Nursing

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1))Suggest additional socioeconomic, spiritual, lifestyle, and other cultural factors related to the patient.
2))Critique your colleagueâ€s targeted questions, and explain how the patient might interpret these questions. Explain whether any of the

questions would apply to your patient, and why.
Case I
Diagnosing and Reasoning a patient situation is pertinent in delivery of care. “guiding learners to transfer their learning to the

practice setting to ultimately improve patient care outcomes. This can only be accomplished if learners understand how to employ their

knowledge to make contextually relevant connections in new situations†(Nursing Education Perspectives, 2015, p.305). The case presented

is of elderly an Asian gentleman who is financially and physically dependent on his daughter. He feels he is a burden to his daughter who

does not have the time to focus on her fatherâ€s needs or resources. He has lost 25lbs in six months and has signs of bruises on multiple

areas of his body and he also has history of falls. His BP is elevated and has a low grade temperature. There are many aspects of this

case study. First, the patient does have medical problems such as hypertension and GERD. His hypertension is currently uncontrolled, is

this because of stress, medication noncompliance, or an underlying condition. Second, is the falls and injury the patient appears to have

undergone? Investigation is needed to determine if they were mechanical falls, or possible abuse. Thirdly, is the emotional aspect of how

the patient is currently feeling? Feeling like a burden can lead to anxiety and depression. His daughter also needs to be evaluated

whether she is capable to take care of her father. The 25lb weight loss could bespoke of neglect or negate to the depression the patient

feels in loss of appetite. Lastly, there is the cultural aspect of his Asian heritage which could prevent the patient from revealing

possible issues.
Cultural and Socioeconomic Factors
Cultural factors for this patient could be family dynamics. In my experiences with Asian patients they have very tight family and are very

private. As this patient is very vulnerable and could in fact be alone for majority of the time with his daughter being busy. The cultural

change for him can be very damaging. All questions should be asked with respect and consideration to the feeling of the patient yet focus

on finding the problem. Although the patient is Asian, it is important not to stereotype. With the highly-dimensional United States

population cultural beliefs are often blended. “Cultural humility involves the ability to recognize oneâ€s limitations in knowledge and

cultural perspective and be open to new perspectives. Rather than assuming all patients of a particular culture†(Ball, Dains, Flynn,

Solomon, & Stewart, 2015, p. 23). An example is that the patient may not want to discuss his injuries to either protect his daughter or to

prevent further burden on her.
Socioeconomic factors with this patient include financial dependency on his daughter, medication costs, and possible need for

assistance. This gentleman is high risk for debility, emotional isolation, and also poverty. Questions for concern would be the patients

insurance status, does he qualify for Medicaid. What are the expenses that could be assisted with? Also, is where he is currently residing

with his daughter safe, would an assisting living facility be an option, what are the patientâ€s desires? As a provider, clinical reasoning

is needed to effectively to patientâ€s medical condition without burdening the patient financially, determining if he is safe and

emotionally stable.â€Clinically reasoning is a situational, practice-based form of reasoning that acknowledges the many variables that are

present in an actual clinical situation, such as social relationships or situations involving patient, family, community, and a team of

health care providers†(Dains, Baumann, & Scheibel, 2016, p. 3).
Sensitive Issues
The topic of abuse is an issue that should be approached carefully but should be addressed during the assessment. If the patient daughter

is present, the patient should be questioned about abuse alone. Elder abuse is a topic that is very close to home for me as my great-

grandfather underwent abuse at the hands of a caregiver, unfortunately was never appropriately screened and family was unaware because he

would not speak up for fear of retaliation. In the case of the patient, he is dependent on his daughter, whether the abuse was intentional

or brought on by neglect; it is a topic he may not wish to discuss. Targeted questions are needed to assess for this. “Further¬ more, the

collection o f sensitive information about abuse could have negative emotional, social, financial or legal consequences for mul¬tiple

parties, leading both the abused older person and the abuser to actively try to hide the abuse. This raises ethical concerns about

conducting research on a vulnerable population†(Wang, Brisbin, Loo & Straus, 2015, p. 575)
Targeted questions
1. Do you feel safe at home?
2. How did you fall?
3. How many meals do you eat a day and what is a typical meal for you?
4. Do you take you medications at the same time daily, where are your medications kept?
5. Do your ever think of harming yourself?
6. Do you check your blood pressure regularly?
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidelâ€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.
Enhancing Clinical Reasoning through Simulation Debriefing: A Multisite Study. (2015). Nursing Education Perspectives, 36(5), 304-310 7p.

