PLEASE RESPOND TO THIS POST BELOW( you don’t need to argue with her, you can add more suggestion to her post on how you can build history by doing health assessment on the case scenario she was assigned. Thank you!)
I was assigned the first case scenario involving a 54 y/o Caucasian male referred to the clinic post seizure r/t ETOH withdrawal. Hx – HTN, ETOH, Cocaine use. Pt is currently homeless and living in a shelter, out of his amlodipine, abstaining from alcohol and cocaine but still smoking.
Homelessness has a distinct link to increased mortality and morbidity and over half of the homeless population is over the age of fifty which additionally increases their risk for disease development (Lee, 2016). Unfortunately, because many homeless citizens are without health insurance or access to appropriate health care, these diseases often go untreated and are allowed to progress unopposed which increases the overall risk to the patient. This often presents a challenge to health care providers because this population is often unable or unwilling to strictly adhere to a suitable health care plan that could not only treat their current ailments but also prevent the development of further disease processes.
Because of this challenge, it is essential to establish a trusting foundation when assessing and treating this patient. Patients in general are more likely to follow a medically recommended care plan if they feel they are involved in the process and both have respect for and feel respected by their care provider. This is especially true when there are substantial obstacles such as in this case, financial, geographical, and educational the patient has to overcome in order to maintain compliance. There are a variety of legitimate concerns regarding healthcare access and compliance for this portion of the population so it is essential to create a plan that is feasible based not only on this patient’s needs but also their capabilities given these hurdles.
It is vital when interacting with this particular patient, that a health care provider remain sensitive and empathetic to their situation. If this patient feels they are being judged, they are unlikely to return for necessary follow up care or prioritize their health care plan. This is equally true regarding patients with substance abuse issues, as is the case in this scenario. Considering approximately 35% of the homeless population suffers from some form of substance abuse or addiction, it is essential that care providers also remain sensitive to this aspect during interactions with these patients (Lee, 2017). While this particular patient states he is currently abstaining from both illegal drugs and alcohol, it is unlikely that he has received any formal treatment for his addiction, therefore, that will need to be explored at this time.
It is also crucial when determining an appropriate treatment plan for both his physical and addictive issues, this patient feels involved and is given options. If the patient feels they have more control over this process, they are more likely to make the effort to maintain their recovery and make efforts to improve their health (Manning & Greenwood, 2019). While discussing these topics with the patient, it is important for the provider to give the patient plenty of opportunities to speak without interruption so they feel they are being heard and their personal concerns and not simply the concerns of the provider are being prioritized.
While this patient may not be viewed as being of a different culture, there is no doubt that the homeless community has established their own culture in our society. Therefore, I believe the RESPECT model would be an effective and beneficial tool to utilize with this patient. The RESPECT model is an acronym for rapport, empathy, support, partnership, explanations, cultural competence, and trust (Ball, et al., 2017). All of these topics should be a priority when establishing a relationship with this particular patient, therefore I think this model would be incredibly helpful in establishing trust between the health care provider and this individual.
Another essential area that needs to be addressed with this patient is his current nutrition status. This would include his access to food, the frequency and consistency of his meals, and whether or not his intake is meeting his nutritional needs. In addition, while this patient states he resides in a shelter, it is important to assess his degree of safety there, as well as any plans he has to establish his own independence. To address this issue, it may be prudent to involve a social worker if one has not already been assigned to this patient. The social worker can help this patient with his current social needs regarding jobs, housing, and available health and addiction treatment access. Some of the essential questions, I would personally like to ask during the examination of this patient are as follows:
What are your health care concerns today?
When was the last time you saw a doctor outside of the hospital? What did you seek treatment for at that time? Do you feel that provider met your needs at that time?
How do you feel about your current living arrangement? Do you feel safe there? When do you feel you will be in a position to establish your own residence? What do you see as the current obstacles preventing you from living on your own?
How often are you able to eat? Where do you get your meals from? How many times a day do you eat? What do your meals consist of? Do you often feel hungry during the day? When you feel hungry, do you have access to food at those times?
When did you last take you amlodipine? Why have you not taken your medication? Where do you usually get your medication? Are you able to afford your medication regularly? Do you know where to go to refill your prescriptions? Are you familiar with programs in place that may help you pay for your prescriptions?
When was your last drink? Are you feeling any withdraw symptoms at this time? Did you have any help to stop drinking or did you do that on your own? Was this your first time abstaining from alcohol or have you made attempts in the past? Is this the first time you ever had a seizure related to alcohol withdrawal? How long after you stopped drinking did you have that seizure? Would you like some help with your addiction? What kind of help do you think would be most beneficial to you at this time?
Do you feel you are ready to quit smoking at this time? Would you like some help to quit smoking? Have you ever tried to give up cigarettes in the past? How are you able to afford your cigarettes?
Resources: (Please use two of the following references on top of other resources you may use for references)
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Chapter 1, “The History and Interviewing Process” (Previously read in Week 1)
This chapter highlights history and interviewing processes. The authors explore a variety of communication techniques, professionalism, and functional assessment concepts when developing relationships with patients
Chapter 2, “Cultural Competency”
This chapter highlights the importance of cultural awareness when conducting health assessments. The authors explore the impact of culture on health beliefs and practices.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.
Chapter 2, “Evidenced-Based Clinical Practice Guidelines”
Melton, C., Graff, C., Holmes, G., Brown, L., & Bailey, J. (2014). Health literacy and asthma management among African-American adults: An interpretative phenomenological analysis. Journal of Asthma, 51(7), 703–713. doi:10.3109/02770903.2014.906605
Credit Line: Health literacy and asthma management among African-American adults: An interpretative phenomenological analysis by Melton, C., Graff, C., Holmes, G., Brown, L., & Bailey, J., in Journal of Asthma, Vol. 51/Issue 7. Copyright 2014 by Taylor & Francis, Inc. Reprinted by permission of Taylor & Francis, Inc. via the Copyright Clearance Center.
The authors of this study discuss the relationship between health literacy and health outcomes in African American patients with asthma.
Centers for Disease Control and Prevention. (2015). Cultural competence. Retrieved from https://npin.cdc.gov/pages/cultural-competence