<\/p>\n
In May 2012, Alice Randall wrote an article for<\/span>\u00a0<\/span><\/span>The New York Times<\/span><\/em>\u00a0<\/span><\/span>on the cultural factors that encouraged black women to maintain a weight above what is considered healthy. Randall explained\u2014from her observations and her personal experience as a black woman\u2014that many African-American communities and cultures consider women who are overweight to be more beautiful and desirable than women at a healthier weight. As she put it, \u201cMany black women are fat because we want to be\u201d (Randall, 2012).<\/span><\/p>\n Randall\u2019s statements sparked a great deal of controversy and debate; however, they emphasize an underlying reality in the health care field: different populations, cultures, and groups have diverse beliefs and practices that impact their health. Nurses and health care professionals should be aware of this reality and adapt their health assessment techniques and recommendations to accommodate diversity.<\/span><\/p>\n In this Discussion, you will consider different socioeconomic, spiritual, lifestyle, and other cultural factors that should be taken into considerations when building a health history for patients with diverse backgrounds.<\/span><\/p>\n Subjective Data PMH: hypertension (HTN), gastroesophageal reflux disease (GERD), b12 deficiency and chronic prostatitis<\/span>\u00a0<\/span><\/span> Review of Systems (ROS) Objective Data HEENT: Atraumatic, normocephalic, PERRLA, EOMI, arcus senilus bilaterally, conjunctiva and sclera clear, nares patent, ornasopharynx clear, edentulous.<\/span>\u00a0<\/span><\/span> Subjective Data Drug Hx: Review of Systems (ROS)<\/span>\u00a0<\/span><\/span> Objective Data HEENT: Atraumatic, normocephalic, PERRLA, EOMI, conjunctiva and sclera clear; nares patent, ornasopharynx clear, good dentition. Piercing in her right nostril and lower lip. Subjective Data Review of Systems (ROS)<\/span>\u00a0<\/span><\/span> Objective Data General: 23 year old male appears well developed and well nourished. He is anxious \u2013 pacing in the room and fidgeting, but in no acute distress. To prepare:<\/span><\/strong><\/p>\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>Reflect on your experiences as a nurse and on the information provided in this week\u2019s Learning Resources on diversity issues in health assessments.<\/span><\/p>\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>Select\u00a0<\/span>one<\/strong><\/span>\u00a0<\/span><\/span>of the three case studies. Reflect on the provided patient information.<\/span><\/p>\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>Reflect on the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient you selected.<\/span><\/p>\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>Consider how you would build a health history for the patient. What questions would you ask, and how would you frame them to be sensitive to the patient\u2019s background, lifestyle, and culture? Develop five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.<\/span><\/p>\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>Think about the challenges associated with communicating with patients from a variety of specific populations. What strategies can you as a nurse employ to be sensitive to different cultural factors while gathering the pertinent information?<\/span><\/p>\n Post a 1 page paper APA format <\/span><\/strong>\u00a0<\/span><\/strong><\/span><\/p>\n 1.<\/span><\/strong> explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated<\/span> with the patient you selected<\/span><\/p>\n 2<\/span><\/strong>. Explain the issues that you would need to be sensitive<\/span> to when interacting with the patient, and why<\/span>. 3.<\/strong> Provide at least five targeted<\/span> questions you would ask the patient to build his or her health history and to assess his or her health risks.<\/span><\/p>\n \u00a0<\/span><\/strong><\/p>\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015).\u00a0<\/span>Seidel’s guide to physical examination<\/em>\u00a0<\/span>(8th ed.). St. Louis, MO: Elsevier Mosby.<\/span><\/p>\n o\u00a0\u00a0 <\/span><\/span>Chapter 2, \u201cCultural Competency\u201d (pp. 21\u201329)<\/span><\/p>\n This chapter highlights the importance of cultural awareness when conducting health assessments. The authors explore the impact of culture on health beliefs and practices.<\/p>\n o\u00a0\u00a0 <\/span><\/span>Chapter 3, \u201cExamination Techniques and Equipment\u201d (pp. 30-49)<\/span><\/p>\n This chapter explains the physical examination techniques of inspection, palpation, percussion, and auscultation. This chapter also explores special issues and equipment relevant to the physical exam process.