NorQuest Health History Form

Practical Nurse
Student Name(s):________________________________________________________________________
NorQuest Health History Form
Health History Information
List your questions in each section prior to the interview
Current Health Status
(a short statement about present state of health; provide chronological
record of current health problems):
The client (B.K.) has been suffering from blood pressure. I initiated the discussion by asking some of
the current issues faced by her.
How are you and what issues are you facing concerning your present health state?
She had been facing some issues with her blood pressure. Although, it was not active while i
was examining her but according to her, the issue related to her blood pressure would
emerge at any point of time and was terribly bad. Apart from this, she felt good and healthy.
I had to take her vital sign examination so i asked for her permission. It would help me to
examine the present health state in a more vital and analyzed manner.
Vital signs:
Height: 148cm
Weight: 70 kg
Body temperature: 35.8 C
Pulse rate: Regular and strong pulse with 75 beats per minutes
Respiratory rate: 15 breaths per minute
Blood pressure: High (140/90 mmHg)
She informed me that she had a healthy lifestyle and there have been not any issue related
to her health apart from this high blood pressure issue. She rated her blood pressure as
3/10.
Chronological record of health: high blood pressure
Explain about your current health condition in a little more detail. When and how
did it started?
The client had been suffering from high blood pressure since a couple of months. It first
examined during a regular health check up on 3rd of January 2019. Initially the issue
emerged as a minor increase in her blood pressure and she thought it would be ok after a
few days of rest and proper diet. But it remained active and was investigated by the physical
examination. Her physical examination conducting doctor had advised her to take rest and
also to follow a healthy food habit but there have been no further improvements in the
present condition.
What makes you feel better and worst in respect of your daily activities and the
increased blood pressure?
The client was facing issues like Severe headache, Chest pain while conducting physical
exercises such as climbing stairs and lifting weights. These activities were very painful at
times. She admitted to be using prescribed medicines as well as medically recommended
HEAS 1000, November 2017 1
Collection Date: 5
April 2019
Collection Time:
1800
Client’s Biographical Data
Initials: B.K.
Identified
Gender:
Female
Age: 40
Birthplace: Nigeria (West Africa)
Marital Status: Married
Occupation: Health care professional

Practical Nurse
exercises which is the main source to make her feel better in pain.
What is the exact point of pain?
The pain is specifically in the chest, head and it is static since the day of its origin. There has
been no any change in the location of pain.
Is it too much intense or mild?
It is intense while climbing stairs and running but apart from these activities the pain is not
active.
Quality and severely:
What are some of the most specific symptoms and is the pain constant or it is
getting worst?
It mostly pains when some of the previously mentioned physical activities are performed and
rest of the times its fine. The pain is constant and it’s neither getting good nor getting worst.
What are the issues you face in your daily life due to your current high blood
pressure issue?
She is not able to climb upstairs at her home and couldn’t get to her office as she had been
advised to take rest.
Timing:
When was the first time you faced issues with this pain?
She first had the pain the very next day while she was working in her kitchen. She was
having issues while trying to lift something. That was the very first time when it was felt by
her.
How often do you experience this pain?
She fees the pain while conducting any physical activity which involves intense movements
like climbing stairs and lifting weights.
Aggravating and relieving factors:
What triggers the pain and what makes it worse?
Physical activities trigger the pain and those involving much stress make it worst. While
activities like driving, household work and general movements are not quite impactful on
triggering the pain. She is afraid to conduct any physical activities any more as she thinks it
would land her in serious health trouble.
What are the precautions or reliving techniques used by you to counter the impacts?
The patient has been using medicines and medicated exercises and these are evident to
provide her some relief.
Associated factors:
Is there any other part of the body affected by this pain? Does it travel?
The client said its still at the same spot as it was on the first day. It doesn’t travel to any
further body parts. It is also constant in terms of pain intensity.
Understand:
What do you understand about this pain?
The client considers it a result of increased blood pressure as the main cause of this pain.
Past Health History
(list childhood illnesses, accidents or injuries, chronic illnesses, mental health
concerns, hospitalizations, operations, obstetrical history, immunizations, most recent examination
dates for physical, dental, vision and hearing):
HEAS 1000, November 2017 2

Practical Nurse
Do you have any history of mumps, measles, strep throat and pertuses?
No
Did you have any serious illness such as scarlet fever, inflammation or pain in
joints?
None
Accidents or injuries:
Have you ever had any accident injuries, fractures or any other related issue?
No
Serious or chronic illness:
Did you have any issues like hypertension, diabetes, or any blood related issue?
No
Hospitalizations:
Have you ever been hospitalized previously? If yes what was the issue and how it
was treated?
She had been hospitalized once while she was expecting a child. It was for a week and
everything went well. She was discharged after a week after she delivered as baby through
normal provisions.
Mental health concerns:
Do you have any mental health issues or concerns?
No
Surgeries:
Have you ever had any surgery? If yes, what was the exact issue, please provide
important information associated with it?
No surgeries till date.
Obstetrical history:
How many pregnancies and deliveries have been conducted? Did you undergo any
abortion and what is the number of Childs living?
She have had one and only delivery. There have been no any abortion and the child is living
and healthy.
Immunization
Do you remember having any immunization related to polio, measles, and
mumps? At what age did you undergo these immunizations?
She couldn’t remember any initial immunization process but has been tested for tuberculosis
and HIV during the initial months of 2017 which resulted in to negative reports.
Most recent medical examination date:
Have you recently visited any physical, vision, dental, hearing and any other such
examination process?
She had undergone a regular medical examination two days after the pain generated and
the reports reflected increased blood pressure. The report reflects normal information apart
from this particular issue.
Past Family History
(ages/health concerns, age at and cause of death of blood relatives – parents,
grandparents, siblings):
Are your parents alive? What are their health conditions? Do you have any family
HEAS 1000, November 2017 3