NURS 6512: Advanced Health Assessment and Diagnostic Reasoning – Discussion Diversity and Health Assessments discussion essay examples
Diversity and Health Assessments
Case #1: “I came for my annual physical exam, but do not want to be a burden to my daughter.” History of Present Illness (HPI): At-risk 86-year-old Asian male – who is physically and financially dependent on his daughter, a single mother who has little time or money for her father’s health needs. According to Dains, Baumann, and Scheibel (2016), an assessment begins with the patient stating their primary concern or reason for the visit. In the case of the 86-year-old Asian male, he is in for his annual physical exam but clearly states that he concerned about burdening his daughter. The patient requires a complete physical exam on this visit, but would also benefit from a comprehensive geriatric assessment (CGA) based on his age but also because of is comment. Functional and social vulnerabilities are challenges characteristic of older populations (Ramani, Furmedge, & Reddy, 2014). Discussion Diversity and Health Assessments discussion essay examples .
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The socioeconomic factor related to this patient is his dependency on his daughter for financial stability. The patient’s daughter is a single mother who does not have money to spend on her father’s health needs. The patient is 86 years old and physically dependent on his daughter, so is unable to contribute to the household both financially or physically. It is unclear if the daughter able to support for her father beyond his health needs. According to Yan, Chan, and Tiwari (2015), Asian cultures prescribe to adult children caring for their elderly parents providing financial support and showing them obedience Discussion Diversity and Health Assessments discussion essay examples . This is based on a Confucian teaching which, according to more recent studies, is being interpreted differently by younger generations who feel that it is dependent on their own circumstances (Yan, Chan, & Tiwari, 2015).
Subjective data obtained from the assessment identified a weight loss of 25 pounds over the past year, multiple bruises on the patient’s upper arms and back, and a history of two falls within the last 6 months. Objective data identified that the patient was hypertensive, even though taking medication for hypertension, and multiple bruises in different stages of healing on his upper arms and back. The patient also has arcus senilus bilaterally, which is common for this age population and does not require intervention. The bruises, weight loss, and hypertension need to be addressed. Discussion Diversity and Health Assessments discussion essay examples .
Sensitive Issues
The patient’s assessment is affected by cultural beliefs and behaviors and the relationship with the family should be explored (Ball, Dains, Flynn, Solomon, & Stewart, 2015). Ball et al. (2015) also indicate that older patients who are physically impaired are at higher risk for elder abuse. A conversation regarding the bruises is a sensitive subject particularly because Asian populations are hesitant to report elder abuse as it is considered a family matter (Yan, Chan, & Tiwari, 2015). According to Yan, Chan, and Tiwari (2015), discussing the potential elder abuse with a third party is considered shameful in Asian culture because the behavior may be seen as a reflection of poor parenting. Addressing the hypertension should include assessing if the patient is taking his medication, which may identify if the daughter is purchasing the medication or not Discussion Diversity and Health Assessments discussion essay examples . This is a sensitive issue because the patient does not want to burden his daughter and may not want to indicate that his daughter is neglecting his needs.
Older adults require health care that goes beyond medical management and includes evaluation of issues such as physical, financial, and environmental aspects that impact their health (Ramani, Furmedge, & Reddy, 2014). Identifying problems with the patient’s social support can aid in obtaining resources for the patient and choices can be made regarding outcomes most important to the patient and his daughter (Ramani, Furmedge, & Reddy, 2014). Lastly, the patient is functionally impaired and may qualify for state or local benefits depending on his income (Ramani, Furmedge, & Reddy, 2014) and since he is being supported by his daughter, this may alleviate the burden on her and improve his access to medications and care that he requires. Discussion Diversity and Health Assessments discussion essay examples .
Targeted Questions
- How do you take your medications each day?
- What do you normally eat and drink each day?
- Are you able to get around okay at home?
- Do you feel safe at home?
- Would you like help with things at home such as bathing, dressing, and mobility?
- Do you often feel sad or depressed?
- Discussion Diversity and Health Assessments discussion essay examples
References
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby.
Ramani, L., Furmedge, D. S., & Reddy, S. H. (2014). Comprehensive geriatric assessment. British Journal of Hospital Medicine (London, England: 2005), 75(8), C122-C125.
Yan, E., Chan, K., & Tiwari, A. (2015). A Systematic Review of Prevalence and Risk Factors for Elder Abuse in Asia. Trauma, Violence & Abuse, 16(2), 199-219 21p. doi:10.1177/152483801455503
NURS 6512: Advanced Health Assessment
Diversity and Health Assessment
Cultural competence is the gradually developed capacity of nurses and healthcare providers to provide safe and quality healthcare to clients of different background (Duan-Ying, 2016). Cultural competence involves recognizing one’s own culture, values, and biases, and using effective patient-centered communication skills (Ball et al., 2015). To be culturally competent, the practitioner must be able to respond to the cultural diversity of her or his patients and adapt to the unique needs of patients from the cultural and spiritual background different from her or his own (Ball et al., 2015). For this forum, the cultural health assessment of MR, the 23-year-old Native American male will be discussed.