<\/p>\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>Dains, J. E., Baumann, L. C., & Scheibel, P. (2016).\u00a0Advanced health assessment and clinical diagnosis in primary care\u00a0<\/em>(5th ed.). St. Louis, MO: Elsevier Mosby.<\/span><\/p>\n o\u00a0\u00a0 <\/span><\/span>Chapter 1, \u201cClinical Reasoning, Differential Diagnosis, Evidence-Based Practice, and Symptom Analysis\u201d<\/span><\/p>\n This chapter introduces the diagnostic process, which includes performing an analysis of the symptoms and then formulating and testing a hypothesis. The authors discuss how becoming an expert clinician takes time and practice in developing clinical judgment.<\/p>\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>Sullivan , D. D. (2012).\u00a0<\/span>Guide to clinical documentation<\/em>\u00a0<\/span>(2nd ed.). Philadelphia, PA: F. A. Davis.<\/span><\/p>\n o\u00a0\u00a0 <\/span><\/span>Chapter 2, “The Comprehensive History and Physical Exam” (pp. 19\u201336)<\/span><\/p>\n o\u00a0\u00a0 <\/span><\/span>Appendices A\u2013E (pp. 225\u2013236)<\/span><\/p>\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>Laine, C. (2012). High-value testing begins with a few simple questions.\u00a0<\/span>Annals of Internal Medicine<\/em>,156<\/em>(2), 162\u2013163. This article supplies a list of questions physicians should ask themselves before ordering tests. The authors provide general guidelines for maximizing the value received from testing.<\/p>\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>Qaseem, A., Alguire, P., Dallas, P., Feinberg, L. E., Fitzgerald, F. T., Horwitch, C., & \u2026 Weinberger, S. (2012). Appropriate use of screening and diagnostic tests to foster high-value, cost-conscious care.Annals of Internal Medicine<\/em>,\u00a0<\/span>156<\/em>(2), 147\u2013150. This article highlights the increasing cost of health care and stresses the need for high-value and cost-conscious testing. The authors provide a list of 37 situations in which more testing provides no benefit or may be harmful.<\/p>\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>Shaw, S. J., Huebner, C., Armin, J., Orzech, K., & Vivian, J. (2009). The role of culture in health literacy and chronic disease screening and management.\u00a0<\/span>Journal of Immigrant & Minority Health<\/em>,\u00a0<\/em><\/span>11<\/em>(6), 460\u2013467.\u00a0<\/span> This article examines cultural influences on health literacy, cancer screening, and chronic disease outcomes. The authors postulate that cultural beliefs about health and illness affect a patient\u2019s ability to comprehend and follow a health care provider\u2019s instructions.<\/p>\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>Wians, F. H. (2009). Clinical laboratory tests: Which, why, and what do the results mean?\u00a0<\/span>LabMedicine, 40<\/em>, 105\u2013113.\u00a0<\/span> This article analyzes the laboratory testing cycle and its impact on diagnostic decision making. This article also examines important diagnostic performance characteristics of laboratory tests, methods of calculating performance, and tools used to assess the diagnostic accuracy of a laboratory test.<\/p>\n \u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span><\/span>LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2009). DeGowin’s diagnostic examination (9th ed.). New York, NY: McGraw- Hill Medical.<\/span><\/p>\n oCase 1<\/span><\/h3>\n
CC: “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.<\/span><\/p>\n
PSH: S\/P cholecystectomy
Drug Hx:
Current Meds: Lisinopril 10mg daily, Prilosec 20mg daily, B12 injections monthly, and cipro 100mg daily.<\/span><\/p>\n
General: + weight loss of 25 lbs over the past year; no recent fatigue, fever or chills.
Head, eyes, ears, nose & throat (HEENT): no changes in vision or hearing, no difficulty chewing or swallowing.
Neck: no pain or injury<\/span>\u00a0<\/span><\/span>
Respiratory:<\/span>\u00a0<\/span><\/span>
CV:<\/span>\u00a0<\/span><\/span>
GI:<\/span>\u00a0<\/span><\/span>
GU: no urinary hesitancy or change in urine stream
Integument: multiple bruises on his upper arms and back.
MS\/Neuro: + falls x 2 within the last 6 months; no syncopal episodes or dizziness
Psych:<\/span><\/p>\n
PE: B\/P 188\/96; Pulse 89; RR 16; Temp 99.0; Ht 5,6; wt 110; BMI 17.8<\/span><\/p>\n
Lungs: CTA AP&L
Cor: S1S2 without rub or gallop
Abd: benign, normoactive bowel sounds x 4
Ext: no cyanosis, clubbing or edema
Integument: multiple bruises in different stages of healing – on his upper arms and back.
