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Diversity and Health Assessments

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Healthcare continues to evolve, adapt, and develop ways to provide the most safe and effective care possible. There is no cease in the growth of patient population as the demand for healthcare remains high. It is always safe to assume the worst diagnosis possible for our patients, but it is never right to stereotype the actual individuals. The case study chosen for this week is abaout a 33-year-old transgender male patient named John Green. The patient recently transitioned about two years ago. This discussion will review patient’s socioeconomic lifestyle, health assessment, as well as targeted questions shifted towards the patient’s case.

Socioeconomic Lifestyle

            The patient has recently has made his full transition debut to family and in public about 2 years ago. The patient’s current living situation is that he has moved back with his family but has no current way of supporting himself financially. The patient smokes heavily with cigarettes amounting about 2 packs a day for 10 years which is about 40 pack years. Aside from smoking cigarettes the patient smokes marijuana every weekend. There are studies that point towards anti-inflammatory benefits for patients living with HIV, but more research is needed. According to Ellis et al. (2021), over use or improper use of cannabis can lead to adverse side effects as well as a higher risk of developing psychiatric symptoms.  There was no disclosure of alcohol use or any other drug use, but should be addressed with the examination. The case study described the patient suffering from intermittent episodes of depression but has not been diagnosed and/or is taking medications. The patient is living with human immunodeficiency virus (HIV), but states that his viral load is suppressed as he is taking Biktarvy. The other medication he is taking are steroids, testosterone, intramuscularly once a week. Due to the current feelings of weakness, he moved back with family.

Health Assessment

            Based on the patient’s current problem list he presents with feelings of weakness. It is known that this patient has a confirmed diagnosis of HIV in which he is currently receiving treatment for. According to Giles et al. (2018), when compared to the general population, people living with HIV have a more than two-fold incidence of related morbidity, myocardial infarctions, and cancers when compared with those living without HIV. Essentially patients living with HIV have a higher risk of developing bacterial pneumonia as well as chronic obstructive pulmonary disease (COPD). The patient has a total of 40 pack years, which is about 2 packs a day throughout the 10 years of smoking. The risk of developing pneumonia is increased in those who currently smoke and have smoked in the past (Baskaran et al., 2019). Screening the patient for respiratory illness is vital at this point in time as well as screening for cardiovascular pathology due to the testosterone self-administrations.

            The patient disclosed having intermittent episodes of depression during the interview. It is important to assess the patient’s Columbia-Suicide Severity Rating Scale (C-SSRS). The assessment tool is used to determine the patients risk for suicide and injury. According to Hill et al. (2017), interrupted and aborted suicide attempts are associated with the frequency of actual suicide attempts, controlling for suicidal ideation and depressive symptoms. Mental health emergencies in healthcare are placed as high-priority patients. Patient’s experiencing any acute mental health issues are advised to promptly seek evaluation and treatment to prevent further deterioration.

Targeted Questions

            Regarding the patient’s case study, a targeted question list has been formulated and developed for the examination and interview of the patient. The questions developed are shifted towards the patient’s present problem list or chief complaints. Listed below are the questions:

  • Aside from smoking cigarettes and marijuana, are there any other drugs on board?
  • Do you drink alcohol? If so, how much/how often do you drink?
  • Do you have any chest pain or shortness of breath?
  • Have you had any recent fevers?
  • Have you experienced any recent weight loss?
  • Do you have any thoughts of harming yourself? If so, do you have a plan on how you might go about and do this?
  • Have you considered smoking cessation?

The list was developed regarding the patient’s current health status. It is important that since the patient is unemployed that he may be referred to a financial counselor so that he can seek ways to receive help with his health care and treatment. The priority of the visit is to figure out why the patient is feeling that his health is declining with the symptoms of weakness. Patient’s with HIV generally are at a higher risk for infection, so it is important to rule out any obvious infections. Suspicion for pneumonia is high due to his smoking history. Smoking while on testosterone therapy places this patient at a high risk for a major cardiovascular event, so it is important to rule out any cardiovascular pathology as well.

