Week 1 Discussion: The Home Care Nurse Is Seeing A 68-Year-O

Week 1 Discussionthe Home Care Nurse Is Seeing A 68 Year Old Vietmanes

The home care nurse is evaluating a 68-year-old Vietnamese woman recently discharged from the hospital with a diagnosis of congestive heart failure (CHF). During the visit, the nurse observes elevated blood pressure, a productive cough, bilateral lower extremity edema, and auscultatory findings of scattered rhonchi in the upper lung bases, which clear with coughing. The patient expresses a dislike for taking prescribed medications, favoring herbal remedies instead, and communicates through her daughter, who acts as an interpreter. This scenario raises important considerations regarding the assessment, management, and culturally sensitive care for patients from diverse backgrounds, especially in the context of chronic illnesses like CHF. These elements are crucial for delivering safe, effective, and personalized nursing care.

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In this case, the most likely cause of the patient's elevated blood pressure, edema, and rhonchi relates to a combination of her underlying congestive heart failure, the potential effects of her herbal remedy use, and possible neglect of prescribed medication regimens. Congestive heart failure often leads to fluid overload, contributing to bilateral lower extremity edema (McMurray et al., 2019). Elevated blood pressure can exacerbate CHF symptoms by increasing the workload on the failing heart, and the presence of rhonchi suggests pulmonary congestion or fluid accumulation in the lungs, characteristic of heart failure's pulmonary manifestations. The patient's reluctance to take prescribed medications and preference for herbal remedies might lead to inadequate control of her condition, potentiating these clinical signs (Choi et al., 2020). Herbal remedies, while culturally significant, can interfere with pharmacologic treatments or mask symptoms, impacting disease management and outcomes.

Addressing these issues requires a comprehensive, culturally competent approach. The nurse should implement interventions targeting medication adherence, symptom management, and patient education. First, the nurse must establish trust and open communication, possibly involving the daughter as a cultural broker, to understand the patient's health beliefs and practices. Educating the patient on the importance of medication compliance, especially for CHF management, is vital, highlighting how herbal remedies can interact adversely with prescribed medications (Mair et al., 2021). The nurse should also assess the patient's understanding of her condition in the context of her cultural background and beliefs, utilizing culturally sensitive educational tools.

Interventions should include regular monitoring of vital signs, oxygen saturation, and edema status, along with encouraging compliance with medications and possibly integrating safe traditional practices with biomedical treatment when appropriate. For example, collaborating with a cultural health mediator or integrating herbal considerations within the care plan can foster a sense of respect and acceptance. Furthermore, lifestyle modifications, such as dietary sodium reduction and activity promotion, should be tailored to accommodate cultural preferences. The nurse also needs to educate about recognizing warning signs of worsening CHF, such as increased edema, cough, or breathlessness, and when to seek medical attention (Jiang et al., 2020).

To become culturally competent, the nurse must engage in ongoing education about Vietnamese health beliefs and practices, demonstrate cultural humility, and develop skills to communicate effectively across cultural differences. This involves understanding traditional health beliefs, the significance of herbal remedies, and family dynamics influencing health decisions. Attending cultural competence training, learning key phrases in Vietnamese, and consulting with cultural liaisons or community leaders can enhance understanding and trust. Building cultural competence also involves reflecting on personal biases, advocating for patient-centered care, and respecting cultural preferences while ensuring safety and effectiveness of treatment (Betancourt et al., 2018).

Finally, to provide care that reflects an acceptance of the patient's health and illness beliefs, nurses should adopt a collaborative and respectful approach. This includes engaging the patient and family in shared decision-making, acknowledging the importance of herbal remedies, and integrating them safely into the treatment plan when possible. The nurse can also employ culturally specific health education strategies—such as storytelling or visual aids—that resonate with the patient’s cultural context. Recognizing the significance of family in health-related decisions and involving family members in education and planning are further steps toward culturally sensitive care (Saha et al., 2019). Such strategies promote trust, enhance adherence, and improve health outcomes by aligning medical recommendations with the patient's cultural worldview.

References

• Betancourt, J. R., Green, A. R., Carrillo, J. E., & Ananeh-Firempong, O. (2018). Defining cultural competence: A practical framework for addressing racial/ethnic disparities in health and health care. Public Health Reports, 118(4), 293–302.
• Choi, E., Werlwas, B., & Han, H. R. (2020). Herbal medicine use and potential drug interactions among cardiac patients. Journal of Clinical Nursing, 29(21-22), 3768–3778.
• Jiang, W., Zhang, G., Min, Q., & Zhao, M. (2020). Culturally tailored interventions for heart failure self-management among Asian Americans. Heart & Lung, 49(4), 356-362.
• Mair, C., Dembkowski, S., & Spangler, J. (2021). Enhancing medication adherence in cultural populations: Strategies and best practices. Journal of Nursing Scholarship, 53(1), 55–62.
• McMurray, J. J. V., Adamopoulos, S., Anker, S. D., & et al. (2019). ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Journal of Heart Failure, 21(11), 1249–1259.