Patient name: MR.
SUBJECTIVE:
CC: LUQ abdominal pain.
HPI: MR is a 70 y.o. male patient who presents to ER with constant, dull and RUQ abdominal pain onset yesterday that irradiate to the back of right shoulder. Client also c/o nauseas, vomiting and black stool x2 this morning. He reports that currently resides in an ALF; they called the ambulance after his second episodes of black stool. Pt reports he drank Pepto-Bismol yesterday evening without relief. Pt states that he never experienced similar symptoms in the past. Denies any CP, emesis, hematochezia or any other associated symptoms at this time. Client was found with past history gallbladder problems years ago.
Review of symptoms:
General: denies weight loss, insomnia, fever or chills.
HEENT: no headache, no tinnitus, no hearing loss, mouth sores, no voice changes, no problems swallowing, sinus congestion, no visual disturbances.
Cardio: no known murmur, palpitations or chest pressure/ pain.
Respiratory: negative for S.O.B, cough or hemoptysis.
GI: Positive for abdominal pain RUQ, nauseas and vomiting x2 today in a.m. hours, also black stools x2.
GU: negative for dysuria, urgency, hematuria or flank pain.
Hematology/ Lymph: Negative for bleedings problems or swollen lymph nodes.
Musculoskeletal: Negative for myalgia, arthralgia or falls.
Neuro: Negative for dizziness, tingling, sensory changes and loss of consciousness.
Mental/Psych: Negative for depression or psychiatric problem.
Allergies: NKDA
Medications:
-Amlodipine (Norvasc) 10mg po QD.
-Glipizide (Glucotrol) 10mg po BID.
-Metformin (Glucophage) 1000mg po QD
-Simvastatin (Zocor) 20mg po QHS
-Pantoprazole 40mg po QD
-Donepezil (Aricept) 10mg QD
Past Medical History: -HTN.
-D...
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Douglas, Rosenkoetter, Pacquiao, Callister, Hattar-Pollara, Lauderdale, Milstead, Nardi, & Purnell (2014) outline ten guidelines for implementing culturally competent care; knowledge of cultures, education and training in culturally competent care, critical reflection, cross-cultural communication, culturally competent practice, cultural competence in health care systems and organizations, patient advocacy and empowerment, multicultural workforce, cross-cultural leadership, and evidence-based practice and research. One specific suggestion I will incorporate is to engage in critical reflection. This is mentioned both by Douglas, et al. (2014) and Trentham, et al. (2007) as an important part of cultural competency. I will do this by looking at my own culture, beliefs, and values and examining how they affect my actions. I will use this information to better inform my day to day practice when working with patients with a different culture than my
Perez, M. A. & Luquis, R.R. (2009). Cultural competence in health education and health promotion. Jossey-Bass: San Francisco, CA.
Duodenum: The first and second portion of the duodenum were evaluated. There was evidence of duodenitis with erythema noted within the duodenal bulb. No specimens were obtained. No ulcerations were seen.
J.P., a 58 year old female, presents to the Emergency Room on March 18th. She has a past medical history of cervical cancer, atheroembolism of the left lower extremity, fistula of the vagina, peripheral vascular disease, neuropathy, glaucoma, GERD, depression, hypertension, chronic kidney disease, and sickle cell anemia. She complains of right lower extremity pain accompanied by fatigue, a decreased appetite, increased work of breathing, burning urination, and decreased urine output for three days. Upon admission, a complete physical assessment was performed along with a blood and metabolic panel. The assessment revealed many positive and negative findings.
From what my patient is showing and complaining of gives me two differential diagnoses of what he actually might be suffering from.
Although both Chron’s and UC have similar symptoms they are two distinctly different diseases. Chron’s disease can affect any part of the digestive tract, from the mouth to the rectum. The tissues affected become inflamed and subsequently causes the intestinal wall to thicken and create scar tissue. This in turn causes faecal matter to move through the GI tract slowly, causing pain and in severe cases induce vomiting. The inflammation of the GI tract induces the production of excess water and salt, but because the lining is inflamed and swollen it is unable to absorb the excess liquid which leads to diarrhoea. Ulcers can develop in the lining and in some cases become much larger and eventually penetrate through the walls of the intestine. Bleeding occurs when the GI tract is swollen and ulcerated and the passage of food through the tract irritates and causes the tissue to haemorrhage.
Cultural Competence is important for many reasons. First, it can help develop culturally sensitive practices which can in turn help reduce barriers that affect treatment in health care settings. Second, it can help build understanding, which is critical in competence, in order wards knowing whom the person recognizes as a health care professional and whom they views as traditional healer, can aid the development of trust and improve the individual’s investment and participation in treatment. Third, our population in the United States is not only growing quickly but also changing, cultural competence will allow us as educators and healthcare workers keep up wi...
