Evaluating Health for Botox Injections: A Comprehensive Assessment Approach

Health Assessment in Prescribing
Introduction
The purpose of this exam is to evaluate the patient known as Miss J for the prospect of Botox injections. The first part of a medical visit is the interview process at the beginning of the Nursing/holistic health assessment. This assessment collects specific data that will advise the Nurse Practitioner about sensitive and definitive health history that may affect the patient for Botox A injections. These next paragraphs will document the correct assessment process (Lymn, 2010).
This assessment must be through and precise, in order to gauge the patient’s success rate in the program. This initial visit allows the Nurse Practitioner to create a rapport with the patient in to build a consensus of mutual trust. The interview will set the direction of the clinical assessment. This is where the Nurse Practitioner uses the recognized tools to provide a precise diagnosis by documenting a clinical reason for proceeding with injections of Botox (Lymn, 2010).
This initial assessment will document overall patient health, and evaluate the success or failure of the patient to be able to complete the regimen. The interview is verbal, and it is not essential to touch the patient in the initial assessment (Murphy, 2009). The Nurse Practitioner will advise the patient the potential risk and safety concerns associated with Botox injections. The interview questions will be open-ended to get the patient to provide detailed information.
The Nurse Practitioner must advise the patient of possible interactions for Botox A injections, due to possible allergic reaction to the toxin, previous diagnosis of neural disease, pregnancy, breath feeding, or injection site infection.

In rare cases, the corresponding injection of aminoglycosides can activate paralysis (Malhotra, 2009). Also discussed, is what action to take is a case of complications. These are the primary fact to pass on to the potential patient is that Botox injections must be prescribed by trained professionals such as a medical doctor or Nurse prescriber (NHS, 2016). The consent form details all the pertinent information the patient needs to make an informed decision. The Nurse Practitioner cautions the patient to think it over, and discuss the procedure with family members, then set up an appointment. Miss J chooses to proceed with the injections.
Before the physical examination, the Nurse Practitioner will assist the patient in answering the assessment survey to gather the patient’s health history. After the initial interview, the Nurse Practitioner will commence with a physical examination, using all the experience and intuition acquired during the education process. Part of the interview process is that the patient understands how religious and cultural diversity could affect the procedure (BACN, 2015). The physical exam is a well-thought-out decision-making process in the doctor-patient affiliation (Habiba, 1). Miss J states there are no issues with this. This allows the Nurse Practitioner assess if Botox is a viable solution for the patient. The Nurse Practitioner looks to identify any previous injection sites. An assessment of the skin quality and thickness is necessary to ascertain whether a higher dose is necessary (Malhotra, 2009).
The Nurse Practitioner identifies the possible areas for Botox injections by producing detailed documentation that assesses the state of the patient’s health and classifying any abnormalities. In the case of an abnormality, the Nurse Practitioner will link the pathophysiology to build a complete description and basic hypotheses that allow the patient to complete the shot regimen. After the physical exam, the patient, and the Nurse Practitioner agree to proceed with the procedure. The patient signs the consent form that states the patients understands all to the benefits and possible side effects of Botox injections. Sovereignty is one of the main ethical observations that underline informed consent in regards to a patient investigating the pros and cons of any medical procedure.The patient must understand all the risk involved and signs the patient historical health form. This document details the patient history as it relates to the possible Botox injections that will reduce the patient’s frown lines.
The Nurse Practitioner works under the supervision of the DPM (Designated Medical Practitioner). The date of this evaluation is 15.04.2016. This evaluation was a comprehensive and detailed exam. This type of exam is crucial to ascertain whether this patient is a candidate for Azzalure® injections.
Miss J is thirty-five, and works a dance instructor and is quite physically active in her work. She is 168 centimeters and weighs 65 kilograms. She does not smoke. She is a vegetarian and is physically active. She consumes ten units of alcohol per week. Miss J is not pregnant or lactating. She does not take any herbal remedies, contraceptives, laxatives, or any other medications. She has no previous history of prescribed medicines, or over the counter medications. She has zero hospital admissions as a patient. Miss J. claims no allergies. She points to the areas of her face she would like to improve. Miss J has already tried many of the over the counter remedies that include peel and creams with little or no results. She states that her frown lines have caused her to feel distressed about how her face is beginning to show signs of aging. There four stages of aging that start with mild- no wrinkles (28-35 years), moderate wrinkles in motion (35-50 years) advanced-wrinkles at rest (50-65 years), and severe-only wrinkles (60-75 years), according to Brannon (2016). Miss J is in the mild stage.
Comprehensive Exam
The Nurse Practitioner examined Miss J and prioritized the range of motion and level of wrinkles while the patient moved her facial muscles. The Nurse Practitioner will then ask permission to touch the patient’s face. This allows Nurse Practitioner to feel for prior injections and locating the contraction points. This physical touching of the face assists in correctly placing the injections that will do the most lift and removal of wrinkles. The correct selection of injection points is crucial to a successful procedure. These areas should be marked on the patient’s face before the injection. These injections go into the muscle’s contraction point (Miller, 2013).
Analysis
The Nurse Practitioner and the patient discuss at length all the information involved in the shared decision-making process. Both came to the agreement that Miss J is an excellent candidate for the procedure and signed all the forms approved by the United Kingdom. The procedure for Botox injection is the currently best source for temporarily removing wrinkles known as frown lines. These frown lines are located in the forehead, glabella, and periorbital crow’s feet and are common injection points (EMC, 2015). The Nurse Practitioner reiterates a summary of all information previously discussed in the assessment. The last statement is about the clinic’s use of Azzalure® as opposed to BoNT, a different vender of Botulinum Type an (Aesthetic, 2013). Miss J accepted the education on side effects and possible procedural consequences. Miss states these frown lines are causing her some concern and anxiety (EMC, 2015). The last bit of information about Botulinum Type A is about not injecting it in areas that have broken skin or rash present (Wilkinson, 2012). The last bit of information is about allergic reactions are rash, itching, red itchy welts, asthma symptoms, wheezing, feeling faint or dizzy. The emergency plan is to contact your PCP (Primary Care Physician) or go to the nearest ER (Emergency Room). This information is available in the MGB Cosmetic guide (2016).
