History taking in patients with suspected haematological disease
This is the first article in a two-part series. The fundamental skill of advanced nursing practice is the ability to undertake concise history taking and examinations to aid differential diagnosis and appropriate referral to specialist services. This article aims to discuss and highlight specific consultation questions and required clinical assessments of a patient with a potential haematological diagnosis. The complexity of a haematological diagnosis may be become clear with the exploration of constitutional symptoms, which include fever, drenching night sweats, loss of appetite or weight. The rapidity of onset of symptoms is pivotal to diagnosis and may influence speed of referral, if required, to specialist haematology teams. Physical symptoms may include shortness of breath, easy bruising, fatigue or palpable enlarged lymph glands. The relevance of these symptoms and what consitutes a haematological emergency will be explored. This article will discuss clinical findings pertinent to haematological diseases, when it is appropriate to refer to specialist haematological services and current national guidance. The second article in this series will examine how critical thinking aids in the diagnosis of blood disorders.
The evolution of advanced nursing practice has been influenced by changes in healthcare delivery, financial constraints and consumer demand. Moore and Sweedman (2004) suggested that the advanced practice role has evolved in response to the development of more complex therapies, limited resources and nursing shortages. Core characteristics of advanced practice include that the practitioner should be clinically autonomous, have a client-centred role and be empowered to make high-level decisions. Many of these decisions become more complex due to the increasing complexity of disease, with malignancies now affecting 1 in 2 of the population and an ageing population (Ahmad et al, 2015).
With increasing access to laboratory tests, diagnostic imaging and other investigations, we should not forget the fundamental importance of history taking and evaluation of patients. In one study of an evaluation of 80 patients, history-taking alone led to the correct final diagnosis in 76% of patients (Peterson et al, 1992).
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