NURS 6512 Week 2 Discussion 2: Health Assessments

Diversity and Health Assessments

Cultural Factors Associated

Sensitive Issues when Interacting with the Patient

Targeted Questions

In May 2012, Alice Randall wrote an article for The New York Times on the cultural factors that encouraged black women to maintain a weight above what is considered healthy. Randall explained—from her observations and her personal experience as a black woman—that 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, “Many black women are fat because we want to be” (Randall, 2012). NURS 6512 Week 2 Discussion 2: Health Assessments

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Discussion 2: Health Assessments ASSIGNMENTS

Randall’s 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.

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. NURS 6512 Week 2 Discussion 2: Health Assessments

Case 1

Subjective Data

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.

PMH: hypertension (HTN), gastroesophageal reflux disease (GERD), b12 deficiency and chronic prostatitis

PSH: S/P cholecystectomy

Drug Hx:

Current Meds: Lisinopril 10mg daily, Prilosec 20mg daily, B12 injections monthly, and cipro 100mg daily.

Review of Systems (ROS)

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

Respiratory:

CV:

GI:

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:

Objective Data

PE: B/P 188/96; Pulse 89; RR 16; Temp 99.0; Ht 5,6; wt 110; BMI 17.8

HEENT: Atraumatic, normocephalic, PERRLA, EOMI, arcus senilus bilaterally, conjunctiva and sclera clear, nares patent, ornasopharynx clear, edentulous.

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

Case 2

Subjective Data

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.

Drug Hx:

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.

Review of Systems (ROS)

General: no fatigue, fever or chills.

Head, eyes, ears, nose & throat (HEENT):

Neck: no pain or injury

Respiratory:

CV:

GI:

GU:

Integument: multiple piercings, and tattoos. Old scars related to “cutting”.

Neuro: no syncopal episodes or dizziness, no change in memory or thinking patterns; no twitches or abnormal movements

Objective Data

PE: B/P 128/76; Pulse 83; RR 16; Temp 99.0; Ht 5,6; wt 128; BMI 20.98

HEENT: Atraumatic, normocephalic, PERRLA, EOMI, conjunctiva and sclera clear; nares patent, ornasopharynx clear, good dentition. Piercing in her right nostril and lower lip.

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.

Ext: no cyanosis, clubbing or edema

Integument: intact without lesions masses or rashes.

Neuro: No obvious deficits and CN grossly intact II-XII. NURS 6512 Week 2 Discussion 2: Health Assessments

Case 3

Subjective Data

CC: “Annual physical exam”

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.

Drug Hx:

Current medication – denied

Allergies: no allergies to food or medications.

Family history: is very positive for diabetes, hypertension, and alcoholism.

Review of Systems (ROS)

General: no recent weight gains of losses, fatigue, fever or chills.

Head, eyes, ears, nose & throat (HEENT):

Neck:

Respiratory:

CV: no chest discomfort or palpitations

GI:

GU:

Integument: history of eczema – not active

MS/Neuro: no syncopal episodes or dizziness, no change in memory or thinking patterns; no twitches or abnormal movements

Psych:

Objective Data

PE: B/P 158/90; Pulse 88; RR 18; Temp 99.2; Ht 5,7; wt 208; BMI 32.6

General: 23 year old male appears well developed and well nourished. He is anxious – pacing in the room and fidgeting, but in no acute distress.

HEENT: Atraumatic, normocephalic, PERRLA, EOMI, sclera with mild icterus, nares patent, ornasopharynx clear, poor dentition – multiple carries.

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. NURS 6512 Week 2 Discussion 2: Health Assessments

To prepare:

Reflect on your experiences as a nurse and on the information provided in this week’s Learning Resources on diversity issues in health assessments.
Select one of the three case studies. Reflect on the provided patient information.
Reflect on the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient you selected.
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’s 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.
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?

By Day 3

Post an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you selected. Explain the issues that you would need to be sensitive to when interacting with the patient, and why. Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.
Read a selection of your colleagues’ responses.

