not sure, but my legs also
seem to be puffy. As a matter of fact, I could barely get my feet in my shoes today!
Nurse Adams: Yes, I see. Are you taking any other type of medication?
Mrs. James: No.
Nurse Adams: So, the dizzy spells, fatigue and swelling in your lower extremity started since you began taking
medication for your hypertension. Is that correct Mrs. James?
Mrs. James: Yes it is. You know that the doctor has me on two different types, don’t you? Do I have to take both
of them? I don’t like taking all these pills. Never took a pill in my life till now.
Nurse Adams: I understand Mrs. James. I have made notes in your chart for the doctor. I see here on your chart
that at your last visit you complained of constipation and being unable to eat well because of your dentures. Do
you still suffer from constipation? Have you been able to go to your dentist to discuss the problems you are
having with your dentures?
16
Unit 7
Answer Key / Wellness Diagnosis
Listening & Writing
H7:2 (cont.)
Mrs. James: Honey, I haven’t been able to see the dentist, but my daughter bought me some wonderful
denture adhesive for my false teeth which is much better than the previous one I had been using. So, now I am
eating much better whenever I can. Just last week I had a whole fruit salad and am trying to eat more
vegetables. It seems to be helping because now I am going to the bathroom more regularly than I was before.
Nurse Adams: That’s good news! Remember you need to include at least 5 fruits and vegetables a day in your
diet. Mrs. James, I also see here that at your last visit you were complaining of having difficulty hearing. Were
you able to consult with a hearing specialist?
Mrs. James: Yes, I did. He wants me to go in for some more testing next week, but I just can’t afford them. The
tests are just too expensive for someone my age. The hearing specialist did tell me that some of my hearing loss
may be due to the hay fever that I have suffered with for years! Did you ever hear such a thing? How could my
loss of hearing and hay fever have to do anything with each other? Sometimes, these young doctors just don’t
know what they are saying!
Nurse Adams: Well, Mrs. James I think it would be better if you could go for the hearing test. After all, I see
here that you are covered by medicare. It is very important to find out why you are having difficulty hearing.
Mrs. James: Well, I suppose I should. I’ll talk to my daughter about it.
B. Read the following passage twice. The first time read at a normal speed, and on the second time
read at a slower speed.
An 83 year old woman has come to the clinic for an annual wellness visit and to renew her
prescription for blood pressure medicine. She is 5’5” and 121 pounds. She is on Norvasc 5mg PO
qd and Altace 5 mg PO qd for hypertension which is presently well controlled. Her BP is 130/80.
Respirations: 17. Temperature 98.4, and pulse of 75. She wears dentures. She complains that she
cannot eat salads because of her dentures. She states that she is having difficulty hearing. She
has consulted with a hearing specialist who verified that she has some hearing loss and has
suggested further testing. The loss of hearing may be due to fluid behind the eardrum due to
chronic allergies. She has allergies to ragweed and pollen. She has refused to return to the ear
specialist for further testing stating that the testing is “too expensive at her age.” She is covered
by private insurance and Medicare. She has a history of bronchitis. She has had cataracts
removed from both eyes one year ago. She is able to see with 20/25 in the left eye and 20/20 in
the right. She is still able to drive a car. She reports being active although she
17
Unit 7
Answer Key / Wellness Diagnosis
Listening & Writing
H7:4
Listening:
experiences joint pain due to mild rheumatoid arthritis. Her diet is healthy. She watches her
cholesterol carefully. She has been instructed to add more protein to her diet. She states that
she thought red meat was bad for her cholesterol. She has mild bone loss due to osteoporosis.
There is a family history of type 2 diabetes and poor circulation. Her glucose levels are within
normal limits. She reports pain in torso especially in her back. MRI reveals degenerative disk in
her spine. Her heart has a normal sinus rhythm and her lungs sounds are clear bilaterally. Bowel
sounds in all 4 quadrants and she reports mild constipation. She is trying to add more fiber to her
diet. She is continent. She just had a mammogram and pap smear 4 months ago. Both
mammogram and pap smear results were normal. She lost her husband 8 years and her children
do not live nearby. Most of her friends are in nursing homes or have died. She is a member of a
church, but is not presently active in her church.
