advanced health assessment

“EB is a 68-year-old black female who comes in for follow-up of hypertension. She has glaucoma and her vision has been worsening during the past few years. She lives alone and is prescribed four hypertension medications (Hydralazine 50 mg PO Q8H, Metoprolol XL 200 mg PO Q12H, Lisinopril 40 mg PO daily, and HCTZ 25mg PO daily). She brings in her medication bottles and she has some medication bottles from the previous year full of medications. She is missing one medication she had been prescribed and says she may have forgotten it at home. Her BP in clinic today is 182/99 with HR of 84.”

Cultural Factors: Socioeconomic, Spiritual, Lifestyle

Understanding a patient’s culture and beliefs is essential to achieve the best outcomes. Culture can be defined as a person’s behaviors, beliefs, attitudes, language, morals, religion, sexual orientation, education, and experiences in life (Ball, J.W., Dains, J.E., Flynn, J.A. Solomon, B.S., and Stewart, R.W. 2019). Every patient is unique based on their experiences in life and should be assessed as an individual. We must listen and understand our patient’s cultures to provide proper care. Respecting your patient’s culture will help build excellent communication and rapport. Socioeconomic status determines variations in health outcomes throughout the world (Williams, D.R. Priest, N., & Anderson, N.B. 2016). Also, a patient’s spirituality/religion can play a role in their adherence to a medication regimen (Abel, W.M., & Greer, D.B. 2017). Considering a patient as a whole and identifying any factors that may influence their care should be addressed by building trust and open communication.

Despite dramatic changes, among the minority groups, significant gaps still exist. There is a likelihood that the level of education for EB is low. Racial discrimination and socioeconomic deprivation are associated with higher psychological stress. According to Braveman et al. (2017), partially, wealth explains ethnic and racial differences in hypertension and depression. Zero net worth, negative net worth, and not owning a home in adulthood are associated with depression and hypertension.

Sensitive Issues

Several sensitive issues need to be addressed with the patient. Finances are a sensitive topic but essential to assess the patient’s ability to pay for medication. Is the patient not taking the medication as prescribed due to cost? Some patients will take medication every other day so that it will last longer. Another sensitive issue is the patient’s education level. Health literacy needs to be assessed. African Americans are more likely to have low health literacy due to education, culture, and the healthcare system (Melton, C., Graff, C., Holmes, G., Brown, L., and Bailey, J. 2014). It is essential to be aware of these statistics but to not stereotype someone based on their race (Ball, J.W., Dains, J.E., Flynn, J.A. Solomon, B.S., and Stewart, R.W. 2019). 

The patient should be assessed as a unique individual based on their culture and beliefs. The patient may not understand the importance of taking the medication as prescribed, as evidenced by the high blood pressure and old medication in the bottles. Educating the patient on their level of understanding is essential without making them feel uneducated. Using words and phrases that they would use to describe things should be assessed. Asking the patient to state their understanding of what you teach them is an excellent way to make sure they are receiving the information in a way they understand.

Targeted Questions

Targeted questions help to build the health history of a patient and assess his or her health risks, the following questions are critical;

1. What is your physical activity and diet regimen like?

This question is essential in establishing the reason why the patient chooses some foods and the kind of physical activities that he or she is involved in, thus making appropriate recommendations.

2. Have you been taking your medicine?

It is crucial to know whether the patient has been taking the medications he or she was given. It is vital to know if the medication is not working or inappropriate dosage.

3. Do you smoke, drink alcohol, or use any drug?

This question is important because smoking cigarettes, drinking alcohol, and drug abuse serve as risk factors for many conditions such as heart disease and hypertension?

4. Have you ever been admitted to the hospital?

This question is vital in establishing the seriousness of the condition that the patient is suffering from.

 

5. How do you fund your medication?

This question is essential in establishing whether the patient can fund his or her medication. 

 

 

References

Abel, W.M., & Greer, D.B. (2017). Spiritual/Religious Beliefs & Medication Adherence in Black Women with Hypertension. Journal of Christian Nursing: A quarterly Publication of Nurses Christian Fellowship, 34(3), 164-169. https//doi-org.ezp.waldenulibrary.org/10.1097/CNJ0000000000000333

Ball, J.W., Dains, J.E., Flynn, J.A. Solomon, B.S., & Stewart, R.W. (2019). Seidel’s guide to physical examination: An interprofesssional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Braveman, P. A., Cubbin, C., Egerter, S., Williams, D. R., & Pamuk, E. (2017). Socioeconomic disparities in health in the United States: What the patterns tell us. American Journal of Public Health, 100(S1), S186-S196. DOI:10.2105/AJPH.2009.166082.

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

Williams, D.R. Priest, N., & Anderson, N.B. (2016). Understanding associations among race, socioeconomic status, and health: Patterns and prospects.  Health Psychology, 35(4), 407-411. https://doi-org.ezp.waldenulibrary.org/10.1037/hea0000242