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Diversity and Health Assessments

Critique targeted questions, and explain how the patient might interpret these questions. Explain whether any of the questions would apply to my patient, and why.  Reply to this discussion

 

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The patient is a 33-year-old trans male presenting to the practice as a new patient. He has fully transitioned to family and friends from female to male approximately two years ago. His past medical history includes HIV positive undetected, depressive episodes, 20 pack-year smoking history, and smoking marijuana 3-6 joints every weekend (has marijuana green card). He obtains his testosterone from the internet and administers it to himself and receives his suppression medications through telehealth three months ago which are free. Building a health history for this patient through the clinical interview is crucial to developing an effective treatment plan as well as building a strong therapeutic relationship. The provider should utilize an affirmative approach since most LGBTQ patients have experienced oppression individually or institutionally (Solomon et al., 2017).

          During the health history the five integral questions that would help the provider get a better understanding of the patient’s socioeconomic, spiritual, or lifestyle needs:

  • Why do you think your health is declining?
  • Do you currently have health insurance?
  • Do you need social work assistance to help you obtain unemployment benefits or health insurance while finding a new job?
  • Do you need a prescription for testosterone?
  • Do you currently see any mental health professionals for your depressive episodes?

        The patient mentions he feels his health is declining, and asking him this open-ended question, “why do you think your health is declining?” is less threatening and allows the patient to freely answer in their own words. If the patient is noticeably struggling to articulate why he feels his health is declining or symptoms, I as the provider will recognize, and adjust the clinical interview to assist the patient in narrowing their thoughts, to allow for a targeted complaint that can be further evaluated clinically. Do you currently have health insurance is important because most Americans are insured through their employer, and if he is not employed, he may not be utilizing the state or federal resources, he is eligible for? Without health insurance patients do not usually seek preventative medicine, cannot afford their prescriptions, and only see their providers when they have health concerns (Eno et al., 2016).  Asking if the patient receives unemployment benefits or any type of government assistance like housing needs, SNAP benefits, Medicaid, transportation, or TANF will allow the provider to ensure he is utilizing his benefits or referring the patient to social work or financial advisor to help the patient apply. This also opens the conversation for, if they don’t have help how do they afford their medications or get to doctor’s appointments (Barber et al., 2015). Since the patient is purchasing testosterone online, asking if they need a prescription to be filled at a local pharmacy would ensure he is receiving testosterone that is FDA-approved, safe, and effective. The patient mentions experiencing depressive episodes, asking what his triggers may be and if he is open to seeing a mental health professional or perhaps, he already has one (Martyn et al., 2013). When conducting the patient sexual activity, I would be extremely sensitive when asking questions, or perhaps utilize a written questionnaire that a patient can answer prior to coming into the exam room. The talking points through the questionnaire would be those that the patient checked as needing more information or anything that would raise concerns about their health and well-being. While we are much more knowledgeable about the LGBTQ approach to healthcare, the medical landscape is constantly evolving. We as providers must continue to stay up to date with the latest research to guarantee we are providing the best possible care and that the patient’s experience is inclusive, nonjudgmental, and unbiased.

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Diversity and Health Assessments

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.

 

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CASE STUDY 2

Shawn Billings, a 28 year-old African American patient comes in to the clinic today. He has been deemed a “frequent flyer” by the staff at the clinic and was at the clinic last week and 4 days ago with a migraine, given a shot of Toradol and Ativan and sent home. He is here today again for an extreme headache. He is very agitated today. He is here with his father and worried that he will not get any medication.

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Diversity and Health Assessments

Diversity and Health Assessments

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).
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.

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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 following patients to consider for this Discussion:
40-year-old male on Prozac who works 60+ hours a week and wants to explore alternative and complementary modalities to help him sleep
Overweight female who traveled to Mexico to have gastric bypass surgery and is now experiencing complications
At-risk elderly 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
Transgendered patient (male-to-female) who is taking estrogen and wants to undergo sex reassignment surgery
32-year-old pregnant lesbian
Examine 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?
Question:

Discuss/give 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.

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