Health assessment comparisons. Health, Medicine, Nursing Essay

Assignment: For the following two scenarios: Critique the targeted questions and explain how the patient might interpret these questions. Explain whether any of the questions would apply to the following patient and why.



Patient information: MR, a 23-year-old Native American male comes in to see you because he has been having anxiety and wants something to help him. He has been smoking "pot" and says he drinks to help himself too. He tells you he is afraid that he will not get into heaven if he continues in this lifestyle. He is not taking any prescriptions medications and denies drug use. He has a positive family history of diabetes, hypertension, and alcoholism.



Assessment one:

This week’s discussion will integrate a scenario that deals with socioeconomic and cultural factors associated with an 86-year old Asian male physically and financially dependent on his daughter. This patient is presenting to the office with a history of multiple comorbidities, including hypertension (HTN), gastroesophageal reflux disease (GERD), vitamin B12 deficiency, and chronic prostatitis. These health conditions may have severe consequences if not properly managed. I am a bit concerned with this presented information because this patient is at risk for many complications. As the advanced practitioner, I would first inquire if the patient can understand me and speak English, being an elderly Asian, he may speak some English. Still, an interpreter may be needed for the patient to fully understand me and the information being provided during the interview.

As an advanced practitioner, I must be culturally competent to provide care for this patient adequately. Culturally competent care requires that healthcare providers be sensitive to patient’s heritage, sexual orientation, socioeconomic situation, ethnicity, and cultural background (Ball, Dains, Flynn, Solomon & Stewart, 2019, p. 23). During my initial interaction with the patient, I would ask, “How are you feeling and what brings you in the office today?” to break the ice and begin a trusting provider-patient relationship, I would also ask about family and grandchildren. I would then begin assessing the patient while collecting a thorough health history and review of systems. My next questions would be focused on the living situation with his daughter and grandchild, lifestyle, diet/nutrition habits, level of physical activity, and religion. Also, inquiring about stressors, support networks, and health literacy are essential topics to cover in the interview.

Melton, Graff, Holmes, Brown & Bailey (2014) define health literacy as the degree to which individuals can obtain, process, and understand necessary health information and services needed to make appropriate health decisions. In Asian culture, the grandparents are looked upon as wise and are, at times, the decision-makers of the family. In the scenario, the patient, J.C, is dependent on his daughter for many of his activities of daily living and care, which may cause stress in the family dynamic. Having limited funds, resources, and a care-taker may cause stress to the patient who could contribute to his hypertension. Associated significant risks include hospitalization, morbidity, and mortality (Wannasirikul, Termsirikulchai, Sujirarat, Benjakul, & Tanasugarn, 2016).

Hypertension decreases older adults’ quality of life and increases their health care costs. The financial burden of health care is an issue for this patient and the daughter. I would conclude the interview with the teaching of programs available for discounted medications and services as well as a social worker, which may help with finding other services to help the patient and family financially to help with J. C. ‘s care.

Targeted Questions

1. Do you speak/understand English?

2. Do you have access to health care? If so what insurance and coverages?

3. Are you adhering to your prescribed medication regimen?

4. What extent of physical and financial health does your daughter provide?

5. What would you expect from me by the end of this visit?



Assessment two:

Cultural competence means understanding and adjusting to the unique needs of patients from various backgrounds (Ahn, 2017). Today’s patients come from all different walks of life, with varying socioeconomic factors, all requiring different needs. Therefore, it is vital for the Advanced Practice Registered Nurse (APRN) to practice cultural competency in all patient interactions. In this discussion, we analyze the techniques for completing a health history for an 86-year-old Asian male who is physically and financially dependent on his daughter. The patient's daughter is a single mother who has little time or resources to devote to his healthcare needs. We will explain the spiritual, socioeconomic, and cultural factors associated with this patient's situation. We will also provide five targeted questions to help assess his health risks.

According to Ahn (2017), upon the initial encounter between a healthcare provider and a patient from a different culture, there may be increase feelings of uncertainty and anxiety. This anxiety can directly influence the level of communication between the APRN and the patient. Healthcare providers who are sensitive to this anxiety can reduce or reverse this effect and thus enhance their relationships with these patients. As with all patients, when building a health history, the APRN must listen, observe, reassure, and always confirm the patient understands the treatment plan. A thorough health history assessment will include chief concern, history of present illness, past medical history, family history, social history, and review of systems (Ball et al., 2019, p.11-14).

When assessing this patient's spiritual needs, it is important to remember that the Asian population is more likely to have a “holistic” approach to healthcare (Ball, Dains, Flynn, Solomon, and Stewart, 2019, p.29). They view their lives as part of a whole that must be balanced and in harmony, and if not, illness can result. They are more apt to use naturalistic healing than to accept modern western medicine. We cannot ignore the naturalistic views of these patients if we are to offer culturally appropriate care.

The assessment of the patient’s lifestyle is critical. Many Asians with hypertension (HTN) lack education on the high amount of sodium found in monosodium glutamate, a staple in Asian cooking (Ball et al., 2019, p.29). Also, adherence to medical treatments is often an issue when assessing cultural factors. In a study by Wannasirikul, Lakkhana, Dusit, Sarunya, and Chanuantong (2016), adherence to hypertensive medications is a significant factor to adequately controlling blood pressure in the Asian population. This study shows that 80 percent of medication adherence is needed to reduce blood pressure sufficiently. However, in the elderly Asian population, there is only medication adherence of 26 to 59 percent. This patient is already expressing concern about being a burden on his daughter. This patient needs education on proper diet and lifestyle modifications that would reduce his risk for a possibly debilitating stroke or heart attack would significantly decrease.

According to Davis et al. (2015), the main socioeconomic factors that affect healthy lifestyles include social conditions, education, income, and housing. The patient's socioeconomic status plays a significant role in the patient's access to care and management of care. The poorly educated and those in poverty die at a higher rate from the same conditions than those that are better educated and economically stable (Ball et al., 2019). Therefore, it is essential to obtain a functional assessment, delving into areas such as sources of income and whether the patient is insured. The patient expresses genuine concern about being a burden to his daughter. In many cultures, there is a desire to remain autonomous, and therefore this patient's dependency on his daughter upsets him. The APRN might assist in this by offering information on senior centers and services in the area that offer support for the elderly. According to Seddigh et al. (2020), daily gatherings at senior centers can increase the level of physical, mental, and social health of the elderly by supplementing their time with various programs, games, and physical activity.

Five targeted questions to ask the patient to build his health history and to assess for health risks:

1. Are you able to perform activities of daily living independently? If not, what amount of help is required? Is this help currently available to you?

2. Do you follow a daily schedule for your prescribed medications? Does a family member help you with the management of your medications? Are you able to financially afford your medications? Any issues with transportation to and from the doctor's office to receive monthly B12 injections?

3. Who is responsible for food preparation? Do you currently maintain a low sodium diet?

4. Are there any particular beliefs or practices surrounding medical treatments? Do you take any supplements or participate in any other holistic medical treatments?

5. Are there any faith-based practices or beliefs that may affect the patient's healthcare?

6. What is the family dynamics? How many generations are living in the house?