NURS 6512 38-year-old Native American pregnant female living on a reservation

38-year-old Native American pregnant female living on a reservation NURS 6512

The case assigned to me is that of a 38-year-old Native American woman who is pregnant and living on a reservation. When working with any patient, understanding their background and personal experience in order to tailor communication to fit the needs of the patient is crucial. To accurately interpret the physical exam, a provider must fully appreciate their patient’s unique orientation in the world (Ball et. al., 2019).  In this situation, having open body language and using open-ended questions are effective methods to help the patient feel comfortable and can improve the provider’s understanding of the patient and her needs. Building the patient’s trust by sharing patient care goals honestly as well as the limitations of the practice will help to build a trusting relationship (Ball et. al., ####).  This trusting relationship is essential for this patient in order to increase her desire to follow up throughout her pregnancy and adhere to the treatment plan. Asking this patient regarding expectations of her care and cultural norms will also help build trust and help the provider create a patient-centered plan of care. Focusing on education and identifying preventable risk factors should be the focus of prenatal care (Johnson, 2020).

Social determinates of health include economic stability, education, access to healthcare, and the environment of the home and neighborhood. Poverty, low education levels, and limited access to healthcare are some of the most common health disparities that place Native American women and their newborns at high risk for mobility and mortality (Johnson, 2020). Asking open-ended questions about access to basic needs will help the provider determine the patient’s economic stability.

When assessing for health risks, asking patients about their past medical history, current medications and family history is essential. For this patient, gathering data from her regarding diet, exercise, and previous pregnancy history would also be important. Native Americans living on reservations are at a higher risk for obesity, substance abuse, diabetes, hepatitis, and mental health problems (Johnson, 2020). Specifically for my patient, asking about a history of substance abuse would be very important. Additionally, knowing the patient’s family history and personal health history would help screen for diabetes and hepatitis. Finally, pregnancy can be a stressful time, and screening the patient for suicidal ideations as well as for domestic violence is advised. Finally, the SIDS rate is elevated for those living on reservations, so the patient should be educated about safe sleep practices (Johnson, 2020). 38-year-old Native American pregnant female living on a reservation NURS 6512

Several risk assessments would be helpful for this patient. First, the Columbia-Suicide Severity Rate Scale (C-SSRS) could assess the patient’s risk of suicide and give the provider an overall view of the patient’s state of mental health. Next, the Native American population is especially vulnerable to adverse childhood events that can lead to depression, anxiety, and other physical health problems that can complicate pregnancy, birth, and parenting (Kenney & Singh, 2016).  Using an ACE score assessment could help open opportunities for the provider to educate the patient and provide resources to assist in meeting the patient’s emotional needs. Finally, a brief screening using the HITS tool to assess for domestic violence would be extremely important. HITS is an acronym for hurt, insult, threaten, and scream. To use it, the provider would ask, “In the past year, how often did your partner hurt you physically, insult you or talk down to you, threaten you with harm, and scream or curse at you?” (Ball, et. al., 2019). Using the HITS tool can be an effective means to gather meaningful information regarding the patient’s wellbeing and home environment. 38-year-old Native American pregnant female living on a reservation NURS 6512

Each patient encounter should be tailored to meet the needs of the patient. While assessments may have a similar style and flow, providers must adjust their questioning to specifically address each patient’s unique needs and risk factors. As such, keeping current on demographic and health risk factors in order to better target patient needs is important for providers.
Targeted questions

1. 1. Tell me about your pregnancy and birth history.
   2. What questions or concerns do you have about your current pregnancy?
   3. Over the last few weeks, how often have you felt anxious, nervous, or on edge?
   4. Over the last few weeks, how often have you felt down or depressed?
   5. Do you feel safe at home?
   6. Do you have any history of substance use in the past?  Do you currently drink alcohol, smoke, or use any illegal drugs?

References

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.