doi:10.5480/15-1672
Wang, X. M., Brisbin, S., Loo, T., & Straus, S. (2015). Elder abuse: an approach to identification, assessment and intervention. CMAJ:

Canadian Medical Association Journal = Journal De Lâ€association Medicale Canadienne,187(8), 575-581. doi:10.1503/cmaj.141329

(GARRETT)

Assessment Case 3
For this discussion on diversity in health assessment, I chose to discuss case three. Case three involves a twenty three year

Native American male who has come in to seek medical help because he has been having anxiety and wants something to help him. He has been

smoking pot and says he drinks to help him too. He tells you he is afraid that he will not get into Heaven if he continues in this

lifestyle. There are multiple concerns in regard to reviewing the patientâ€s present condition. In order of data collected, there is

concern for the patientâ€s use of alcohol, and marijuana to cope with his anxiety. The family history for diabetes, hypertension, and

alcoholism is not good at all. The patients BMI is indicitave of obesity with a maximum weight being one hundred sixty pound for hit

height. Finally the pacing and fidgeting, along with mild icterus and dental carries indicate psychological distress, liver distress, and

poor nutrition, and dentition.
Cultural Awareness
When greeting, meeting, and developing a relationship with cultural diverse patients, the provider must humble himself and

realize that people of differing cultures are culturally incompetent to each other (Ball, Dains, Flynn, Solomon, & Stewart, 2015). Even

with training it is difficult to be completely proficient. By realizing this, the caregiver can be aware and sensitive to techniques used

for communication. At the same time, a provider must never stereotype either. A humble, sincere introduction with low tone speech in a

neutral posture is warranted if there are not any hearing or visual deficits. Some cultures since loud speech and even certain types of

posture as aggressive. Communication is of the highest priority, so if needed make arrangements for a translator.
When treating patients with different cultural backgrounds than your own, it is important to consider the patientâ€s health

beliefs and practices. Do they utilize modern medicine, and do modern medical techniques interfere with their spiritual beliefs, or

considered taboo? Spiritual balance and approach is important to the NA population. Holistic care is well received, and care of the body

and soul is needed. Native Americans believe that language and thoughts are very powerful, and have the power to ensure certain outcomes.

For this reason, it is important to consider how you present information and the tone in which you do so. After speaking with NA it is

important to give them time to process and formulate a response, for this is the normal response (Ball et al., 2015).
Specific Questions
For this particular patient, the primary concern is his alcohol consumption, and marijuana use for self-medicating. The

finding of liver enlargement and mild icterus is of great importance also. With poly drug use and abuse there is a specific tool that can

be utilized to assess the patient. It is called the “The Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV

(AUDADISIV), which looks at negative consequences as well as other addictions and disorders that can be associated with alcohol misuseâ€

(Patterson, David, Durran, Dullas, & Manning, 2014, p. 402). This tool is used for all populations of patients.
Questions:
1.) How much do you drink each day?
2.) How much marijuana do you smoke each day?
3.) What do you believe is the cause of your anxiety?
4.) Do you utilize any other drugs, or herbs for your anxiety, or recreational use?
5.) Do you have any support system to help with your anxiety, drinking alcohol, and smoking marijuana?
6.) Would you like assistance in obtaining help to stop drinking alcohol, smoking marijuana, and decreasing your anxiety attacks?
References
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidels guide to physical examination(8th ed.). St.

Louis, Missouri: Elsevier Mosby.
Patterson, S. W., David, A., Durran, B., Dullas, K., & Manning, A. (2014, April). Alcohol screening and brief intervention as standard

practice: Working with the American Indian/Native Alaskan populations. Journal of Human Behavior in the Social Environment, 24(3), 399-

407. http://dx.doi.org/http://dx.doi.org.ezp.waldenulibrary.org/10.1080/10911359.2014.875340

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