Case Study

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The following cultural assessment is about JC, who is a 65-year-old female African American patient with a history of Congestive Heart Failure. Although the cultural assessment could be a representative of many African American, who have been diagnosed with a history of congestive heart failure, it is not a representative of all the African American community.  The 65-year-old male patient was presented to the emergency room having been complaining of breathlessness for the past three days. The assessment of cardiac history indicates positive for myocardial infarction three years ago that was followed by four-vessel coronary artery bypass surgery (Giamouzis, et al., 2011). The patient has additionally been asymptomatic since the surgery having no complaints of chest pains.

Over the past three months, the patient has complained of onset shortness of breath while walking stairs, unloading groceries as well as the other strenuous ADLs. Two weeks ago the patient was unable to undertake his daily one-mile walk at the high school track. He additionally noted the swelling of his feet as well as ankles. Four days PTA the patient wore at 3 am short of breath and was forced to sleep in his recliner for the rest of the night. The patient has been unable to lay flat in bed at night from the time the complications started and has been using three pillows to sleep. Yesterday the patient became breathless, and he was walking from one room to the other and has presented himself today with extreme shortness of breath although he denies the presence of chest pain.

In relation to the cultural assessment of the patient, it is clear that the structure of the African American families is nuclear as well as extended; being composed of non-related family members. The family is patriarchal even though the father or the wife is involved in the making of most of the decisions that affect their family (Malgady, 2011). He asserts that the older generation in their society is conservative in nature and maintains a traditional view of the gender roles. He additionally says that the elders are highly respected in the society and plays an active role in looking after his grandchildren.

Regarding the diet, JC says that most of the members of the community love hearty meals as fish, white and sweet potatoes, meat, grits, rice, corn, peanuts, eggplant, turnips as well as the homemade desserts. The leafy greens that are preferred in the community include collards, spinach, kale, mustard as well as cabbage. In his assessment, a healthy diet implies a meal that has least refined products and more of the traditionally available products as the greens and the sweet, white potato. In maintaining good health, he has ensured that he avoids most of the refined foods that he can. When he is ill, he only takes meat from fish and all the greens that his family can find. JC says that he has quit all the high-risk lifestyles since the diagnosis and has avoided all alcoholic drinks and cigarettes. He, however, confesses that he takes a glass of whine when he is feeling well. He does not use recreational drugs but ensures that he undertakes soft exercise by walking around the school ground twice a day, in the morning and the evening.

JC has a strong religious affiliation with the Catholic Church and ensures that he maintains a healthy association with the good religious practices. He says that the congregation has offered immense support to him over the years since the diagnosis, with their financial contributions being vital in helping him access the surgeries. He further says that the strong religious affiliation has been instrumental in ensuring that he overcomes the challenges that are associated with the treatment.

According to (Giamouzis, et al., 2011), the nursing diagnosis for JC includes:

  1. Decreasing the cardiac output that is related to the changes in the myocardial contractility. It additionally will revolve around the changes in the frequency, cardiac contraction and rhythm along with the structural changes.
  2. The activity for the reduction of intolerance that is related to the imbalance that is prevalent between the oxygenation supply needs. It should additionally encompass the changes that are associated with the vital signs, pate, dyspnea as well as sweating.
  3. Reduction of the excessive fluid volume that is related to the decreased glomerular filtration rate along with the decreased production of the ADH and retention of sodium and water.
  4. Reduction of the risk that is associated with the impaired skin integrity in the context of bed rest, edema and decreased tissue perfusion.

According to (Giamouzis, et al., 2011), desires outcomes of the nursing diagnosis include:

  1. B/P that is within the JC’s normal range
  2. Unlabored respirations at the rate of 12-20/minute
  3. The ordinary mental status of the client
  4. Improvement in the breath sounds
  5. Attainment of an apical pulse that is at the rate of 62-100 beats every minute and should be regular
  6. Usual and warm skin color
  7. Absence of syncope and dizziness
  8. 30 ml/hour urine output
  9. Peripheral pulses that are palpable
  10. Decrease in jugular and edema vein distention
  11. Less than 3 seconds in the refilling of the capillary

Giamouzis, et al., 2011 says that the nursing interventions that will be observed in the attainment of these outcomes include:

  1. The assessment of the Auscultation apical pulse, the frequency as well as heart rhythm
  2. Recording the heart sounds
  3. Palpation of nonessential pulses
  4. Assessment of the skin of cyanosis along with the whiteness
  5. Providing a contented furthermore calm environment

Part two

  1. Checking for the vital signs before as well as after the activity, predominantly when JC is using vasodilator, diuretic.
  2. Recording the cardiopulmonary reaction to activity, noting the tachycardia, dyspnea, district, sweating, pale.
  3. Assessing the causes which could include treatment, pain, and medication.
  4. Assessment of any increase in activity intolerance.
  5. Provision of assistance in the self-care activities that are by the hint.

Part three

  1. Monitoring of the urine output
  2. Calculation of the balance of income along with output 24 hours.
  3. Maintaining a semi-Fowler arrangement during the severe phase
  4. Auscultation of sound record or breath sounds as well as an additional reduction.
  5. Monitoring the blood pressure.

The assessment of the care will be informed the rate at which JC can resume his normal operations once we have started the care plans. Considering that the overall objective is ensuring that JC can carry out all the activities he used to before the commencement of the complications, it will be easier to evaluate the care depending on his response. The observation of the dietary, as well as lifestyle changes we recommend, will additionally be a vital measure that assesses the effectiveness of the care as the observation of the recommendations and prescriptions we give will be vital in ensuring that he recovers.

References

Giamouzis, A.,Kalogeropoulos, Georgiopoulou, S., Laskar, A.L. Smith & Dunbar, et al. (2011) Hospitalization epidemic in patients with heart failure: risk factors, risk prediction, knowledge gaps, and future directions J Card Fail, 17 (2011), pp. 54–75

Malgady, R., (2011). Cultural Competence in Assessment and Intervention with Ethnic Minorities. Bentham Science Publishers.



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