NURS 6512 Discussion: Diversity and Health Assessments

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Week 2 discussion
For this week, I chose to work with the scenario of the 54-year-old Caucasian male referred for follow-up after a hospital admission related to an alcohol withdrawal seizure. This gentleman has a history of hypertension, in the context of alcohol and cocaine abuse. Patient is also homeless, currently domiciled in a local shelter, but has run out of his blood pressure medications. Although patient is reporting current abstinence from alcohol and drugs, he is reporting a correlating increase in his cigarette smoking.

 

From a socioeconomic perspective, this patient has limited means of support due to homelessness. It is not discussed if the patient is receiving any type of income, whether that be by working, unemployment, or disability services.  However, it would be safe to infer his available finances are minimal, since the scenario tells us he cannot afford housing for himself, which assumes he may have limited finds to purchase prescription medications.

Health literacy is a person’s capacity to process and understand health information to make medical decision for themselves (Vernon, Trujillo, Rosenbaum, & DeBuono, 2007). The recent Pharmacy Times article identified although health literacy disproportionally affects minority groups, Caucasian American males make up the largest population of persons in the United States with low health literacy skills (Vernon, Trujillo, Rosenbaum, & DeBuono, 2007). Low general healthy literacy skills can exacerbate the problem of ineffective communication, affects how they make decisions about their health, such as adopting a healthier lifestyle, and may prevent patients from seeking care or treatment (Vernon, Trujillo, Rosenbaum, & DeBuono, 2007). An example in poor health literacy in this patient’s case, is his attempt to stay away from alcohol and drugs by compensating with an increase in his smoking behaviors.  He may believe his alcohol abstinence is a positive health outcome, not understanding he has now put himself at greater risk or other health conditions due to increased tobacco exposure.

When eliciting a health history from this particular patient it is important to be observant of how alcohol could potentially affect other areas of his life. Thomas Jefferson University and Addiction Research Foundation of Ontario created a screening questionnaire based on the link of traumatic injury and alcohol abuse (News in mental health nursing. Trauma history may shed light on elusive alcoholics, 1997). If patient answers yes to two or more the provider is directed to further question the patient about alcohol consumption and effects of the patients life (News in mental health nursing. Trauma history may shed light on elusive alcoholics, 1997). Alcohol penetrates every organ in the body interfering with physiological function, alters cellular membrane, destroys nerve pathways, changes muscle cells, and decreases immune system function (Glenn, Parsons, & Stevens, 1989).Alcoholic are prone to liver disease, cancers, cardiovascular disease, Thyroid problems, pancreatitis, diabetes, respiratory disease, gastrointestinal disease, accidents, and self-inflicted injuries (Glenn, Parsons, & Stevens, 1989).Evidence has been found that indicates physiological differences in alcoholics with and without family history of alcoholism (Glenn, Parsons, & Stevens, 1989).Alcoholics suffer widespread medical issues, identifying patient with drinking problems can accelerate resources, prevention, and treatment in persons with the most need (Glenn, Parsons, & Stevens, 1989).

 

Important question to ask during health history of this patient:

  1. How frequently do you drink through the week?
  2. What types of alcohol do you drink?
  3. How long have you been drinking like this?
  4. Have you ever been hospitalized due to drinking or drinking related illness?
  5. Do you ever experience alcohol withdrawal symptoms? Such as tremors, anxiety, hallucinations, or seizures when you suddenly stop drinking?
  6. Do you have family members with history of alcoholism?
    1. Are they living or dead? If dead, how did they die?

 

Glenn, S. W., Parsons, O. A., & Stevens, L. (1989). Effects of alcohol abuse and familial alcoholism on physical health in men and women. Health Psychology : Official Journal of the Division of Health Psychology, American Psychological Association, 8(3), 325–341.

News in mental health nursing. Trauma history may shed light on elusive alcoholics. (1997). Journal of Psychosocial Nursing & Mental Health Services, 35(7), 8.

Vernon, J. A., Trujillo, A., Rosenbaum, S., & DeBuono, B. (2007). Low health literacy: Implications for national health policy. Washington, DC: Department of Health Policy, School of Public Health and Health Services, The George Washington University.

Wk 2 Discussion
EB is an older African American woman that presents with chronic health conditions including hypertension and glaucoma. Her hypertension is uncontrolled, her vision is worsening and upon inspection of her medications, she has not been taking them as prescribed. She lives alone and my immediate concerns are that she has poor vision, has not been taking her medications as prescribed and she did not bring all of her medication so it is currently unknown what else she is taking. In the United States, hypertension affects nearly 78 million adults aged 18 years or older and is a major modifiable risk factor for other cardiovascular diseases (CVD) and stroke (Price et. al., 2020). EB’s hypertension is currently uncontrolled and may also be a contributing factor to her worsening vision and glaucoma.

 

 

The questions I would ask are as follows:

  1. D you have anyone that helps you at home? Many older adults that live alone have personal care services or companion services to assist with ADL and IADL tasks throughout the day. This will also let me know if she has a willing or able caregiver to enlist to educate about her medication regimen.
  2. Describe your typical day for me? This will allow me a glimpse into what EB does daily, what priority she places on her daily activities, her level of exercise and what she finds important in her life.
  3. Can you explain to me what this medication is for? I’d do this for each medication. Instead of asking EB a yes/no question, this allows me the opportunity to see how much she understands of her medications and educate her on what each of her medications does.
  4. When do you take your medications? A lot of medication adherence issues stem from side effects of the medications. For example, many people stop taking diuretics due to having to urinate frequently overnight. This may be alleviated by taking the medication earlier during the day.
  5. Do you ever notice swelling or tightness in your feet or legs? If so, how often? This allows me to understand how frequently EB’s BP is high, and also to determine if she has taken her medication and is still experiencing symptoms if the current dosage is effective.
  6. What is the highest grade you completed in school? This will allow me to determine if literacy is a barrier to EB taking her medications properly.

