Cultural Considerations: Ethnicity, Occupation, Religion, Fa ✓ Solved

Cultural Considerations Ethnicity Occupation Religion Family Supp

Cultural considerations, ethnicity, occupation, religion, family support, insurance. Socioeconomic/Cultural/Spiritual Orientation & Psychosocial Considerations/Concerns, to include the following Social Determinants of Health: Patient is retired and not employed, married and lives with spouse, has received prior health advice and has knowledge on health, is American, and prefers English.

History of Present Illness (HPI): The 63-year-old patient was admitted to Holy Cross Hospital on September 22, 2020, presenting with new onset of right facial weakness and numbness consistent with stroke. Stroke was ruled out; further evaluation revealed lateral medullary syndrome and atrial fibrillation. Patient has an elevated hemoglobin A1c of 6.1.

Medical History: The patient has been on medication; none had contraindications found. No known allergies. Family history includes heart diseases, with onset ages of 50-60 in grandfather and 60 in father.

Surgical History: Right hand surgery and ACL repair of the lower extremity.

Social History: Denies drug use, smoking, and alcohol consumption. Has a supportive spouse.

Chief Complaint: Numbness and weakness on right facial side.

Admitting Diagnosis: Lateral medullary syndrome and significant four-vessel coronary artery disease.

Patient Information: Name: M.S., Age: 63, Gender: Male, Code Status: Full code, DPOA: NA, Living Will: Yes.

Patient Education & Discharge Planning:

• Continue follow-up with primary care physician.
• Encourage adequate rest.
• Medications are to be issued but not lifelong.
• Drink fluids to prevent electrolyte imbalance.
• Home blood pressure monitoring.
• Patient demonstrated understanding of dietary changes and lifestyle modifications.
• Instruct in energy-conserving behaviors.

Concept Map #1: Student Name: Adidley Garcia, Instructor: Yader Perez.

Diagnostic Tests/Lab Results with Dates and Normal Ranges:

• CT scan (No abnormalities identified, 10/11/2020).
• Hemoglobin level (13.8 to 17.2 grams per deciliter, 22/09/2020).
• RBC (4-6 million, 10/29/2020).
• WBC (5, 10/29/2020).

Erickson’s Developmental Stage: The patient is in the integrity vs. despair stage, consisting of individuals over 60 years old.

Interventions #1: Assess impairment extent regularly, inspect skin for pressure points, and change positions at least every two hours.

Priority Nursing Diagnosis #1: Impaired Physical Mobility due to neuromuscular weakness.

Vital Signs: Temp: 36.6, Pulse: 75, SpO2: 98 at room air.

Neurological Assessment: Mild right facial weakness, alert and oriented.

Respiratory Assessment: Diminished lung sounds at bases.

Priority Nursing Diagnosis #2: Disturbed Sensory Perception due to neurological trauma.

Outcomes/Goals: Patient will regain consciousness and perceptual functioning by shift’s end and maintain/increase strength prior to discharge.

Interventions #2: Observe behavioral responses, use calm speech, and reorient the patient frequently.

Assessment/Evaluation: Goals met for mobility and sensory perception, implemented interventions appropriately.

Potential Complications: Risk of injury related to altered sensory perception.

Nutrition/Hydration: Well-nourished.

Medical Management/Orders: Medications include Enoxaparin to prevent clots, Oxycodone for pain, and Cyclobenzaprine as a muscle relaxant.

References: Gross, Y. (2020), RaiÄ, M. (2017), Saleem, F. (2020), Unsworth, D. J. & Mathias, J. L. (2017), Vera, M. et al. (2020).

Paper For Above Instructions

In the context of health care, understanding cultural considerations such as ethnicity, occupation, religion, family support, and socioeconomic factors can greatly influence patient care and outcomes.The patient in question is a 63-year-old retired male, married and adept in English, with a nuanced medical history that includes significant family predispositions to heart disease. Cultural backgrounds can dictate not only health beliefs but also attitudes toward healthcare systems, impacting compliance and interaction with providers (Betancourt et al., 2016).

Patient education and discharge planning are critical components of care, ensuring that patients fully understand their health conditions and treatment plans. For instance, this patient demonstrated a clear understanding of dietary restrictions and lifestyle changes necessary to manage his atrial fibrillation and associated comorbidities (American Heart Association, 2019). It reflects not just personal commitment but also the effectiveness of the educational interventions enacted during his hospital stay.

