26 Sep BK is a 16-year-old Caucasian female who comes in
BK is a 16-year-old Caucasian female who comes in with her grandmother for an annual exam. The grandmother reports BK has been “acting strange, staying in her room all the time and refusing to do all the things she used to enjoy like singing in the youth choir”. Grandmother shares that BK’s mother is a drug addict is currently incarcerated so she is worried BK is using drugs and wants her tested for drugs. BK is not on any medications. She is obese and does not make eye contact when you enter the room. Post an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you were assigned. Explain the issues that you would need to be sensitive to when interacting with the patient, and why. Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks. please response separeately Respond on or before Day 6 on 2 different days to at least two of 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. Explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you were assigned. At the age of 16, most adolescents do not know how to differentiate good form bad. Most children at this age are eager to try new things and make a decision without any assistance from family members. Parents need to be careful at this level and be very observant of any changes out of the ordinary. This is an age where parents often see warning signs of mental health issues or substance abuse problems (Morin, 2018). Socioeconomically, 16 years old are totally dependent on their family for food, clothing, and shelter. Most of them do not keep a full-time job. They sometimes work on holidays to be able to have money to pay for things like phone bills and fast food. Spiritually, adolescents learn from what they see their family and peer doing. The main settings that influence the way children and adolescents grow up include families, neighborhoods, and schools. The quality of these settings, and whether they are supportive and nurturing or dangerous and destructive, have a profound influence on adolescents’ chances for leading successful adult lives (Escarce, 2003). Culturally the patient is a 16-year-old Caucasian who barely takes orders from family. On the one hand, her mother does not take an active role in the patient’s life because she is incarcerated for drug abuse; this makes it difficult for the child to get a good sense of their culture. In this instance, the likely hood of the 16-year-old to know their culture is through her grandmother and her peers. Explain the issues that you would need to be sensitive to when interacting with the patient, and why. One of the issues that I will be sensitive when discussing with the adolescent is the use of drugs. The reason is that the patient family has a history of drug abuse, so in other for the patient to open up, I will need to be careful when talking about it. An estimated 741,000 adolescents suffered from an illicit drug use disorder in 2017, or about 3% of this population (Thomas, 2020). It is a crisis, and it needs to be addressed patient by patients. Another issue that I will be sensitive when discussing with the patient is depression and suicide. Depression is a major issue facing our society today. The patient has been staying in her room and does not want to talk to anyone and does not engage in social activities. These are signs of depression, which can lead to suicide, so it should be addressed with care. Depressed adolescents have a suicide rate of 7.7%, a fivefold increased risk for a first suicide attempt. Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks. Do you have any suicidal thoughts and if so do you have a plan in place Are you taking any illicit drugs? If yes, what is the name of the drug? So you feel lonely without your mother I will also ask an open-ended question, which is what is bothering you and what your concerns are. Finally, I will ask the patient what her past medical condition is and if she is pregnant. Escarce, J. J. (2003, October). Socioeconomic status and the fates of adolescents. Retrieved March 4, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1360943/ Hauenstein, E. J. (2003, March). Depression in Adolescence – Journal of Obstetric … Retrieved March 4, 2020, from https://www.jognn.org/article/S0884-2175(15)34053-3/fulltext Morin, A. (2018, October 19). Here’s What to Expect From Your 16-Year-Old. Retrieved March 3, 2020, from https://www.verywellfamily.com/16-year-old-developmental-milestones-4171922 Thomas, S. (2020, February 3). Addiction Statistics: Drug & Substance Abuse Statistics. Retrieved March 4, 2020, from https://americanaddictioncenters.org/rehab-guide/addiction-statistics This post will discuss and explain the socioeconomic, spiritual, lifestyle, and other cultural factors of a 23-year-old Native American male with anxiety who self-medicates by smoking marijuana and drinking alcohol and is afraid he will not get into heaven with his lifestyle. He states he isn’t taking any prescription medications and denies drug use but admits to a family history of diabetes, hypertension, and alcoholism. This post will also explain the issues the advanced practice registered nurse (APRN) needs to be sensitive to and will provide five targeted questions the APRN will ask the patient to build a health history. Socioeconomic, Spiritual, Lifestyle, and other Cultural Factors There are specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with this 23-year-old Native American Male. For example, Espey et al. (2014) found that obesity is becoming more prevalent in Native Americans because of the food and water improvements from the Indian Health Service (HIS), and consequently, more Native Americans are developing cancer, diabetes, heart disease, and stroke. Therefore, with the patient’s family history of diabetes and hypertension, the APRN should explore this patient’s diet and exercise program. Due