Allergic Reactions
Indications of an allergic reaction to Azzalure® Cosmetic include itching, rash, red itchy welts, wheezing, asthma symptoms, or dizziness or feeling faint. Tell your doctor or get medicinal help right away if you are wheezing or have asthma symptoms, or if you become dizzy or faint. There will be some bruising and tenderness at the injection location.
The Nurse Practitioner must inform the patient about the possibility of pain at the injection sites. The patient receives specific details about what not to do after the procedure. They must also receive a pamphlet on the clinics Botox drug Azzalure® (Botulinum Type A) about what signs to look for and what to do in case of an emergency or problem. Azzalure® can have side effects that occur in some patients. The reactions are usually minor in nature and mostly temporary and associated with the injection site (Galderma, 2015).After the Nurse Practitioner answers, all her questions and the patient is able to sign the consent forms with confidence. The form used in this instance is the Botox Cosmetic Injection: Consent Form (BMC, 2016). Miss J states she understands and is ready to proceed.
The United Kingdom recognizes Azzalure® as a cosmetic medicine that is injected into the muscles that smooth out the wrinkles around the eyes and mouth. The Clostridium Botulinum Type A is the active e ingredient (UK-MHPRA, 2016). Azzalure® is specified for the temporary improvement in the presence of perpendicular lines between the eyebrows known as frown lines (EMC, Galderma, 2015). Azzalure® is injected with a BD Ultra-Fine™ Syringes with 6 mm needles (BD, 2016). This known as fine positioning in between and above the eyebrows, Baker et al, (2016) promotes a different vender name of Botulinum Type-A, called BoNT, but subscribes to the same techniques as Azzalure®. Botulinum Type A in all its forms is a viable product that works on a temporary reduction in the frown lines previously discussed. The article by Baker et al (2016) in Aesthetics Journal, writes about Botulinum Type A’s effects on all muscles involved in frown lines of the face and other dermatological uses and methods of delivery.
Diagnostic Conclusions
This health assessment provides the right information received from the Nurse Practitioner and the patient ends in a consensus that Miss J is a good candidate for Azzalure® Botulinum Type An injections. She meets the current criteria list for removing the wrinkles called frown line. Abbasi et al (2012) used the scientific name rhytid, (Latin for wrinkle). At this point is time for the DMP (Designated Medical Practitioner) to oversee the Nurse Practitioner and approve the diagnosis for injecting three areas on Miss J’s face. The Nurse Practitioner assisted Miss J with the completion of all consent forms (Selinger, 2009). She is required to initial each area on the form that she has read and understood every section of the form. This is also a standard is required by the American Society of Plastic Surgeons (2016). The prescription for injections is listed as Azzalure® 125 Speywood in a container of one-vial carafes as the recommended dose for each of the three regions identified by the Nurse Practitioner and the DPM (EMC-SPC, 2015).
Explanation of Side Effects
Injection of Azzalure® can result in unexpected side effects for some patients. It can cause light bruising at injection location, flu-like signs, flaccidity in the facial features and temporary weakness. These signs should be temporary. Serious issues like double or blurred vison can occur anywhere from hours, days, or weeks after the procedure, but this is rare (EMC-SPC, 2015). If the patient is experiencing issues with speaking, breathing, or swallowing, the clinic suggests going to the nearest ER immediately.
Miss J understands that she will remain in the clinic for four hours after the procedure. She must sit upright and refrain from bending over. This process is for catching any major reactions before she leaves the facility. After leaving the facility, she must refrain from extreme facial movement and alcoholic beverages for a period of twelve hours after the procedure. She should not rub or massage these injection sites in order not to spread the Azzalure® to other areas on the face. This process takes about a week to stabilize. She must not apply makeup to the affect areas. She must be gentle with face washing and gently pat the face dry with a towel. This will prevent migration of Azzalure® from the injection sites. For two weeks, she must avoid sunlight, frigid air, and saunas. Heat and cold make the blood vessels expand and contract. This may cause Azzalure® migration (MHPRA, 2016).
Conclusion
After the procedure, the patient is installed in a chair to wait out the necessary four hours. The clinical staff cleans up the injection area by inventorying the needle count and supplies, making sure all are accounted for. This assures the clinic that nothing has been left in the patient that should not be there. After two weeks, the patient will come for a follow-up visit to analyze the success of the procedure. It is at this time the Nurse Practitioner, under the supervision of the DMP will ascertain the results are successful (Mayo Clinic, 2016). Azzalure® usually has minimal downtime. Most patients can return to normal life in about 24 hours to several days. For Miss J, one full day was sufficient. The Nurse Practitioner advised Miss J that the reduction in wrinkles is temporary and that she may need to return in six months to repeat the procedure. Miss J agreed that she understood the process, and plans to return in six months for the Nurse Practitioner to reevaluate her injection sites. She is also advised to spend less time in full sunlight, which can cause skin damage and more wrinkle in the affected areas. The sun can affect the success of Botox injections. Avoid excessive sun exposure until the swelling and redness are reduced. The Nurse Practitioner suggests wearing a 30-SPF sunscreen to protect the face from burning (Lissa’s World, 2016).
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