C. Read the following passage twice. The first time read at a normal speed, and on the second time
read at a slower speed.
An 83 year old woman has come to the clinic for an annual wellness visit and to renew her
prescription for blood pressure medicine. She is 5’5” and 121 pounds. She is on Norvasc 5 mg PO
qd and Altace 5 mg PO qd for hypertension which is presently well controlled. Her BP is 130/80.
Respirations: 17. Temperature 98.4, and pulse of 75. She wears dentures. She complains that she
cannot eat salads because of her dentures. She states that she is having difficulty hearing. She
has consulted with a hearing specialist who verified that she has some hearing loss and has
suggested further testing. The loss of hearing may be due to fluid behind the eardrum due to
chronic allergies. She has allergies to ragweed and pollen. She has refused to return to the ear
specialist for further testing stating that the testing is “too expensive at her age.” She is covered
by private insurance and medicare. She has a history of bronchitis. She has had cataracts
removed from both eyes one year ago. She is able to see with 20/25 in the left eye and 20/20 in
the right. She is still able to drive a car. She reports being active although she experiences joint
pain due to mild rheumatoid arthritis. Her diet is healthy. She watches her cholesterol carefully.
She has been instructed to add more protein to her diet. She states that she thought red meat
was bad for her cholesterol. She has mild bone loss due to osteoporosis. There is a family history
of type 2 diabetes and poor circulation. Her glucose levels are within normal limits. She reports
pain in torso especially in her back. MRI reveals degenerative disk in her spine. Her heart has a
normal sinus rhythm and her lungs sounds are clear bilaterally.
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Unit 7
Answer Key / Wellness Diagnosis
Listening & Writing
H7:5
Bowel sounds in all 4 quadrants and she reports mild constipation. She is trying to add more
fiber to her diet. She is continent. She just had a mammogram and pap smear 4 months ago.
Both mammogram and pap smear results were normal. She lost her husband 8 years and her
children do not live nearby. Most of her friends are in nursing homes or have died. She is a
member of a church, but is not presently active in her church.
Unit 7
Answer Key / Wellness Diagnosis
Grammar Review
H7:7
Grammar Note: Present and Past Perfect Tense
Language in context – Present & Past Perfect
Over the last twenty years, the average size of households has fallen dramatically. The number of
one person households has grown, due largely to the ageing of the population, as has the number
of one parent families. Couples having smaller families have also contributed to the fall in
household size.
In 1976, 60% of families were couples with children. By 1996, this had fallen to 51%. Part of this
change can be attributed to the increase in one parent families with dependent children, but
most of the change is due to the increase in the proportion of couple only families. People are
now having children later in life, and are living longer. Therefore, they are spending more time
living in couple-only families, both before they have families and after their children have left
home.
However, children are leaving home later. In 1981, 34% of children aged 20-24 lived with their
parents. By 1991, this had increased to 40%. This increase has, to some extent, countered the fall
in the couples with non-dependent children only.
(Source: ABS Yearbook Australia 1997, Number 79, p. 81)
Directions: Find and write the four remaining present perfect verbs and the two past perfect tenses on
the lines below.
2. Second present perfect tense verb: has grown
3. Third present perfect tense: have also contributed
4. Fourth present perfect tense verb: have left
5. Fifth present perfect tense verb: has countered
6. First past perfect tense verb: had fallen
7. Second past perfect tense verb: had increased
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Unit 7
A.
Answer Key / Wellness Diagnosis
H7:8
Past perfect or simple past tense?
1.Jack has lived (live) in Boston for the past 15 years.
2. Janet worked (work) for Smith and Brothers before she came to work for us.
3. Dad have you finished (you/finish) reading the paper yet?
4. I would love to visit Prague sometime. Unfortunately, I have never been (be/never) there.
5. Peter played (play) Tennis for five years when he was (be) at school.
B. Answers will vary.
Unit 7
Answer Key / Wellness Diagnosis
Summary
H7:9
Reading Comprehension and Note Taking
C. Fill in the blanks with the words you hear.
Sometimes when writing a wellness diagnosis it can be challenging to identify a particular
condition that contributes to the client’s response, in particular if it has existed for some time.
