Advanced Health Assessment Discussion Response Paper
Great Post! I agree that in order to be a culturally competent healthcare practitioner, one should be capable of adapting to the individual requirements of patients from diverse cultures and backgrounds (Ball et al., 2015). Cultural competency is generally regarded as a critical element for minimizing inequities in health care by providing culturally sensitive and fair treatment. As pointed out by the Centers for Disease Control (CDC, 2019), culturally competent care is described as care that acknowledges patient diversity as well as cultural aspects that might influence health and healthcare, like behaviors, attitudes, beliefs, communication styles, and language Advanced Health Assessment Discussion Response Paper.
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Understanding what socioeconomic status entails is critical when dealing with this client’s socioeconomic status issue. Health behavior, environmental exposure, and healthcare are all influenced by socioeconomic status (SES). A broad variety of health issues, including hypertension, cardiovascular disease, cancer, diabetes, and many others, are associated with socioeconomic status, whether defined by profession, education, or income.
I agree with all of your questions, however, I believe the following should have been addressed: How have you dealt with your glaucoma diagnosis and how has it altered your way of living? Although the above question is critical, healthcare providers, especially nurse practitioners conducting a comprehensive evaluation, should concentrate on or apply Maslow’s Hierarchy of Human needs. Applying the Maslow Hierarchy will assist you in addressing the needs of your clients in order of significance and what is most pertinent or significant to them. Above all, everything must be centered on safety. Considering that the patient has visual problems and is on medications for the past year, I would have questioned her safety. For instance, I would ask, “Have you ever had a fall?” or “How do you distinguish your medicine?” “Show me the container in which you keep your medicine Advanced Health Assessment Discussion Response Paper.”
References
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby. https://www.elsevier.com/books/seidels-guide-to-physical-examination/ball/978-0-323-11240-6
Centers for Disease Control and Prevention. (2015). Cultural competence. Retrieved from https://npin.cdc.gov/pages/cultural-competence
Discussion response When treating any patient, the advanced practice nurse should always consider the patient’s culture in every aspect of care. This includes recognizing the factors influencing the patient, but also realizing any limitations and biases the nurse may have. Culturally competent care requires lifelong learning about different cultures, and also understanding patient individuality (Ball, Dains, Flynn, Solomon, & Stewart, 2019). To start, I would ask the patient “is there a reason for not taking your blood pressure medication?”. Whatever their reasoning is, is what will need to be overcome in order to ensure compliance. Leading with this will create a patient centered approach. The patient in this case study is a 68 year old black female who has been prescribed multiple antihypertensive therapies with poor compliance and elevated blood pressure of 182/99 on assessment. She also has a history of glaucoma with worsening symptoms. While there are many things to consider and assess for, to begin, culture should be considered. One cultural consideration is health literacy disparities among the elderly population Advanced Health Assessment Discussion Response Paper.
One of the biggest barriers to compliance with care is a lack of health literacy. Medication adherence for hypertension among the elderly population ranges from 26- 59%, despite an 80% compliance needed to maintain elevated blood pressure. Elderly patients who have a low health literacy report a difficult time understanding treatment and therefore are less likely to follow the plan of care (Wannasirikul, Termsirikulchai, Sujirarat, Benjakul, & Tanasugarn, 2016). One example is the patient may have adverse side effects of one medication and believe that any medication for hypertension would cause this side effect, and therefore are not willing to take the medication. One way to combat health literacy issues is to provide high quality education to the patient that meets their needs and ensure understanding. This could include using an interpreter if needed, have the patient do a teach-back, and include a patient’s family member in the training (Ball, Dains, Flynn, Solomon, & Stewart, 2019). The advanced practice nurse should also assess for impaired cognition, as this is a large barrier to compliance, and memory decline may be under reported by the elderly (Wannasirikul, Termsirikulchai, Sujirarat, Benjakul, & Tanasugarn, 2016). Some targeted questions to address these concerns include “blood pressure medication needs to be taken every single day at a scheduled time. What barriers do you see to doing this?” “Do you ever find yourself forgetting to take your medication?”, “have you ever used a pill organizer?” “What would happen if you forgot to take your blood pressure medication?”. Another factor to consider is that African American females have the highest rates of hypertension in the United States and therefore are at the highest risk for adverse outcomes. Some cultural beliefs among the American American population related to the cause of hypertension include that it is caused by headaches, that it is related to stressors of racism and descrimination, or that all black people have it. If the patient feels this way, they may be less likely to adhere to medication (Spike et al., 2019). African Americans are more likely to have a lower level of education due to social inequities which may also contribute to a lower health literacy (Melton, Graff, Holmes, Brown, & Bailey, 2014) In addition, social inequities among African Americans may lead to increased depressive symptoms and a lack of social support Advanced Health Assessment Discussion Response Paper.
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Increased stressors have been shown to have poor outcomes on health (Spike et al., 2019). Some targeted questions to address these issues include “what kind of support do you have?”,, “Does anyone in your family have high blood pressure?”, “How has your family member dealt with their high blood pressure?”. On top of these considerations, I would also review the medications that the patient is taking for hypertension, which include Hydralazine 50 mg PO Q8H, Metoprolol XL 200 mg PO Q12H, Lisinopril 40 mg PO daily, and HCTZ 25mg PO daily. According to the JNC8 algorithm, patients over 60 years old who are black should begin with treatment on a thiazide diuretic and/or a calcium channel blocker. The guidelines then call for addition of an ace inhibitor or ARB if maximum doses have been reached with lifestyle changes and no improvement in blood pressure (JAMA Network, 2014). The patient in this scenario is not on a calcium channel blocker, which is something I would consider. I also would determine what lifestyle modifications, if any, the patient has made. Some targeted questions would include “What does a typical day of meals look like?” “Do you exercise? How often?” and provide necessary education on the importance of a low salt diet and exercise Advanced Health Assessment Discussion Response Paper