to cultural factors, the APRN should examine this patient’s use of alcohol and other drugs and also his potential to harm himself or others. According to Espey et al. (2014), there is a high homicide and suicide rate and chronic liver disease in the Native American population compounded by the abuse of alcohol and other drugs. Therefore, the APRN needs to be culturally aware of these social determinants leading to drug and alcohol abuse. The use of marijuana may be increasing his anxiety. According to Leadbeater et al. (2019), young adults age 22 and up who used marijuana developed more psychotic symptoms. Therefore, the APRN should explore all the possible reasons for this patient’s anxiety, including marijuana use. Sensitive Issues The APRN needs to be sensitive to patient-specific issues while interacting with this patient. For example, Espey et al. (2014) discussed how Native Americans have “endured a legacy of injustice and discrimination with multiple negative manifestations, including alarming health disparities and inadequate health care” (p.S303). Therefore, the APRN needs to be sensitive to this patient’s history of injustice and discrimination while building his health history. To be sensitive to this patient’s unique needs, the APRN needs to be culturally competent. Being culturally competent means the APRN has the attitude and behavior to effectively work as a professional in a cross-cultural situation (Centers for Disease Control and Prevention, 2015). Likewise, Ball et al. (2019) discussed achieving cultural competence “through a learning process that requires self-awareness, reflective practice, and knowledge of core cultural issues” (p.22). The patient, in this example, expressed concerns about his spiritual beliefs and getting into heaven. Thus, the APRN should be culturally sensitive to this patient’s religious beliefs when offering treatment. According to Mehl-Madrona (2016), APRNs are more successful with targeted interventions towards the individual’s beliefs about death in native communities. Therefore, this APRN should offer drug and alcohol counseling consistent with his spiritual beliefs. Five Targeted Questions to Build a Health History For the APRN to build a health history and assess this patient’s health risks, she should ask targeted questions. Since according to Willging et al. (2018), Native American’s are more likely to be uninsured, suffer from more significant morbidities, have poorer health outcomes, have a lower quality of life, and lower life expectancies, the APRN should focus her targeted questions on these health disparities. For example, the APRN should ask the patient if he has access to health care and should focus on his access to insurance, proximity to a health care center, and willingness to be compliant with suggested preventative care. Next, the APRN should ask how much and how often the patient smokes marijuana and drinks alcohol to determine the extent of his drug and alcohol problem. These questions should help the APRN make the appropriate treatment recommendations. The third and fourth targeted questions should be what type of diet the patient follows and what his exercise routine is. Since the patient’s health history is positive for alcoholism, hypertension, and diabetes, the APRN could use this information to guide treatment options. For example, Allison (2017) discussed how diet and exercise contributed to the successful management of chronic diseases such as diabetes and hypertension. Therefore, the APRN could use this information to assess this patient’s health risks. Finally, the APRN should ask a targeted question about the patient’s mental health since he reported anxiety, uses alcohol and marijuana, and talked about death. The APRN should ask the patient if he wants to hurt or kill himself, or hurt or kill others as a risk assessment screening tool. For example, Leavitt et al. (2018) discussed that suicide rates in American Indians was 3.5 times higher than in other racial and ethnic groups. Therefore, a targeted question on this patient’s mental health would assist the APRN in building this patient’s health history. References Allison, R. L. (2017). Back to basics: The effect of healthy diet and exercise on chronic disease management. South Dakota Medicine, Spec No, 10–18. Retrieved from www.sdsma.org Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby. Centers for Disease Control and Prevention. (2015). Cultural competence. Retrieved from https://npin.cdc.gov/pages/cultural-competence Espey, D. K., Jim, M. A., Cobb, N., Bartholomew, M., Becker, T., Haverkamp, D., & Plescia, M. (2014). Leading causes of death and all-cause mortality in American Indians and Alaska Natives. American Journal of Public Health, 104(Suppl 3), S303–S311. doi:10.2105/AJPH.2013.301798 Leadbeater, B. J., Ames, M. E., & Linden, C. A. N. (2019). Age‐varying effects of cannabis use frequency and disorder on symptoms of psychosis, depression and anxiety in adolescents and adults. Addiction, 114, 278–293. doi:10.1111/add.14459 Leavitt, R. A., Ertl, A., Sheats, K., Petrosky, E., Ivey-Stephenson, A., & Fowler, K. A. (2018). Suicides among American Indian/Alaska Natives – National Violent Death Reporting System, 18 sates, 2003-2014. Morbidity & Mortality Weekly Report, 67, 237–242. doi:10.15585/mmwr.mm6708a1 Mehl-Madrona, L. (2016). Indigenous knowledge approach to successful psychotherapies with aboriginal suicide attempters. Canadian Journal of Psychiatry, 61, 696–699. doi:10.1177/0706743716659247 Willging, C. E., Sommerfeld, D. H., Jaramillo, E. T., Lujan, E., Bly, R. S., Debenport, E. K., Verney, S. P., & Lujan, R. (2018). Improving Native American elder access to and use of health care through effective health system navigation. BMC Health Services Research, 18, 464-480. doi:10.1186/s12913-018-3182-y
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