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Case 3: Culturally Competent Health Assessment of the 23-year-old Native American Male
MR, a 23-year-old Native American presents with complain of anxiety, history of smoking “pot,” alcoholism, a family history of diabetes, hypertension, and alcoholism. He is afraid of the adverse outcomes of his lifestyle choices. He is not currently on prescription medication and denies drug use. He needs some prescriptions to help him with his anxiety.
According to Espey at al. (2013), “American Indians in the United have long endured a legacy of injustice and discrimination with multiple negative manifestations, including alarming health disparities and inadequate healthcare.” Patterns of mortality among Native Americans are strongly influenced by the high incidence of diabetes, smoking prevalence, problem drinking, and social determinants (Epsey et al., 2013). For many young Native Indian Americans like MR, the problem of poor health, smoking, and alcohol abuse can be explained by poverty, unemployment, and lack of education. Sarche & Spicer (2008) state that more than one-quarter of American Indian and Alaskan Native is living in poverty, a rate that is more than double of that of the general population. The discrepancy in education and employment is also found and overall, there are fewer individuals within the American Indian and Alaska community who possess a high school diploma or GED (71% versus 80%) or a bachelor degree (11% versus 24.4%) (Sarche & Spicer, 2008). The social determinants of health including poor-socioeconomic status, poor education, low income as well as unhealthy lifestyle and poor access to healthcare services play a major role in MR’s anxiety, alcohol use, and “pot” smoking Discussion Diversity and Health Assessments discussion essay examples . MR health seeking behavior is related to his spiritual beliefs that he might not “get into heaven” if he continues to have an unhealthy lifestyle. This attitude is an excellent initiative towards a healthier lifestyle.
Addressing critical issues when interacting with the patient
According to scenario 3, MR has multiple health risks. He has a family history of hypertension, diabetes, and alcoholism. He is a current “pot” smoker, alcohol drinker, and a very anxious young man looking for prescriptions against anxiety. Anxiety is one the withdrawal symptoms and therefore, MR may have drug addiction issue. This patient may need a psychiatric consult for better assessment of his drug addiction status. He is also at risk for cardiovascular diseases and lung cancer related to “pot” smoking, hypertension and diabetes-related to family history and alcoholism. Discussion Diversity and Health Assessments discussion essay examples
Targeted Questions
1- How are you doing today? How can I help you with your visit?
2- You stated that you have been smoking “pot.” How long have you been smoking?
3- What do you think is the cause of your anxiety?
4- You stated that drinking alcohol can help cope with your anxiety. How many drinks do you have in one day?
5- Have you ever felt you should cut down on your drinking? (CAGE questionnaire)
6- Have people annoyed you by criticizing your drinking? (CAGE questionnaire) Discussion Diversity and Health Assessments discussion essay examples
7- Have you felt bad or guilty about drinking? (CAGE questionnaire) (Addiction & Recovery, 2018).
8- Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover? (CAGE questionnaire)
9- Do you have insurance coverage? Do you have concerns about how to cover your medical expenses?
10- Before coming to this health center did you seek help from a family member, spiritual leader or a friend? Did they listen to you or provide any support? Reference
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., Stewart, R. W. (2015). Seidel’s Guide to
Physical Examination. (8th E.). Elsevier, Mosby. St. Louis, Missouri.
Addiction and Recovery (2018). CAGE Questionnaire. Addiction Self-Assessment.
Retrieved from https://addictionsandrecovery.org/addiction-self-test.htm
Duan-Ying, C. (2016). A Concept Analysis of Cultural Competence. International Journal of
Nursing Sciences. Volume 3, Isuue3, pages 268-273.
https://doi.org/101016/j.ijnss.2016.08.00 Retrieved from
https://www.sciencedirect.com/science/article/pii/S2352013216300795
Espey, D. K., Jim, M. A., Cobb, N., Bartholomew, M., Becker, T., Haverkamp, D.,
Plescia, M. (2014). Leading Causes of Death and All-Cause Mortality in American
Indians and Alaska Natives. American Public Health Association.
Doi: 10.2105/AJPH.2013.3017.98 Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4035872/ Discussion Diversity and Health Assessments discussion essay examples
Sarche, M., Spicer, P. (2008). Poverty and Health Disparities for American Indian and Alaska
Native Children: Current Knowledge and Future Prospect. American Indian and Alaska
Native Programs. Doi: 10.1196/annals.1425.017. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2567901/pdf/nihms58363.pdf Discussion Diversity and Health Assessments discussion essay examples