I may not be able to get through all of these questions at the first visit, especially question # 3. If she has a caregiver or family member that is currently helping or willing to help, I would like to conduct this training with the patient and the caregiver, followed up with several home health visits to further engage them and instruct them on using a pill box or medi-minder device.

In reconciling EB’s medications, it is important to find out the medication that she left at home in order to avoid duplicative or contraindicative therapy. Because it appears that she is non-adherent, I would combine her hydrochlorothiazide with either the lisinopril or hydralazine to reduce the number of pills that she takes daily. More than 70% of adults treated for primary hypertension will eventually require at least two antihypertensive agents, either initially as combination therapy or as add-on therapy if monotherapy and lifestyle modifications do not achieve adequate blood pressure control (Smith, Lennon & Carlsgaard, 2020).

 

References:

Price, J. D., Jayaprakash, M., McKay, C. M., Amerson, N. L., Jimenez, P. L., Barbour, K. E., & Cunningham, T. J. (2020). Evidence-Based Interventions for High Blood Pressure and Glycemic Control Among Illinois Health Systems. Preventing Chronic Disease, 17, 1–9. https://doi-org.ezp.waldenulibrary.org/10.5888/pcd17.190058

Smith, D. K., Lennon, R. P., & Carlsgaard, P. B. (2020). Managing Hypertension Using Combination Therapy. American Family Physician, 101(6), 341–349.

 

Discussion: Diversity and Health Assessments

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).

Photo Credit: Getty Images

Randall’s statements sparked a great deal of controversy and debate; however, they emphasize an underlying reality in the healthcare field: different populations, cultures, and groups have diverse beliefs and practices that impact their health. Nurses and healthcare 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. Your Instructor will assign a case study to you for this Discussion.

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.
  • By Day 1 of this week, you will be assigned a case study by your Instructor. Note: Please see the “Course Announcements” section of the classroom for your case study assignment.
  • Reflect on the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient assigned to you.
  • 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 of Week 2

Post an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you were assigned. 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.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Read a selection of your colleagues’ responses.

By Day 6 of Week 2

Respond on or before Day 6 on 2 different days to at least two of your colleagues who were assigned a different patient than you. 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.

 

 

You made a point of stating that alcohol could potentially affect other aspects of a person’s life. Alcoholism can affect families and damage relationships. It destroys trust and makes it hard for family members to develop a strong connection with that individual.  Also, parents that struggle with alcoholism often neglect the physical and emotional needs of their children, which can lead to serious developmental issues. Alcoholism can also lead to domestic abuse, strain on finances and physical and mental health issues. Alcoholism does not just affect the person with the problem, it affects everyone around them as well.

References

Treehouse Rehab Editorial Team. (2019, November 22). 5 Effects of of Alcoholism on Family. Retrieved from Turning Point : https://www.turningpointtreatment.org/blog/5-effects-alcoholism-on-family/

 

Thank you for your post related to alcoholism.  This man appears to be self-medicating whether it is the easiest and cheapest access or whether it could be the most convenient way in which to cope with life stress.  Everaerd, Henckens, Bloemendall, and Maas (2020) share about the positive effects in which sleep has on memory performance as well as on positive coping mechanisms.  I personally can relate to this study since I am one who requires a great amount of sleep in order to deal with daily life challenges.  I realize that life can throw one different and unpredictable challenges, but a good night’s rest enables me to deal with daily problems in a suitable manner.

It appears as if this individual has looked for other ways in which to cope with his stressors which are unhealthy such as cigarette smoking.  This serves as a temporary satisfaction and in turn negatively impacts one’s health long-term.  It is unfortunate for people lose their way in life and resort to drugs and alcohol for methods in which to cope with challenges.  Baldacchino, Cruz, Reyes, & Colet (2017) report about using spiritual and/or religious beliefs as ways in which to cope with stress.  I find that being spiritual helps alleviate my stress and in turn helps maintain physiological health such as maintain my blood pressure and heart rate.  It also helps with my ability to acquire a better quality night’s sleep.

I feel as if family support helps too.  Kamaryati and Malathum (2020) share about the benefits of having family support in order to deal with challenges.  I find that many of those who resort to alcohol and/or drugs as means to cope with life stress that many of them have severed ties with family support.

References

Baldacchino, D., Cruz, J., Reyes, R., & Colet, P. (2017). Spiritual coping strategies scale. Journal of Religion and Health, 56. 1381-

1396.

Everaerd, D., Henckens, M., Bloemendall, M., & Maas, F. (2020). Good vibrations: an observational study of real-life stress

induced by a stage performance. Psychoneuroendocrinology, 114. https://doi-org.ezp.waldenulibrary.org/10.1016/j.psyneuen.

2020.104593

Kamaryati, N. & Malathum, P. (2020). Family support: a concept analysis. Pacific Rim International Journal of Nursing Research,

     24(3), 403-411.