Homeless Case Study Essay Assignment
Homeless Case Study Essay Assignment
History of Present Problem:
George Mayfield is a 68-year-old African American male with a past history of hypertension, but has not taken his meds the past year because it was too much bother and he felt fine. He is seen at a clinic that serves the homeless in a large metropolitan community.
George came to the clinic because of a headache that has been persistent the past week and blurred vision. His clothing is dirty and he has a strong body odor as well as smelly feet. His shoes are shabby and he has lots of callouses on his feet. George is missing many teeth and those that remain are yellow and brown with dental decay. When the nurse reviewed the health screening questions, George admitted that he has had a productive cough with occasional blood tinged yellow mucus the past couple weeks. His initial BP is 188/96. Homeless Case Study Essay Assignment
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Personal/Social History:
George is veteran who served in Vietnam. He has struggled with alcohol abuse in the past but denies ETOH use in the past year. He has been homeless since he lost his job as a mechanic ten years ago and currently lives in his car, a 1980 Cadillac, with Milo, his white poodle.
He has never married and has no close friends or relatives with whom he stays in contact. He smokes one pack of cigarettes a day. Homeless Case Study Essay Assignment
What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
i. Blurred vision and persistent headaches.
ii. Productive cough with blood-tinged yellow mucus
iii. A blood pressure of 188/96
i. Could be a possible indicator of hypertensive crisis or uncontrolled hypertension.
ii. Could be a potential TB, Lung infection and chronic bronchitis.
iii. A possibility of poorly managed hypertension.
RELEVANT Data from Social History: Clinical Significance:
i. Past history of alcohol abuse.
ii. Homelessness and living in a car.
iii. Smoking a pack per day
i. Could possibly be a liver disease or other complications.
ii. Being at a risk of poor hygiene, inadequate healthcare access and limited access to resources.
iii. Increases the risks of COPD, lung cancer, and cardiovascular diseases.
Patient Care Begins: Homeless Case Study Essay Assignment
Current VS: P-Q-R-S-T Pain Assessment:
T: 97.6 F/36.4 C (oral) Provoking/Palliative: Nothing/nothing
P: 90 (regular) Quality: Dull ache
R: 18 (regular) Region/Radiation: head
BP: 182/90 Severity: 7/10
O2 sat: 90% room air Timing: continuous
What VS data are RELEVANT and must be interpreted as clinically significant by the nurse?
RELEVANT VS Data: Clinical Significance:
i. BP: 182/90
ii. O2 sat: 90% on room air i. Signifies poorly managed hypertension hence being at a risk of stroke and other heart diseases.
ii. Indicate Borderline hypoxia, possibly due to lung disease infection.
Current Objective Assessment:
GENERAL
APPEARANCE: Clothing soiled, hair and beard unkept. Has foul body odor, shabby shoes and smelly feet with callouses. Teeth are yellow stained and many are missing with obvious poor dentition
RESP: Breath sounds clear bilaterally upon inspiration, coarse rhonchi heard in bases bilaterally upon expiration, occasional harsh productive cough with blood-tinged yellow mucus
CARDIAC: Pink, warm & dry, no edema, heart sounds regular with no abnormal beats, pulses strong, equal with palpation at radial/pedal/post-tibial landmarks
NEURO: Alert & oriented to person, place, time, and situation (x4)
GI: Abdomen flat, soft/nontender, bowel sounds audible per auscultation in all four quadrants
GU: Voiding without difficulty, urine clear/yellow Voids three times during the night
SKIN: Dirt on hands and under fingernails, fungal toenails present on both feet, feet persistently itch, are swollen, macerated and moist with peeling of the skin layers between toes on both feet. Homeless Case Study Essay Assignment
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Current Subjective Assessment:
SUICIDAL RISK:
Assessment: George did not demonstrate the presence of suicidal ideation but as a homeless man with no family or friends he may well be at risk. It would be imperative to perform a mental health checkup to ensure that there is no possibility of suicidal thoughts. Clinical Significance: For individuals in his situation, depression and suicidal thoughts are more common, which means that constant supervision and psychological counseling are essential.
SLEEP ASSESSMENT: Assessment: George is currently homeless and resides in his car, and this can have negative impacts such as poor sleeping habits and lack of cleanliness. It is possible to experience loss of sleep or interrupted sleep because of discomfort and stress.
Clinical Significance: Lack of sleep affects total health, memory, learning capacity and worsens some psychological illnesses.
NUTRITIONAL ASSESSMENT: Assessment: In this case George is a homeless man which means he doesn’t always have proper meals and thus can be malnourished. Other oral health issues which include the absence of teeth and dental caries also impede his capacity to consume adequately.