Regarding the patient's presentation, lateral medullary syndrome was diagnosed, evidenced by neurological deficits such as facial weakness and numbness. This is a significant condition primarily resulting from vascular events in the medulla oblongata and underscores the importance of a quick and accurate diagnosis to facilitate proper intervention (Saleem, 2020). His elevated hemoglobin A1c level indicates pre-diabetes, necessitating counseling on lifestyle changes, particularly concerning diet and exercise, as mentioned during his discharge planning.

Patient history reveals a supportive social network, particularly his spouse. Research indicates that social support can have profound impacts on mental health and recovery (Uchino, 2009); stress related to health concerns can be mitigated through strong family ties, underscoring the need to enlist family in the healing process.

The Erikson's developmental stage relevant to this patient emphasizes integrity versus despair. Individuals navigate reflections on their lives, which may influence mental and emotional well-being. Those struggling with this stage may face increased risks of psychosocial complications, impacting recovery trajectories (Gross, 2020). Consequently, healthcare providers should integrate assessment of psychosocial status into routine evaluations.

Interventions, as outlined in the care plan, include diligent monitoring of neurological status and physical capabilities. This patient will require regular reassessment of mobility and sensory perception due to his condition. These assessments aim to prevent complications such as pressure injuries and falls, reflecting the nursing diagnosis of impaired mobility (Nolan et al., 2014).

Additionally, the nursing staff addressed potential complications by ensuring patient safety during activities of daily living. This involves tailoring interventions to accommodate the patient’s neurological deficits while promoting maximal independence and safety, thus enhancing quality of life and fostering recovery.

Medical management of this patient includes anticoagulant therapy with Enoxaparin, while pain relief employs Oxycodone/acetaminophen. Both medications require careful monitoring for side effects, particularly with Oxycodone, which can lead to dependency issues (Mayo Clinic, 2020). The case highlights the necessity of balancing effective pain management with the risk of adverse outcomes, a common challenge in geriatric patients.

The outcome goals set for the patient are comprehensive: enhancing mobility, preventing complications, ensuring understanding of health management, and supporting psychosocial well-being. These goals reflect a holistic approach to nursing care, emphasizing the interconnectedness of physical and emotional health (Heath et al., 2020).

In summary, the incorporation of cultural, socioeconomic, and medical historical factors into the care of a patient such as M.S. enhances the care process and supports better health outcomes. Each patient's care plan should be uniquely tailored, reflecting their personal context while adhering to best practices in medical and nursing care. The interdisciplinary collaboration among healthcare providers further enriches the patient's journey to recovery.

References

• American Heart Association. (2019). Heart disease and stroke statistics—2019 update. Circulation, 139(10), e56-e528.
• Betancourt, J. R., Green, A. R., Carrillo, J. E., & Ananeh-Firempong, O. (2016). Defining cultural competence: A practical framework for addressing racial/ethnic disparities in health and healthcare. Public Health Reports, 121(5), 493-501.
• Gross, Y. (2020). Erikson's Stages of Psychosocial Development. The Wiley Encyclopedia of Personality and Individual Differences: Models and Theories.
• Heath, B. J., et al. (2020). Integrating behavioral health and primary care: A guide for providers. Journal of Health Care for the Poor and Underserved, 27(2), 289-298.
• Mayo Clinic. (2020). Oxycodone and acetaminophen (oral route) description and brand names. Retrieved from https://www.mayoclinic.org/drugs-supplements/oxycodone-and-acetaminophen-oral-route/description/drg-20038477
• Nolan, L. D., et al. (2014). Implications for the management of patients with impaired mobility: A review of current evidence. Rehabilitation Nursing, 39(6), 308-315.
• Saleem, F. (2020). Lateral Medullary Syndrome. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7631231/
• Uchino, B. N. (2009). Understanding the links between social support and physical health: A life-span perspective with emphasis on the separability of perceived and received support. Perspectives on Psychological Science, 4(3), 236-255.
• Unsworth, D. J., & Mathias, J. L. (2017). Traumatic brain injury and alcohol/substance abuse: A Bayesian meta-analysis comparing the outcomes of people with and without a history of abuse. Journal of Clinical and Experimental Neuropsychology, 39(6).
• RaiÄ, M. (2017). Depression and heart diseases: Leading health problems. Psychiatria Danubina, 29(Suppl 4), 770-777.