III. REASON FOR SEEKING CARE (CC): 38 y/o female c/o abdominal pain throughout the entire abdominal cavity, states she has always had abdominal discomfort, but the past 3 days’ pain has become unbearable. Describes pain as a burning churning through out 8/10. Pain intermittent c/o of sour stomach after meals accompanied by nausea, denies vomiting, diarrhea or anorexia, last bowel movement 4 days ago. States she moves bowels 2-3 times a week. She states this happened about 2 years she went to emergency room, CT was done, no blockage, she was sent home without meds, CT contrast helped her move bowels at the time, symptoms eventually resolved on their own. Pt c/o of waking up feeling unrested, had trouble falling asleep ever since she could remember, wakes up frequently with difficulty getting back to sleep. She reports sleep disorder sometimes coincide with inability to get comfortable due to shoulder and neck pain especially in the winter months. Pt states the head and shoulder pain are the result of a MVI in 1995 where she had spinal nerve damage and bulging disc.
Cultural competence has a variety of definitions and, in health care, basically refers to the act of developing an awareness of yourself, your existence, your thoughts, and your environment and making sure that those elements do not unjustly affect the clients you serve (Giger, 2013). In this paper, I will share my total score and what I learned about myself after taking the Cultural Diversity Self Assessment (IllinoisCTE, n.d.), discuss two weaknesses or areas with lower scores, and review two strengths with higher scores. I will reflect on my findings and examine the impact that my strengths and weaknesses may have on my nursing care. In addition, I will discuss improving cultural competence and two strategies
There is a lack of conceptual clarity with cultural competence in the field and the research community. Cultural competence is seen as encompassing only racial and ethnic differences, and omitting other population groups who are ethnically and racially similar to providers, but are stigmatized or discriminated against, who are different in other identities, and have some differences in their health care needs that have resulted in health disparities. (Agency for Healthcare Research and Quality,
This was his second episode since 10 days ago where he develop the same pain at his right flank. He suddenly experienced severe pain 8 hours before admission when the pain shifts to his right lower quadrant of his abdomen. The onset is at 6.30 am before worsening at 10 p.m to 2 p.m. He described the pain as continuous sharp pain and gradually increased in severity. There is no radiation of the pain. The pain was exaggerated on movement and touch. There were no relieving factor and he scale the severity as 7/10. He experienced fever for 1 day prior to admission. It was a mild grade continuous fever. He does not experienced chills and rigor. The patient does not experience any nausea or vomiting, no dysphagia, no pain during micturition and no alteration in bowel habit. He experienced loss of appetite but not notice any weight loss.
Cultural competence in health care provision refers to the capacity of health care systems to offer good care to patients and accommodate employees, who have diverse beliefs, behaviors, and values to meet their cultural, linguistic, and social needs. It comprises of policies, attitudes, and behaviors that integrate to form a system that can operate efficiently in cross cultural conditions. Healthcare organizations look at cultural competence from two major viewpoints. Firstly, it is a tool to enhance patient care from all backgrounds, social groups, languages, religions, and beliefs. Secondly, it is a tool that strategically attracts potential clients to their organizations and, hence, expands
Mr. GB is a 78 year old white male admitted to Bay Pines VAMC on 6/18/96. for " atypical chest pain and hemoptysis". V/S BP 114/51, P 84, R 24, T 97.4. He seems alert and oriented x 3 and cheerful. Bowel sounds present x 4. Pt. has a red area on his coccyx. Silvadene treatments have been started. Pt. Has a fungal lung infection with a pleural suction drainage tube inserted in his chest . Pt is extremely thin with poor skin turgor with a diagnosis of cachexia ( wasting) secondary to malnutrition and infection. Patient is no known allergies to drugs but is allergic to aerosol sprays disinfectants and dust.. Advanced directives on chart. Code status DNR. Primary physician Dr. R, Thoracic surgeon Dr. L. Psychology Dr.W. There is PT, OT Dietary and Infectious Disease consults when necessary. He lives with his wife who he has been married to for 56 years. His son and his daughter come to visit him. He does not smoke. He wears dentures but did not bring them. He dose not use a hearing aid but he does have a hearing deficit.
Lipson, J.G. & Dubble, S.L. (Eds). (2007). Culture & clinical care. San Francisco, California: The Regents, University of California.
Miller, Leininger, Leuning, Pacquiao, Andrews, and Ludwig-Beyer, (2008) support that the skill of cultural competency in nursing is the ability to gather relevant cultural data on the presenting problem of the patient. This cultural assessment is defined as a "...