Clinical Significance: Apart from deterioration of his general well-being, he can develop different health issues associated with malnutrition such as decreased immunity and emerging complications linked to chronic diseases, such as hypertension. Homeless Case Study Essay Assignment
ETOH ABUSE:
Assessment: Although George does not admit having used alcohol within the past year, he has featured in alcohol abuse. Prolonged sexual abstinence should be established, he requires periodic examination for other liver related illnesses.
Clinical Significance: His history of excessive alcohol intake in the past increases the chances of developing liver disease and could be the reason for developing additional health problems even if he does not consume alcohol at present time.
DEPRESSION
ASSESSMENT: Assessment: Despite George not coming out and saying he is depressed, he is at a very high risk because of the lack of support, being homeless, and lonely, as seen from his history. His living environment, unclean appearance, and overall apparent abandonment may indicate that he experiences some degree of depression.
Clinical Significance: Homeless patients especially those with depression are less likely to report their condition or receive treatment and this results in neglect of personal health care, higher risks and low quality of life. Both screening and mental health intervention are essential.
What assessment data is RELEVANT and must be interpreted as clinically significant by the nurse?
RELEVANT Assessment Data: Clinical Significance:
i. BP: 182/90 Homeless Case Study Essay Assignment
ii. Productive cough with blood-tinged mucus
iii. O2 saturation: 90% on room air
iv. Poor dentition (yellow, decayed teeth) i. Reveals poorly controlled hypertension, which further poses George for heart attack, stroke or heart failure. His past non-adherence to medications worsens the situation.
ii. A possible indicator of TB, Respiratory infections, and other pulmonary issues.
iii. Suggest a possible hypoxia or an underlying respiratory problem, that requires further investigation, especially in terms cough and mucus.
iv. Poor oral hygiene increases risk for systemic infections and malnutrition. It also complicates proper food intake and contributes to poor health. Homeless Case Study Essay Assignment
RELEVANT SUBJECTIVE
Assessment Data: Clinical Significance:
i. Blurred vision and persistent headaches
ii. Being homelessness and living in a car
iii. Prior history of not adhering to hypertension medication
iv. Smoking a pack of cigarettes daily.
v. Past alcohol abuse history i. Could be a possible indicator of hypertensive crisis or uncontrolled hypertension.
ii. Being at a risk of poor hygiene, inadequate healthcare access and limited access to resources.
iii. Increases the risk of further complications such as stroke and kidney failure.
iv. Increases the risks of COPD, lung cancer, and cardiovascular diseases.
v. Could possibly be a liver disease or other complications.
1. List the physical and psychosocial problems that are adversely impacting his health? What are the physiological OR psychosocial causes of the problem?
Physical Problem(s) Cause and/or Pathophysiology
Hypertension Homeless Case Study Essay Assignment
Productive cough with hemoptysis
Fungal and skin infections
Poor dentition
Blurred vision and headache
Malnutrition
A Blood Pressure of (182/90) is likely due to non-adherence to antihypertensive medications for the past year.
Possible causes might be respiratory infection, chronic bronchitis, or tuberculosis (TB). It can impact lung cancer when one lives in poor conditions such as in his car.
Fungal infections and maceration between the toes are as a result of bad hygiene practices, tight shoes, and wet environment. Additionally, he is likely to get further infections and experience complications with his mobility.
Failing to clean the teeth results in tooth decay, decreasing the chances of getting well-nourished and free from body infections. It may also affect his ability to take proper meals to worsen his health.
Perhaps because of high blood pressure, which may affect blood vessels in the eyes (hypertensive retinopathy) and lead to headaches due to increased pressure.
Lack of proper nutrition could have resulted from poor access to food and dental problems in George’s case. This increases his overall frailty and decreases immunity, as well as other associated diseases such as hypertension.
Psychosocial Problem(s) Cause and/or Pathophysiology
Homelessness and isolation Homeless Case Study Essay Assignment
Mental health (possible depression) It impacts poor self-care, lack of access to healthcare, and deteriorating health.
These are lack of social interaction, loss of job, and homelessness are some of the causes of depression.
2. Is there a RELATIONSHIP between his social history and physical/psychosocial problems that may have contributed to the development of another problem?
Physical Problem(s) What then Developed?
Uncontrolled hypertension Homeless Case Study Essay Assignment
Smoking a pack per day
Poor hygiene and fungal infection Headaches, Blurred vision and risk of cardiovascular diseases.
Issues in respiratory system such as hypoxia, chronic cough and possible COPD.
Fungal infection on the feet could affect mobility due to infections.
Psychosocial Problem(s) What then Developed?
Homelessness
Past alcohol abuse history
Social isolation
Lack of access to healthcare. It contributes to malnutrition, poor hygiene, poor access to healthcare and worsening of conditions such as hypertension.
