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Advanced Health Assessment & Diagnostic Reasoning

Respond to your colleagues who were assigned a different patient than you. 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. Advanced Health Assessment & Diagnostic Reasoning Patient Scenario: EB is a 68-year-old black female who comes in for a 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 the clinic today is 182/99, with HR of 84. Providing quality care is an essential part of being a provider; therefore, it is vital to be able to build trust with patients regardless of cultural factors such as socioeconomic status, religion, lifestyle, or health beliefs. It is essential to recognize and assist in bridging the gap between cultural diversity and healthcare. Socioeconomic Factors There are several areas incorporated with socioeconomic status; these areas include financial, educational, and social status. According to Fiscella, Franks, Gold, and Clancy (2018), the aspects of one\’s quality of life, opportunities, and freedoms within society play a role in their socioeconomic status. Socioeconomic factors related to EB include that she is a minority as she is a black female of retirement age; thus, the practitioner should assess EB\’s financial status, health insurance status, as well as her health education status. EB has vision loss due to her glaucoma, and her hypertension has not improved as she is not taking her medications appropriately, she lives alone and most likely does not have the financial means to pay a caregiver to come in and assist her with her care and medications. Spiritual Factors Assessing EBs religious practices related to her healthcare as her religious beliefs may impact an essential part of her care as her choices and behaviors toward her healthcare. According to LeDoux, Mann, Demoratz, and Young (2019), healthcare may be influenced by religious practices and devotion to religious and cultural customs such as Jehovah\’s Witnesses not accepting blood transfusions. Other spiritual factors such as inner peace, compassion, and gratitude can beneficially affect one\’s health by promoting positive emotions and diminishing the destructive consequences of stress on one\’s health; thus, affecting the patient\’s blood pressure positively or negatively (Fitchett & Powell, 2019). Lifestyle and Other Cultural Factors According to Braveman et al. (2017), racial discrimination is linked to unfavorable health results as well as diverse psychological and emotional states; therefore, depression, smoking, and other unhealthy behaviors occur within minority populations. EB\’s lifestyle could play an essential role in her high blood pressure, so finding out what kind of diet she follows as well as if she smokes cigarettes or drinks alcohol will play an essential role in the treatment of her care. Sensitive Issues According to Brooks, Manias, and Bloomer (2018), quality care and patient safety have improved, but sensitive communication has not due to being poorly understood; therefore, practitioners must gain the understanding of communicating sensitive information with their patients. Health insurance and financial status may be a sensitive issue to discuss with EB as she may be embarrassed to talk about these issues as she may be struggling to pay her bills as well as not having any health insurance to cover her visit. Another sensitive subject to discuss with EB is elder abuse, as older patients will generally not talk about these issues as they fear retaliation and the fear of not having someone available to assist them when needed. End of life issues are also another sensitive issue as the patient, and the family may not be ready to discuss this information. Targeted Questions What symptoms are you having? What if any difficulties are you having with taking your prescribed medication? What does your diet consist of? Do you utilize cigarettes, alcohol, or street drugs? Can you explain your diagnosis and treatment plan regarding your hypertension? Do you have the means to pay for your medication?

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