Question

Topic 1: Culturally Sensitive Care of a Family with Complex Healthcare Needs

Mr. Jagn Tam is a 72-year-old Hmong man with a history of cardiovascular disease who was admitted to the emergency department complaining of intense chest pain. He stated that he felt a pressure on his chest, like a car leaning on him. He also stated that the pain increases with exertion. He rated his chest pain as 9 on a scale of 0 to 10. The pain was radiating to his shoulders, arms, and upper abdomen. He is sometimes short of breath. He stated that over-the-counter analgesics do not relieve the acute pain. He has diaphoresis and feels weak. He has tachycardia and JVD. The admitting nurse found that the patient was diagnosed 4 years ago as having limited blood flow in 2 major coronary arteries, hypertension, atherosclerosis, and hypercholesterolemia. He is Full Code. He has NKA and is on bed rest. The attending physician ordered a nitroglycerine 0.5 mg tablet stat, repeat x 2 prn chest pain, a chewable aspirin 325 mg times 1, and morphine 2 mg IV push PRN Q2H prn chest pain. The physician ordered O2 at 2L via NC, titrate to maintain SpO2 >92%. Labs ordered include; CBC with differential, BMP, BNP, CK, CK-MB, troponin, and PT/ INR. A 12 lead ECG demonstrates ST depression in leads II, III, and aVF. The on-call cardiologist is on his way and anticipates a potential coronary artery bypass graft (CABG) operation. Mr. Tam and his family state that they have been using traditional treatments to release dim pa, including cupping and pricking of his fingers. They are refusing surgery at this time. His wife has been with him since admission. His wife speaks little English, so a Hmong interpreter is needed during consultations and updates. Through an interpreter, the wife said that a shaman is on his way to see Mr. Tam. Mr. Tam’s condition has not improved since the traditional treatments, so a soul-calling ceremony is being planned.

1. What are the top three highest priority nursing diagnoses for this patient and family?

2. For the diagnoses you identified, create a table describing subjective and objective assessment data associated with the diagnosis, a plan of care, and the methods that will be used to evaluate care given.

3. Discuss the implications of Hmong cultural beliefs on your plan of care.

Answer 1

What are the top three highest priority nursing diagnoses for this patient and family?

The 4 diagnosis are Chest pain, Shortness of breath, JVD and Tachycardia. Priority ones are Chest pain, SOB and JVD.

For the diagnoses you identified, create a table describing subjective and objective assessment data associated with the diagnosis, a plan of care, and the methods that will be used to evaluate care given.

Nursing interventions for a patient with above mentioned diagnosis emphases on administration of the patient’s actions and fluid consumption.

-Endorsing activity acceptance. An over-all of 30 minutes of bodily movement every day should be heartened, and the nurse and the doctor should cooperate to mature a timetable that endorses marching and arrangement of actions.

-Management of fluid capacity. The patient’s fluid position should be observed carefully, auscultating the lungs, nursing everyday body weight, and supplementary the patient to follow to a low sodium diet.

-Regulatory nervousness. When the patient exhibitions anxiety, the nurse should endorse physical ease and deliver psychological provision, and commence education conducts to regulator anxiety and circumvent nervousness aggravating circumstances.

-Minimalizing helplessness. Inspire the patient to express their anxieties and deliver the patient with decision making chances.

Discuss the implications of Hmong cultural beliefs on your plan of care.

The elderly get the greatest respect of all members of the household and are referred when vital choices need to be completed. They aid chastisement the younger kids. The ageing endure with the family during their lifetime. Grannies may or may not really be existing throughout healthcare appointments, but they characteristically make key choices about management disease in the family.