Neuro: No obvious deformities, CN grossly intact II-XII<\/span><\/p>\nCase 2<\/span><\/h3>\n
CC: “I am here for my annual physical exam and have been having vaginal discharge.”
History of Present Illness (HPI): 32-year-old pregnant lesbian – her pregnancy has been without complication thus far. She has been receiving prenatal care from an obstetrician. She received sperm from a local sperm bank.<\/span><\/p>\n
Current Medications: prenatal vitamins and takes Tylenol over the counter for aches and pains on occasion
Family Hx: She a strong family history of diabetes. Gravida 1; Para 0; Abortions 0.<\/span><\/p>\n
General: no fatigue, fever or chills.
Head, eyes, ears, nose & throat (HEENT):<\/span>\u00a0<\/span><\/span>
Neck: no pain or injury<\/span>\u00a0<\/span><\/span>
Respiratory:<\/span>\u00a0<\/span><\/span>
CV:<\/span>\u00a0<\/span><\/span>
GI:<\/span>\u00a0<\/span><\/span>
GU:<\/span>\u00a0<\/span><\/span>
Integument: multiple piercings, and tattoos. Old scars related to “cutting”.<\/span>\u00a0<\/span><\/span>
Neuro: no syncopal episodes or dizziness, no change in memory or thinking patterns; no twitches or abnormal movements<\/span><\/p>\n
PE: B\/P 128\/76; Pulse 83; RR 16; Temp 99.0; Ht 5,6; wt 128; BMI 20.98<\/span><\/p>\n
Lungs: CTA AP&L
Cor: S1S2 without rub or gallop
Abd: benign, normoactive bowel sounds x 4
GU: external genitalia intact, no lesions or masses. White copious discharge with an amine odor; no cervical motion tenderness; adenxa intact.<\/span>\u00a0<\/span><\/span>
Ext: no cyanosis, clubbing or edema
Integument: intact without lesions masses or rashes.
Neuro: No obvious deficits and CN grossly intact II-XII<\/span><\/p>\nCase 3<\/span><\/h3>\n
CC: “Annual physical exam”<\/span>\u00a0<\/span><\/span>
History of Present Illness (HPI): 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 him too. He tells you he is afraid that he will not get into Heaven if he continues in this lifestyle.<\/span>\u00a0<\/span><\/span>
Drug Hx:
Current medication – denied
Allergies: no allergies to food or medications.<\/span>\u00a0<\/span><\/span>
Family history: is very positive for diabetes, hypertension, and alcoholism.<\/span><\/p>\n
General: no recent weight gains of losses, fatigue, fever or chills.
Head, eyes, ears, nose & throat (HEENT):
Neck:<\/span>\u00a0<\/span><\/span>
Respiratory:<\/span>\u00a0<\/span><\/span>
CV: no chest discomfort or palpitations
GI:<\/span>\u00a0<\/span><\/span>
GU:<\/span>\u00a0<\/span><\/span>
Integument: history of eczema \u2013 not active
MS\/Neuro: no syncopal episodes or dizziness, no change in memory or thinking patterns; no twitches or abnormal movements
Psych:<\/span><\/p>\n
PE: B\/P 158\/90; Pulse 88; RR 18; Temp 99.2; Ht 5,7; wt 208; BMI 32.6<\/span><\/p>\n
HEENT: Atraumatic, normocephalic, PERRLA, EOMI, sclera with mild icterus, nares patent, ornasopharynx clear, poor dentition \u2013 multiple carries.<\/span>\u00a0<\/span><\/span>
Lungs: CTA AP&L
Cor: S1S2, +II\/VI holosystolic murmur; without rub or gallop
Abd: benign, normoactive bowel sounds x 4; Hepatomegaly 2cm below the costal margin.
Ext: no cyanosis, clubbing or edema
Integument: intact without lesions masses or rashes.
Neuro: No obvious deficits and CN grossly intact II-XII<\/span><\/p>\nReadings<\/span><\/h4>\n
Retrieved from the Walden Library databases.<\/span><\/p>\n
Retrieved from the Walden Library databases.<\/span><\/p>\n
Retrieved from the Walden Library databases.<\/span><\/p>\n
Retrieved from\u00a0<\/span>http:\/\/labmed.ascpjournals.org\/content\/40\/2\/105.full<\/span><\/span><\/p>\nOptional Resources<\/span><\/h2>\n<\/p>\n