NURS – 6512N Discussion: Diversity and Health Assessments
Sample Discussion
CASE STUDY 1 JC, an at-risk 86-year-old Asian male is physically and financially dependent on his daughter, a single mother who has little time or money for her father’s health needs. He has a hx of hypertension (HTN), gastroesophageal reflux disease (GERD), b12 deficiency, and chronic prostatitis. He currently takes Lisinopril 10mg QD, Prilosec 20mg QD, B12 injections monthly, and Cipro 100mg QD. He comes to you for an annual exam and states “I came for my annual physical exam, but do not want to be a burden to my daughter.
Hypertension is common in Asian populations and is a major cause of cardiovascular diseases. Lifestyle modification is important for patients with hypertension. Previous studies have shown that smoking, heavy alcohol consumption, a diet high in salt, and a sedentary lifestyle are associated with hypertension. A lot of times though, a lifestyle modification alone is usually not enough to control high blood pressure. A good portion of patients requires antihypertensive medications to achieve the target blood pressure. (Cheung & Cheung, 2014)
As a provider, I will need to be sensitive to the fact that my patient is Asian, and that they believe that we are to understand and respect their culture. As well, a bit of humility will be needed in order to recognize my own limitations on his cultural perspectives. (Ball et al., 2019)
Successful communication between healthcare providers and their patients from different cultural backgrounds depends on developing an awareness of the normative cultural values of patients and how these differ from the cultural values of most western medical professionals. When cultural differences are poorly understood, a variety of adverse clinical outcomes may result in reduced participation in preventive screenings, delayed immunizations, inaccurate histories, use of harmful remedies, non-compliance, and decreased satisfaction with care. (Careret, 2010).
This patient sounds frail with multiple chronic health issues as well as some psychosocial issues. It appears that some testing, education, and outside resources will need to be discussed in a sensitive manner. Also remembering that with aging comes changes. With the aging adult, there may be memory and confusion. There may be a loss of hearing or poor sight. The elderly may not report pain because they think it is due to old age. The main not want to report much of anything because to do not want to be a bother or burden to anyone. (Ball et al., 2019).
I think what would mystify me since he is of Asian descent which is a culture that tends to provide care to older adults, and he doesn’t want to burden his daughter. Taking care of the elderly is a highly regarded cultural belief and continues to play an important factor in the life of older adults in the Asian culture. With knowledge, however, I would know that as more Asian families migrate from traditional Asian culture to Western society’s emphasis on individualism, traditional values such as respect for older adults, familial harmony and filial care may undergo constant modification. (Dong, Chang, Wong, Wong, Skarupski, & Simon, 2010)
The patient indicates that he is there for his annual physical so a complete health history may not be required. I would first have him fill out an adult questionnaire form to see if there might be anything new going on.
We already know he is here for an annual exam. That he is 86 and his race is Asian. I would want to know if he has completed an advanced health care directive. Next would be any current symptoms he may have. This may include,
Respiratory- Recent fevers/sweats, Cough/wheeze, Unexplained weight loss/gain, Cough/wheeze, Coughing up blood
Skin- rash, new or change in mole
Gastrointestinal- Heartburn/reflux, Nausea/vomiting/diarrhea, Pain in abdomen
Cardiovascular-Chest pains/discomfort, Palpitations, Short of breath with activity
Ears/Nose/Throat/Mouth- Difficulty hearing/ringing in ears, Hay fever/allergies/congestion, Trouble swallowing
Psychiatric- Anxiety/stress, sleep problem
Genitourinary- Painful/bloody urination, Leaking urine/Nighttime urination, Concern with sexual functions, Discharge from penis
Neurological- Headaches, Memory loss, Fainting Blood/Lymphatic
Lymphatic- Unexplained lumps, Easy bruising/bleeding
Breast- Breast lump, Nipple discharge
Musculoskeletal- Muscle/joint pain, Recent back pain
Endocrine – Cold/heat intolerance, Increase thirst/appetite
Next, I would look at labwork/test (If not done I would order the following)
BMP, CMP, CBC, Lipids, Liver panel, TSH, Hemoglobin A1C, and glucose, B12
PSA
Sigmoidoscopy or Colonoscopy
Prostate exam
Dexascan (osteoporosis)
I would confirm all medications and doses as well as over the counter medications, herbs, and supplements. I would confirm for any medication allergies. I will confirm there is PMH and a family medical history on file. I will next go on to discuss his social history inquiring about,
Alcohol/Drug/Tobacco use
Caffeine intake
Sexual activity
Weight/Diet/Exercise
Safety habits
ADLs
Five targeted questions I would ask my patient are as follows;
Mr. JC, I know you are here for an annual exam, but is there anything else we can do for you today? (in hopes that we will expand more on his situation)
How do you feel about your health? How do you feel about your diagnosis’? Do you understand how they affect you? Do you know the names of your medications and what they do? (He may be very confused about everything.)
Are you concerned about paying for your medical care or medications?
Would you be willing for us to set you up with resources to Help with daily living activities? (This could help relieve any guilt that he is burdening his daughter)
In the past month, have you experienced a lack of interest/pleasure in activities, felt down, depressed or hopeless? (Again, being concerned that he thinks he is a burden to his daughter.)
I realize being Asian that the patient’s goal is most likely to improve health and well-being overall, not just to focus on a single ailment and beat it. To add, if applicable I cannot minimize or dismiss the value of holistic or traditional treatments. As a provider, I would encourage what he may believe in as long as it is not detrimental to his health. I will also be mindful that in the Asian culture, he may value harmony, the idea of fighting a battle may be more alarming than motivating. I will also need to watch my overall tone of outreach materials and should have them assessed through pre-translation cultural consulting.
Recourses
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Careret, M. (2010). Cultural Values of Asian Patients and Families. Retrieved from https://monkessays.com/write-my-essay/dimensionsofculture.com/2010/10/cultural-values-of-asian-patients-and-families/
Cheung TT, & Cheung BM. (2014). Managing blood pressure control in Asian patients: safety and efficacy of losartan. Clinical Interventions in Aging, 443. Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=edsdoj&AN=edsdoj.f27e2f75b1344766a1eeed2c86104713&site=eds-live&scope=site
XinQi Dong, E-Shien Chang, Esther Wong, Bernarda Wong, Kimberly A. Skarupski, & Melissa A. Simon. (2010). Assessing the Health Needs of Chinese Older Adults: Findings from a Community-Based Participatory Research Study in Chicago’s Chinatown. Journal of Aging Research. https://doi/10.4061/2010/124246
