Case 1 Subjective Data CC: "I came for my annual physical exam, but do not want to be a burden to my daughter." History of Present Illness (HPI): At-risk 86-year-old Asian male - who is physically and financially dependent on his daughter, a single mother who has little time or money for her father's health needs. PMH: hypertension (HTN), gastroesophageal reflux disease (GERD), b12 deficiency and chronic prostatitis PSH: S/P cholecystectomy Drug Hx: Current Meds: Lisinopril 10mg daily, Prilosec 20mg daily, B12 injections monthly, and cipro 100mg daily. Review of Systems (ROS) General: + weight loss of 25 lbs over the past year; no recent fatigue, fever or chills. Head, eyes, ears, nose & throat (HEENT): no changes in vision or hearing, no difficulty chewing or swallowing. Neck: no pain or injury Respiratory: CV: GI: GU: no urinary hesitancy or change in urine stream Integument: multiple bruises on his upper arms and back. MS/Neuro: + falls x 2 within the last 6 months; no syncopal episodes or dizziness Psych: Objective Data PE: B/P 188/96; Pulse 89; RR 16; Temp 99.0; Ht 5,6; wt 110; BMI 17.8 HEENT: Atraumatic, normocephalic, PERRLA, EOMI, arcus senilus bilaterally, conjunctiva and sclera clear, nares patent, ornasopharynx clear, edentulous. Lungs: CTA AP&L Cor: S1S2 without rub or gallop

Abd: benign, normoactive bowel sounds x 4 Ext: no cyanosis, clubbing or edema Integument: multiple bruises in different stages of healing - on his upper arms and back. Neuro: No obvious deformities, CN grossly intact II-XII 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.  Selectoneof the three case studies. Reflect on the provided patient information.  Reflect on the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient you selected.  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 to 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 the pertinent information?