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Chapter 3: Cultural Competence in the History and Physical Examination

Cultural Assessment #1

Customized or tailored to the client’s unique background.

Health history and physical exam interrelated.

With growing diversity comes the need for nurses to develop knowledge and skills in cultural assessment.

Cultural Assessment #2

Assessments form the foundation for the plan of care.

Tend to be broad and comprehensive.

Cultural assessment usually integrated into the overall assessment.

Health History #1

The purpose of the health history is to collect subjective data.

This is combined with the objective data from the physical examination for both well and ill clients.

Question #1

Is the following statement true or false?

Subjective data refer to things that people say or relate about themselves, whereas objective data result from the physical examination and the laboratory findings.

Answer to Question #1

True

Rationale: Subjective data come from the client and are information only they can give and confirm; objective data are observable and confirmed through sources other than the client.

Health History #2

Major data categories to be considered when conducting a culturally competent health history:

Biographic data and history

Genetic data

Review of medications and allergies

Reason for seeking care

Health History #3

Major data categories to be considered when conducting a culturally competent health history (cont.):

Present health and history of present illness (culture-bound syndromes)

Past health

Family and social history

Review of systems

Question #2

Is the following statement true or false?

Most cultures recognize the difference between prescribed medications and over-the-counter medications including herbs.

Answer to Question #2

False

Rationale: It is important to note all prescription and over-the-counter medications, including herbs, that clients might purchase or grow in home gardens. Because of cultural differences in peoples’ perceptions of which substances are considered medicines, it is important to ask about specific items by name.

Physical Examination #1

Accurate assessment and evaluation of clients require:

Knowledge of normal biocultural variations among healthy members of selected populations

Assessment skills that will enable you to recognize variations that occur in illness

Physical Examination #2

Biocultural variations in:

Measurements

Height, body proportions, weight (see Table 3-5)

Vital signs, including pain

General appearance

Physical Examination #3

Skin

Mongolian spots

Vitiligo

Hyperpigmentation

Cyanosis

Jaundice

Pallor

Erythema, petechial, ecchymoses

Addison’s disease, uremia, albinism

Normal age-related skin changes

Physical Examination #4

Body secretions

Apocrine glands

Eccrine sweat glands

Head

Hair (texture, color)

Eyes (structure, color, visual acuity)

Ears (size, shape, cerumen, hearing loss)

Mouth (pigmentation, cleft lip/palate, leukoedema)

Teeth (developmental, hygienic, nutritional indicators)

Physical Examination #5

Musculoskeletal system

Bone composition

Bone density

Bone curvature

Body composition

Question #3

Where is the most reliable location to assess for petechiae in a person with darkly pigmented skin?

Palms of the hands

Soles of the feet

Lining of the mouth

Upper chest and shoulders

Answer to Question #3

C. Lining of the mouth

Rationale: In dark-skinned clients, petechiae are best visualized in the areas of lighter melanization, such as the abdomen, buttocks, and volar surface of the forearm. When the skin is black or very dark brown, petechiae cannot be seen in the skin. Petechiae are most easily seen in the mouth, particularly the buccal mucosa, and in the conjunctiva of the eye.

Laboratory Tests

Biocultural variations occur with some lab test results, such as:

Hemoglobin

Hematocrit

Cholesterol

Serum transferrin

Blood glucose

Renal (creatinine, GFR)

Clinical Decision-Making and Actions

The three major modalities to guide nursing judgments, decisions, and actions are:

Cultural care preservation or maintenance

Cultural care accommodation or negotiation

Cultural care repatterning or restructuring

Question #4

Which is an example of cultural care accommodation?

Arranging the client’s dressing changes to avoid scheduled prayer times

Providing the client with foods that are aligned with his or her religious dietary concerns

Explaining to the client the need to reduce fat content from his or her ethnic high-fat diet

Arranging for an interpreter to facilitate communication

Answer to Question #4

A. Arranging the client’s dressing changes to avoid scheduled prayer times

Rationale: Cultural care accommodation or negotiation refers to professional actions and decisions that help people of a designated culture to adapt to or to negotiate with others for beneficial or satisfying health outcomes with professional care providers.