Case 5:
AG is a 54-year-old Caucasian male who was referred to your clinic to establish care after a
recent hospitalization after having a seizure related to alcohol withdrawal. He has hypertension
and a history of alcohol and cocaine abuse. He is homeless and is currently living at a local
homeless shelter. He reports that he is out of his amlodipine 10 mg which he takes for
hypertension. He reports he is abstaining from alcohol and cocaine but needs to smoke cigarettes
to calm down since he is not drinking anymore.
Explanation of socioeconomic, spiritual, lifestyle, and other cultural factors
According to the scenario, the client’s socioeconomic status is compared with him being
homeless which includes his economic and sociological levels, and how those factors are
measured on the lower end of the spectrum. For example, the Advanced Nurse Practitioner is
required to understand that when a client’s socioeconomic status consists of homelessness, the
interview and communication process must consist of thoroughly assessing health related risk
factors, and an individualized screening tool. Although the case study does not mention the
client’s spiritual factors, the Advanced Nurse Practitioner is required to understand that spiritual
needs do not always resemble religious needs. Therefore, the communication process must
involve detailed questions that address the client’s needs, such as ethical factors, meaningful
influences, right and wrong considerations, and elements about their faith (Nurse.Org. 2017). For
example, individualized questions should include assessing spiritual needs, like what is most
meaningful, asking the client about ethical decisions concerning the dying process, and their
needs for support from spiritual leaders or counselors. Furthermore, the case study mentions the
client’s lifestyle factors, such as a history of smoking, alcohol, and cocaine abuse. With that said,
the Advanced Nurse Practitioner is required to educate the client about risk factors and evidence-
based solutions to help promote effective outcomes. To help the client understand the severity of
cigarette smoke and how it contributes to hypertension,2the Advanced Nurse Practitioner is
required to explain that nicotine is a sympathomimetic medicine which releases catecholamines,
increases heart rate and cardiac contractility, constricts cutaneous, and coronary blood vessels,
and rapidly increases blood pressure (Benowitz, 2009). With that said, the Advanced Nurse
Practitioner must warn the patient that they are at an increased risk for stroke or heart attack
because of their lifestyle and noncompliance with their blood pressure medication (amlodipine
102mg).
Addressing sensitive issues when interacting with the patient
While communicating, addressing, and interacting with the patient, the Advanced Nurse
Practitioner is required to utilized an evidence-based technique that establishes trust and provide
a foundation for health care support that help resolve sensitive issues. Ball et al., (2019), points
out that the RESPECT Modell guides the practitioner through addressing sensitive issues.
Because the patient in this case study requires the practitioner to focus on psychological issues as
well as health risks, the RESPECT Modell upholds ethical elements, such as rapport, empathy,
support, partnership, explanation, cultural competence, and trust (Ball et al., 2019). For that
reason, the Advance Nurse Practitioner is required to build a strong rapport by being
nonjudgmental, show empathy through helping and providing the patient with resources for
housing, support the patient by providing resources for financial assistance, ensure partnership
by working together to find public health programs that addresses smoking and substance abuse,
provide an explanation for compliance and health risks associated with a low socioeconomic
lifestyle, as well as establish trust through assuring confidentiality (Ball et al., 2019).
Targeted Questions
1. When was the last time you checked your blood pressure?
2. When was the last time you had a seizure?
3. How many packs of cigarette do you smoke daily?
4. How did you become homeless?
5. What are your financial issues?
2
References
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019).2Seidel's guide
to
physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier
Mosby.
Benowitz, N. L. (2009). Pharmacology of nicotine: addiction, smoking-induced disease, and
therapeutics.2Annual review of pharmacology and toxicology,249, 57–71.
Nurse.Org. (2017). Nursing Tips: How to build rapport with your patients. Retrieved
from https://nurse.org/articles/building-rapport-with-your-patients/
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