Johnson, M. B. (2020). Prenatal Care for American Indian Women. MCN: The American Journal of Maternal Child Nursing, 45(4), 221–227. https://doi-org.ezp.waldenulibrary.org/10.1097/NMC.0000000000000633

Kenney, M. K., & Singh, G. K. (2016). Adverse childhood experiences among American Indian/Alaska Native children: The 2011-2012 National Survey of Children’s Health. Scientifica, ID 7424239. https:// doi.org/10.1155/2016/7424239

PEER RESPONSE

Hello Hayley,

Insightful post. And to add to your thoughts, the health history, and interview process differ with every patient because every patient is unique in specific ways, involving cultural background, socioeconomic status, and patient-centered care. Effective communication and professional presentation can help build strong and trustful relationships with each patient encounter, asking questions that encourage patient participation and allowing enough time for the patient to process and answer the questions (Ball, Dains, Flynn, Solomon & Stewart, 2019). Targeting the questions to build health history requires a strong connection with the patient, asking open-ended questions, acknowledging the patient’s presence and family members, patient expectations during the visits, what the patient would like to discuss, and ensuring every issue is covered (Ball et al., 2019). 38-year-old Native American pregnant female living on a reservation NURS 6512

The risk assessment of this 38-year-old Native American pregnant female living on a reservation involves social history about behaviors like consuming alcohol, smoking tobacco, drugs that might interfere with the fetus development and prenatal care, and social determinants like living conditions and family support and assessing sexual orientation and any past sexually transmitted diseases.  The risk assessments can be correlated with the patient current problem or factors outside the current medical issues, either directly or indirectly. The environmental setting is a crucial issue. It ensures the patient has access to medical services and transportation to seek medical care when needed. The cultural and religious beliefs should consider that might impact patients’ health (Sullivan,2019).

The Pregnancy Risk Assessment Monitoring System (PRAMS) was developed in 1987 to reduce infant morbidity and mortality by influencing maternal behaviors before, during, and immediately after pregnancy. It is a joint research project between the state departments of health and the Centers for Disease Control and Prevention, Division of Reproductive Health (CDC, 2019). The PRAMS assessment involves standard questions utilized by all states and core questions about the individual. Sample of the PRAMS questions assessments involves attitudes and feelings about the most recent pregnancy, preconception care, content of prenatal care, Medicaid and WIC participation, breastfeeding, cigarette smoking, and alcohol use, health insurance coverage, physical abuse, Infant health care, Contraceptive use (CDC,2019).

Some other developed targeted questions may also include:

1) Tell me what brought you to the hospital today?

2) Any current illness I need to know about? Are you currently seeing an obstetrician for prenatal care?

3) The last menstrual period and the expected date of delivery?

4) Do you belong to any religious or spiritual community? How do your religion and beliefs affect care?

References

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.

CDC. (2019). PRAMS Questionnaires. Retrieved from: https://www.cdc.gov/prams/questionnaire.htm

Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.

Discussion: Building a Health History

To prepare:

With the information presented in Chapter 1 of Ball et al. in mind, consider the following:

• By Day 1 of this week, you will be assigned a new patient profile by your Instructor for this Discussion. Note: Please see the “Course Announcements” section of the classroom for your new patient profile assignment.
• How would your communication and interview techniques for building a health history differ with each patient?
• How might you target your questions for building a health history based on the patient’s social determinants of health?
• What risk assessment instruments would be appropriate to use with each patient, or what questions would you ask each patient to assess his or her health risks?
• Identify any potential health-related risks based upon the patient’s age, gender, ethnicity, or environmental setting that should be taken into consideration.
• Select one of the risk assessment instruments presented in Chapter 1 or Chapter 5 of the Seidel’s Guide to Physical Examination text, or another tool with which you are familiar, related to your selected patient.
• Develop at least five targeted questions you would ask your selected patient to assess his or her health risks and begin building a health history.

