Case Study – Patient with Hypertension and Glaucoma
This is a case analysis for EB, an old black African woman who is 68 years old. She presented with progressing visual loss over the past few years. She is known to have hypertension and glaucoma. She takes hydralazine 50mg, metoprolol XL 200mg, HCTZ 25mg, and Lisinopril 40mg. She stays alone. It seems she does not comply with her medication. Of note is that she has an impaired memory because she forgot some of her drugs at home. On today’s visit, the blood pressure was at 182/99mmHg with a pulse rate of 84 beats per minute.
How to Build a History from a Patient
To obtain information from a patient from a different cultural and ethnic background, the nurse should use a common language, be respectful when asking questions, and empower the patient to express their views regarding culturally sensitive healthcare (Hultsjö et al., 2020). My experience with the patient was great. I welcomed her into the office, greeted her, offered her a seat, and assured her of confidentiality. She was comfortable speaking English and Swahili to express her complaints. I actively listened to her, observing non-verbal cues and noting the changes in her voice tone.
Challenges of Communication and the 5 Target Questions
The challenges I encountered when communicating with this patient were the language barrier and her visual problem. The solution is using plain language, being positive and hopeful, and empowering the patient (Gerchow et al., 2020). Being specific and visual improves communication. The target questions I would ask are; when were you diagnosed with hypertension? Do you monitor your blood pressure? What precautions are you taking to prevent complications? Why don’t you take your medicine as prescribed? What lifestyle modification activities does she involve herself in, a healthy diet and physical exercise?
Cultural, Socioeconomic, and Spiritual Lifestyle Associated With the Patient
Tomar & Kulkarni (2020) note that psychological stress is a risk factor involved in the etiology of hypertension. Causes of psychological stress are social isolation, poor sleep quality, and lack of support. African American culture believes in spiritual faith to cope with stressful moments and illness. This explains the cause of hypertension and why the patient comes with bottles full of medicine from the previous years.
References
Gerchow, L., Burka, L. R., Miner, S., & Squires, A. (2020). Language barriers between nurses and patients: A scoping review. Patient Education and Counseling.
Hultsjö, S., Bachrach-Lindström, M., Safipour, J., & Hadziabdic, E. (2019). “Cultural awareness requires more than theoretical education”-Nursing students’ experiences. Nurse education in practice, 39, 73-79.
Tomar & Kulkarni. (2020). Global Racial, Ethnic, and Religious Subculture and Its Impact on Healthcare Organizations In Global Issues and Innovative Solutions in Healthcare, Culture, and the Environment (pp. 253-270). IGI Global.
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Question 
Hypertension and Glaucoma
“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 clinic today is 182/99 with an HR of 84.”
Hypertension and Glaucoma
To prepare:
- Reflect on your experiences as a nurse and on the information provided in this week’s Learning Resources on diversity issues in health assessments.
- By Day 1 of this week, you will be assigned a case study by your Instructor. Note: Please see the “Course Announcements” section of the classroom for your case study assignment.
- Reflect on the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient assigned to you.
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- Consider how you would build a health history for the patient. What questions would you ask, and how would you frame them to be sensitive to the patient’s background, lifestyle, and culture? Develop five targeted questions you would ask the patient to build his or her health history and assess his or her health risks.
- Think about the challenges associated with communicating with patients from a variety of specific populations. What strategies can you as a nurse employ to be sensitive to different cultural factors while gathering pertinent information?
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 assess his or her health risks.