Potential long-term damage to his kidney and the liver, hence affecting his general health.
Contributes to development of depression.
Contribute to long-term untreated chronic diseases such as hypertension.
2. What are the priority physical/psychosocial problems and resultant assessments?
PRIORITY Problems: PRIORITY Nursing Assessments:
Hypertension Homeless Case Study Essay Assignment
productive cough and hypoxia
Malnutrition
Poor hygiene and fungal infection on the feet
Psychosocial issues such as isolation Regular monitoring of BP and assessment of its signs such as headaches and vision changes.
Lung sounds assessment, oxygen saturation, and monitoring respiratory infections.
Assess his diet, body weight and dental health.
Inspection of the feet for a possible infection sign, mobility assessment and provision of hygienic care.
Screening for suicidal thoughts and depression. Assessment of mental health
What are the nursing interventions at the primary, secondary and tertiary level of care?
(Nursing roles to consider are the following: educate, advocate, manage, collaborate, leadership)
Primary Prevention Level:
Keep disease or injury from occurring. (Educate)
Primary prevention for George entails using health promotion strategies whereby George is informed on the health behaviors that might further decline his health status. This includes anti-smoking campaigns, learning how smoking affects the respiratory system, and where to get help to quit this behavior. Ensuring that nurses collaborate in monitoring his blood pressure is instrumental, hence the need to educate him on the importance of taking medications as prescribed and the need to take a healthy diet. Hygiene education is also of extreme importance and includes foot care, where George is to be educated on how to dry and clean his feet besides being encouraged to wear shoes as a way of avoiding getting infections. Homeless Case Study Essay Assignment
Secondary Prevention Level:
Detect and treat existing disease or injuries. (Screen and treat)
At secondary level, the main nursing interventions include assessment and management of known chronic disorders. Blood pressure measurement is required to identify hypertension and its treatment with medication and dietary modifications. Screening tests should then be performed on a regular basis to check for such new diseases as tuberculosis or chronic bronchitis. Finally, they entail mental health examination in order to rule out depression or suicidal thoughts, as well as refer George to mental health care that may be required to support him throughout the process of recovery.
Tertiary Prevention Level:
Reduce the disease or injury to lowest level to minimize disability. (Rehabilitation).
Tertiary prevention seeks to reduce the chances of developing complications from the two chronic health conditions of George. Respiratory rehabilitation aims at looking into chronic respiratory illnesses like COPD, ensuring that appropriate treatment is taken and encouraging lung wellness. Nutrition is also important as referring George to sources that help him work on his nourishment and making sure he gets the dental work that will aid in his eating is essential. There should also be continuous, consistent foot care, with regards to the fungal infections, the ulcers, and consistent assessment of the conditions that could worsen and affect George’s mobility and independence.Homeless Case Study Essay Assignment
High Incidence Problems in Homeless Population:
Start by considering all the information you have regarding this client who is homeless. What are the problems most frequently seen in a homeless population?
i. Malnutrition
ii. Respiratory infections such as TB
iii. Chronic conditions such as hypertension
iv. Poor hygiene that might impact infections.
v. Substance abuse such as alcohol abuse
Practice Settings/Community Resources:
Pick the practice settings that might offer resources to the patient. Describe the resources offered and/or the nursing role for the selected settings. Only choose the relevant practice settings.
Practice Setting Community Resources Role of Nurse
Public Health Immunization programs, public health clinics, and the mobile health units. Offering vaccinations, providing health related education, and screening for chronic diseases.
Forensic
Clinic Free clinics and Federally Qualified Health Centers (FQHC).
Chronic disease management, offering primary care and provision of referrals to social services.
School
Occupational
Faith-Based Food pantries and faith related shelters.
Provision of holistic type of care that include spiritual support, counselling and mental health services.
Home Health/hospice
Senior Center
Homeless shelter Offering of free shelters, services of managing substance abuse and other outreach programs. Connection o housing services, conducting health assessments to patients and educating on proper measures of hygiene and selfcare.
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Transcultural:
Describe how the cultural factors relate to the care of this patient in the categories listed below.
Race/Ethnicity: It means that when consulting for a patient, one must be sensitive to his or her origin, ethnicity, and gender; in this case, George is an African-American male. Hypertension and smoking related diseases are predominant in the black individuals and these should help in the development of his care plan.
Environmental Health He has been living in his car and has probably made his respiratory conditions and general hygienic conditions are worse, hence requiring health treatments with emphasis on his unstable housing status.
Vulnerable Population: To begin with, George is homeless elderly and he belongs to the category of the vulnerable people. His inconsistent utilization of health care and social services must inform nursing care, directing him to community resources, including elderly’s services and housing support services
Homeless Case Study Essay Assignment