Respond to Catherine and Jasmine in the following way: Critique your colleague’s targeted questions, and explain how the patient might interpret these questions. Explain whether any of the questions would apply to your patient, and why.

At least 2 citations and 2 matching references

Catherine  

Main Post, week 2 case study

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Main Post

A 68 year old black female arrives at the clinic for a follow up of HTN. Her current BP is 182/99 and HR 84. She is on four different HTN medications (Hydralazine 50 mg PO Q8H, Metoprolol XL 200 mg PO Q12H, Lisinopril 40 mg PO daily, and HCTZ 25mg PO daily.) Some of her medication bottles from last year are still full, and she is missing one bottle that may still be at home. She lives alone and has glaucoma that is worsening her vision over the last few years.

When interviewing an elderly patient its important to introduce yourself clearly and do not speak too quickly. Ask your patient how they would like to be addressed. Elderly patients tend to respect formal language such as “Mr., Mrs., Ms., etc.” using words like “hon” can sound patronizing. Taking the time to establish good rapport has been shown to improve health outcomes and strengthen patient-provider relationships (NIH, 2017.) In addition to the fact this patient is elderly, studies have shown African Americans do not trust healthcare providers for a variety of reasons which usually stem from prior experiences with discrimination. Research has shown that racial and ethnic minorities feel they are less valued by health care providers and receive a lower standard of care (Hansen, Hodgson & Gitlin, 2016.) Providers should aim to gain trust of their patients by actively listening and engaging with them. It’s also important to note that her vision may be poor. Staff at the clinic may need to help this patient with any paper forms that may need to be filled out.

A few target questions I would ask this patient are:

1. What is your chief complaint or reason for visiting today?

2. Have you been taking your medications as prescribed?

3. It appears some of the bottles of your medications are still full, do you have difficulty reading the bottles?

4. Do you feel that you are on too many medications to keep up with?

5. Tell me about your home?

6. Do you have reliable transportation?

7. Do you have an ophthalmologist you are seeing for your glaucoma?

8. Are you on any eye drops for your glaucoma?

9. I see that you live alone, do you have a family member or friend to help if needed?

Glaucoma is the leading cause of irreversible blindness worldwide. Proper routine monitoring is key to reducing permanent vision loss (McMonnies, 2017.) It’s important to ensure that this patient has a follow up appointment with an ophthalmologist to keep this under control. I would also suggest trying to treat her BP with fewer medications if possible. I would suggest this patient coming in more often to re-evaluate her BP and ensure the medications are working. It may also be beneficial to set up maybe a home health consult, family member, or some kind of service that can help organize the patients pills and help with ADL’s if needed.

References

Hansen, B. R., Hodgson, N. A., & Gitlin, L. N. (2016). It’s a matter of trust: Older African           Americans speak about their health care encounters. Journal of Applied           Gerontology, 35(10), 1058-1076.

McMonnies, C. W. (2017). Glaucoma history and risk factors. Journal of optometry, 10(2), 71-   78.

NIH. (2017, May 17). Tips for improving communication with older patients. Retrieved June 8,   2020, from https://www.nia.nih.gov/health/tips-improving-communication-older-patients

Jasmine: Week 2 Discussion

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All patients come in with different backgrounds and different stories. Working as a mental health nurse the past year has really opened my eyes to a lot of different things. Patients go through many different obstacles in life and everyone deals with these obstacles differently. Some situations are difficult for certain people to handle compared to others. Working at a mental health facility, I also care for patients suffering from substance and alcohol abuse, these patients are going through addictions and withdrawals.

Patient AG a 54 year old Caucasian male comes into the clinic after a recent hospitalization due to having a seizure related to alcohol withdrawal. The patient has hypertension and a history of cocaine and alcohol abuse.The patient is homeless, the number of people experiencing being homeless has increased nearly three percent in 2019. and states that he stopped taking his hypertension medication. Patient states that he is abstaining from alcohol and cocaine but needs to smoke cigarettes to calm down due to not drinking anymore. Studies show that alcohol related mortality and suicides have increased since the late 1990s (Glei, 2019).

Starting this patients assessment, I would want to know the patient’s outlook on his health and how he feels the cocaine and alcohol are affecting his life. Being that the patient just had a recent hospitalization due to a seizure but states he is abstaining from alcohol and cocaine, I would want to know when did he stop drinking and using? When was the last time he used? I would also want to know in his words, what causes him to relapse? Due to the patient being homeless, some financial questions would be in concern such as, how does he support his habit? Questions about medication compliance would also be very beneficial. I would want to know how much the patient knows about hypertension and medication compliance. Hypertension is a major risk factor in adults for cardiovascular disease and causing death (Kang, 2020).

Targeted questions

1. How do you feel alcohol and cocaine are effecting your life?

2. When was the last time that you used cocaine and alcohol?

3. What are your concerns pertaining to your health?

4. Tell me about your medication compliance.

5. Tell me about the stressors in your life that cause you to relapse?

6. Do you have any financial concerns?

7. Are you having any suicidal/homicidal thoughts?

References

Glei, D. A., & Weinstein, M. (2019). Drug and Alcohol Abuse: the Role of Economic Insecurity. American Journal of Health Behavior,

     43(4), 838–857.

Homelessness in the United States: The federal government’s annual census of unhoused people. (2020). Congressional Digest, 99(5), 3–5.

Jiyeon Kang, & Yeon Jin Jeong. (2020). Psychological Resistance to Drug Therapy in Patients with Hypertension: A Qualitative

Thematic      Analysis. Korean Journal of Adult Nursing, 32(2), 124–133.

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