By Day 3 of Week 1

Post a summary of the interview and a description of the communication techniques you would use with your assigned patient. Explain why you would use these techniques. Identify the risk assessment instrument you selected, and justify why it would be applicable to the selected patient. Provide at least five targeted questions you would ask the patient.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit! 38-year-old Native American pregnant female living on a reservation NURS 6512

Read a selection of your colleagues’ responses.

By Day 6 of Week 1

Respond to at least two of your colleagues on 2 different days who selected a different patient than you, using one or more of the following approaches:

• Share additional interview and communication techniques that could be effective with your colleague’s selected patient.
• Suggest additional health-related risks that might be considered.
• Validate an idea with your own experience and additional research.

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 1 Discussion Rubric

Post by Day 3 of Week 1 and Respond by Day 6 of Week 1

To Participate in this Discussion:

Week 1 Discussion

Assignment: Case Study

The case involves an 82-year-old patient who was evaluated by GI specialists due to abdominal discomfort.
Weight loss, loss of appetite, and nausea were also reported by the patient.
He has diabetes and a solid mass in his pancreas head.
The goal of this assignment is to identify potential metastasis sites, tumor stage, carcinogenesis, and tissue levels affected in the patient.

Potential
Metastasis Sites Most Common

The patient is diagnosed with pancreatic cancer, which has most likely spread to the liver.
Because of the high level of perfusion, live is the most common site for metastasis.
As a result, the peritoneum and lung are two other possible sites of metastasis.
The tumour cells are carried in the blood to other parts of the body and that is why the lung and liver which receives most materials circulated in the body are likely to be the sites for metastasis. As a result, the adrenal gland and bones may be affected (Gospodarowicz et al., 2017).

The Definition of Tumor Markers and the Importance of Testing

Tumor markers are protein molecules that are normally produced in the body but increase when a patient has cancer.
Cancer is characterized by abnormal cell division, which leads to an increase in the production of specific protein molecules.
As a result, tumor cell markers are ordered as part of pancreatic cancer screening tests.
The markers are organ-specific, with CA-19-19 being associated with pancreatic cancer (Wang et al., 2020).

The Importance of TNM Staging

TNM staging is determined by the size of the tumor, spread to nearby lymph nodes, and metastasis.
The tumor in this case is large and has spread to other parts of the body.
The tumor is larger than 2cm in diameter and has spread to the lymph nodes (Gospodarowicz et al., 2017).
As a result, the patient is most likely in stage IV of the cancer disease.
The staging is important because it helps determine the best treatment approach and the patient’s prognosis.
Patients with advanced cancer have a lower survival rate and are more likely to be treated with chemotherapy rather than surgery as a result of metastasis.

The Characteristics of Malignant Tumors

Malignant tumors are distinguished by uncontrollable cell division and metastasis.
The cells divided abnormally, causing changes in their characteristics such as nuclear size and shape.
Malignant cells have the ability to spread and affect other organs in the body.
Through suppressor genes, the body has mechanisms for controlling cell division.
In malignant tumors, the role of suppressor genes becomes dysfunctional.

The Tumor Metastasis Phase and the Carcinogenesis Phase

Carcinogenesis is divided into four stages: initiation, promotion, malignant conversion, and tumor progression (Wang et al., 2020).
At the third stage of carcinogenesis, benign tumors transform into malignant tumors, resulting in metastasis.
Metastasis is a common feature of malignant tumors.

Affects Tissue Level

The patient is suffering from pancreatic cancer.
The pancreas is an epithelial tissue composed of simple cuboidal, stratified cuboidal, and simple epithelium (Wang et al., 2020).
The transitions in epithelial tissue type are determined by the parts of the pancreas that are affected.

Conclusion

Finally, the patient has a pancreatic malignant tumor that has spread.
Because of the advanced staging, managing such a condition is difficult.
Understanding cancer staging, as in this case, assists healthcare providers in making the best treatment decision for the patient.