Question

CHINESE CASE STUDY #1

An elderly, Asian-looking man is admitted to the emergency room with chest pain; difficulty breathing; diaphoresis; vomiting; pale, cold, clammy skin; and apprehension. Three people, speaking a mixture of English and a foreign language to one another, accompany him. The nurse tries to speak English with the man, but he cannot understand anything she says. Accompanying the elderly man are two women (one elderly and very upset and one younger who stands back from the other three people) and one younger man.

The younger man states that the elderly man, whose name is Li Ying Bin, is his father; the elderly woman, his mother; and the younger woman, his wife. The son serves as the translator. Li Ying Bin comes from a small village close to Beijing. He is 68 years old, and he has been suffering with minor chest pain and has had trouble breathing for 2 days. He is placed in the cardiac room, and the assessment continues.

Mr. Li is on vacation, visiting his son and daughter-in-law in the city. His son and daughter-in-law have been married for only 1 year, but the son has lived in the West for 7 years. Mr. Li’s daughter-in-law looks Chinese but was born in the United States. She does not speak very many words of Chinese. Further physical assessment reveals that Mr. Li has a history of “heart problems,” but the son does not know much about them. Mr. Li had been to the hospital in Beijing but did not like the care he received there and returned home as soon as possible. He goes to the local clinic periodically when the pain increases, and the health-care provider in China used traditional Chinese medicine, herbs, and acupuncture. In the past, those treatments relieved his symptoms.

Medications are ordered to relieve pain, and Mr. Li undergoes diagnostic procedures to determine his cardiac status. The studies reveal that he did sustain massive heart damage. Routine interventions are ordered, including heart medications, anticoagulants, oxygen, intravenous fluids, bedrest, and close monitoring. His condition is stabilized, and he is sent to the cardiac intensive-care unit. In the cardiac unit, the nurse finds Mrs. Li covering up Mr. Li until he sweats, and Mrs. Li argues with the nurse every time her husband is supposed to dangle his legs. She complains that he is too cold and brings in hot herbal beverages for him to drink. She does not follow the nurse’s and physician’s orders for dietary restrictions, and she begins to hide her treatments from the staff. Her son and daughter-in-law try to explain to her that this is not good, but she continues the traditional Chinese medicine treatments.

Mr. Li is a very quiet patient. He lies in bed and never calls for help. He frequently seems to be meditating and exercising his arms. When he does talk to his son, he speaks of the airplane ride and the problems of being so high. He believes that may have caused his current heart problem. Mr. Li also wonders if Western food could be bad for his system. Mr. Li’s condition gradually deteriorates over the next few days. Nurses and physicians attempt to tell the family about his condition and possible death, but the family will not talk with them about it. Mr. Li dies on the 5th day.

Study Questions

5. What are the common health risks for the development of chronic obstructive pulmonary disease among Chinese people?

6. What are some of the reasons that Mr. Li waited so long to enter the hospital?

7. Mr. Li did not complain of chest pain in the cardiac intensive-care unit. Is this a common behavior? Why?

8. True or False: The Chinese family will expect health-care providers at the hospital to provide most of the care for Mr. Li.

Answer 1

5. What are the common health risks for the development of chronic obstructive pulmonary disease among Chinese people?

ANS: Morbidity and mortality, with tobacco smoking, biomass fuel use and genetic susceptibility being the major risk factors.

7. Mr. Li did not complain of chest pain in the cardiac intensive-care unit. Is this a common behavior? Why?

ANS: Older Chinese people may try traditional medicine first and only seek Western medicine when traditional medicine does not seem to work. Many Chinese Americans consider seeing Western health-care providers as a waste of time and money. Yes, this is common because Chinese tend to describe their pain in terms of more diverse body symptoms, whereas Westerners tend to describe pain locally. They tend to use explanations of pain from the traditional Chinese influence of imbalances in the yin and yang combined with location and cause.

8. True or False: The Chinese family will expect health-care providers at the hospital to provide most of the care for Mr. Li.

ANS: False