If conditions cannot be identified, a one-part diagnosis can be used, i.e., the response only.
On the other hand, a two-part diagnosis can be used if a condition can be identified. In most
cases, if a two-part diagnosis is used, the short-term goal relates to the condition and the
long-term goal relates to the reponse. When deciding which condition to use in writing a
wellness diagnosis, clinical judgments are made. It is important when writing a wellness
diagnosis that the nurse be able to identify certain conditions that the nurse can intervene in.
For example, in the case of a mother whose 3-year old child has died, a diagnosis of ”normal
grief response due to death of a child”, would not be considered to be a helpful wellness
diagnosis since the nurse can do nothing about the fact that the patient’s child has died.
However, a diagnosis of “progressive resolution of grief related to reminiscing about death of
child” would be acceptable because the nurse could encourage the parent to talk about or
show pictures of the child.
20
Unit 7
Answer Key / Wellness Diagnosis
Unit 7 Assessment
H7:10
D. Match the word or phrase to the correct definition.
Word/Phrase
Definition
1._i_ can’t afford
a. legs, feet
2._h_ dizzy spells
b. bonding agent/glue
3. _e_ Medicare
c. ate
4. _a_ lower extremity
d. allergic reaction to pollen
5. _j_ puffy
e. U.S public health care for senior citizens
6. _c_ had
f. discuss
7. _b_ adhesive
g. dentures
8. _d_ hay fever
h. dizziness/ unsteady
9. _f_ consult
i. to not have enough money for something
10._g_ false teeth
j. swollen
E. Fill in the blanks with the words/phrases /numbers you hear.
11. The surgery was a success as the doctor could hear bowl sounds in all four quardrants.
12. As it progresses, rheumatoid arthritis symptoms may feel like the flu, with achiness, muscle
aches, and loss of appetite.
13. Hypertension risk factors include obesity, drinking too much alcohol, smoking, and family
history.
14. Degenerative disc disease is not really a disease but a term used to describe the normal
changes in your spinal discs as you age.
15. There are over 100 types of arthritis , including osteoarthritis, rheumatoid arthritis, and gout.
16. The bone loss with osteoporosis occurs over many years and is severe.
17. Effective medications and psychotherapy can help relieve the depression and make chronic
pain more tolerable.
18. An annual physical exam is a tradition for many U.S. adults, but it is not always necessary,
according to a new study.
21
Unit 7
Answer Key / Wellness Diagnosis
Unit 7 Assessment
H7:9 (cont)
19. Rheumatoid arthritis affects the joints bilaterally, but not always at the same time.
20. Bronchitis occurs when the airways in your lungs are inflamed and make too much mucus.
F. Fill in the blanks using the words in the box.
drugs
vomiting
balanced
immunizations
experienced
sensitivity
gait
physical
swell
Johnny comes to the clinic to get a sports physical for participation in football. He hopes to try
out for quarterback. He has never experienced a concussion, never had any broken bones, and
no injuries to report since his last visit. He denies any dizziness. He states that he has not
experienced any shortness of breath, or racing heart. He is 145 lbs. and 5’10” tall. He does not
have any known drug allergies. His eyes turn red, itch, and swell when he is around cats, dust, or
pollen. He assumes that he is allergic to these items, but has never undergone formal medical
allergy testing. He has sensitivity to peanuts and other nut products. When he accidentally
ingests food with peanuts or other nut products, he will experience projectile vomiting until the
substance is completely purged from his system. He states that he is healthy and feels well. He
exercises by working out 4-5 times per week. He states that he enjoys school and gets good
grades. He is looking forward to going to college at the University of Texas. He reports that he
eats a balanced diet although he does enjoy ordering pizza on weekends with his friends. He has
recently been to the eye doctor and has 20/20 vision in both eyes. He denies using any
recreational/illegal drugs or alcohol. His immunizations are up to date. He has not had any
surgeries other than wisdom teeth removal. He wears braces which should be coming off in
about 6 months. His heart sounds are normal and lungs are clear. He does not report any GI
problems with diarrhea or constipation. Reflexes, gait, and balance are normal.
22