By Day 6

Respond on or before Day 6 to at leastone of your colleagues who selected a different patient than you, using one or more of the following approaches:

Suggest additional socioeconomic, spiritual, lifestyle, and other cultural factors related to the patient.
Critique your colleague’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. NURS 6512 Week 2 Discussion 2: Health Assessments
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NURS 6512 Week 3 Initial Post Answer (Walden)

NURS 6512N-26: Advanced Health Assessment

INITIAL POST

Health Issues and Risks of Children’s Weight

Body measurements can provide a general picture of whether a child is receiving adequate nutrition or is at risk for health issues. These data, however, are just one aspect to be considered. Lifestyle, family history, and culture—among other factors—are also relevant. That said, gathering and communicating this information can be a delicate process.

For this Discussion, you will consider examples of children with various weight issues. You will explore how you could effectively gather information and encourage parents and caregivers to be proactive about their children’s health and weight.

To prepare:

Consider the following examples of pediatric patients and their families:

Overweight 5-year-old boy with overweight parents
Slightly overweight 10-year-old girl with parents of normal weight
5-year-old girl of normal weight with obese parents
Slightly underweight 8-year-old boy with parents of normal weight
Severely underweight 12-year-old girl with underweight parents
Select one of the examples on which to focus for this Discussion. What health issues and risks may be relevant to the child you selected?
Based on the risks you identified, consider what further information you would need to gain a full understanding of the child’s health. Think about how you could gather this information in a sensitive fashion.
Consider how you could encourage parents or caregivers to be proactive toward the child’s health.

By Day 3

Post an explanation of the health issues and risks that are relevant to the child you selected. Describe additional information you would need in order to further assess his or her weight-related health. Taking into account the parents’ and caregivers’ potential sensitivities, list at least three specific questions you would ask about the child to gather more information. Provide at least two strategies you could employ to encourage the parents or caregivers to be proactive about their child’s health and weight.
Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on 2 different days who selected a different example than you, using one or more of the following approaches:

Suggest additional health risks or issues that could be relevant to the child.
Critique your colleagues’ questions, and suggest how the parents or caregivers might interpret these questions. Provide alternate or additional questions.
Suggest an additional strategy for gathering patient information or promoting proactivity.

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NURS 6512 Week 4 Initial Post Answer (Walden)

NURS 6512N-26: Advanced Health Assessment

INITIAL POST

Skin Conditions and their Differential Diagnoses

Properly identifying the cause and type of a patient’s skin condition involves a process of elimination known as differential diagnosis. Using this process, a health professional can take a given set of physical abnormalities, vital signs, health assessment findings, and patient descriptions of symptoms, and incrementally narrow them down until one diagnosis is determined as the most likely cause.

In this Discussion, you will examine several visual representations of various skin conditions, describe your observations, and use the techniques of differential diagnosis to determine the most likely condition.

Note: Your Discussion post should be in the SOAP (Subjective, Objective, Assessment, and Plan) note format, rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in this week’s Learning Resources for guidance.Remember that not all comprehensive SOAP data are included in every patient case.

To prepare:

Review the Skin Conditions document provided in this week’s Learning Resources, and select two conditions to closely examine for this Discussion.
Consider the abnormal physical characteristics you observe in the graphics you selected. How would you describe the characteristics using clinical terminologies?
Explore different conditions that could be the cause of the skin abnormalities in the graphics you selected.
Consider which of the conditions is most likely to be the correct diagnosis, and why.

By Day 3

Post a description of the two graphics you selected (identify each graphic by number). Use clinical terminologies to explain the physical characteristics featured in each graphic. Formulate a differential diagnosis of three to five possible conditions for each. Determine which is most likely to be the correct diagnosis, and explain your reasoning.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days. Make sure that you respond to colleagues who selected at least one graphic that is different from the ones you selected. For each, address all of the following:

Critique your colleague’s clinical description of the physical characteristics of each.
Suggest an additional possible condition for each graphic, and explain your reasoning.
Provide an alternative correct diagnosis, and explain your reasoning.
Validate an idea with your own experience and additional research.