Student-Homeless-Community Health PDF

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Homelessness Community Health Reasoning

George Mayfield, 68 years old

Primary Concept Health Promotion Interrelated Concepts (In order of emphasis) Collaboration Patient Education Communication Addiction x Clinical Judgment x x x x

Copyright © 2018 Keith Rischer, d/b/a KeithRN.com. All Rights reserved.

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 bloodtinged yellow mucus the past couple weeks. His initial BP is 188/96.

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. What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse? RELEVANT Data from Present Problem: Clinical Significance:

history of HTN, hasn't taken meds in 1 yr due to being a bother and he feels fine, has persistent headache for 1 week and blurred vision, cough with bloody musus

since he has not taken his medication his HTN might be getting worse, there could be new stress in his life making the HTN worse giving him a headache from it and that could be a cause for the blurred vision.

RELEVANT Data from Social History:

Clinical Significance:

he is a war veteran, he stuggled with substance abuse but says he has not drank in the past year, homeless past 10 yrs since losing his job, lives in his car, never married, no friends/family

PTSD from the war could have brought on the substance abuse, homelessness and not having the support system could have made him depressed leading to the substance abuse and the depression could have gotten worse when he tries to stop the substance abuse.

Patient Care Begins: Current VS: T: 97.6 F/36.4 C (oral) P: 90 (regular) R: 18 (regular) BP: 182/90 O2 sat: 90% room air

P-Q-R-S-T Pain Assessment: Provoking/Palliative: Nothing/nothing Dull ache Quality: head Region/Radiation: 7/10 Severity: continuous Timing:

What VS data are RELEVANT and must be interpreted as clinically significant by the nurse? RELEVANT VS Data: Clinical Significance:

blood pressure low oxygen sat. heachache 7/10 continuous

his blood pressure being elevated could be the reasoning behind the headache and blurred vision, the low oxygen saturation could be due to the high continuous pain from the headache

Copyright © 2018 Keith Rischer, d/b/a KeithRN.com. All Rights reserved.

Current Objective Assessment: GENERAL 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 APPEARANCE: Breath sounds clear bilaterally upon inspiration, coarse rhonchi heard in bases bilaterally RESP: 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.

Current Subjective Assessment: SUICIDAL RISK:

homeless, no close family or friends, never married, post-war veteran, history of hypertension, has dog companion, lives in his car, lost job 10 yrs

SLEEP ASSESSMENT:

lives in car with dog in big metropolitan area

NUTRITIONAL ASSESSMENT:

homeless, missing teeth, yellow/decaying teeth,

ETOH ABUSE:

struggled for years with substance abuse but claimes to not used for the past year

DEPRESSION ASSESSMENT:

homeless, not married, no close friends or family, does have dog companion

What assessment data is RELEVANT and must be interpreted as clinically significant by the nurse? RELEVANT Assessment Data: Clinical Significance:

Alert & oriented ,Abdomen flat, soft/nontender, bowel sounds, Dirt on hands, under fingernails, fungal toenails on both feet, swollen, macerated and moist with peeling of the skin

his feet issues could be due to his hypertension and the wear and tear of his shoes could be causing the rest of his swollenness and peeling of the skin

RELEVANT SUBJECTIVE Assessment Data:

Clinical Significance:

voiding without difficulty, urine clear/yellow, voiding 3x at night, feet persistently itch

his feet could be ithcy due to the lack of personal hygiene

Copyright © 2018 Keith Rischer, d/b/a KeithRN.com. All Rights reserved.

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 headache the headache might be from his hypertension, lack of food care

Psychosocial Problem(s) depression

Cause and/or Pathophysiology being homeless with no wife or close family or friends only dog compaianship

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) headache lack of hygiene cough

What then Developed? blurred vision was a result of the headache and poor foot health was a result of the lack of hygiene

Psychosocial Problem(s) depression

What then Developed? from the depression I believe that his lack of personal hygiene

2. What are the priority physical/psychosocial problems and resultant assessments? PRIORITY Problems: PRIORITY Nursing Assessments:

headache lack of hygiene cough

give pain medication to eliminate headache monitor BP collect and test sputum

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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) proper footware and proper personal hygiene

Secondary Prevention Level: Detect and treat existing disease or injuries. (Screen and treat) collect a sputum specimen and send it for testing observe oral cavity and listen to breath sounds

Tertiary Prevention Level: Reduce the disease or injury to lowest level to minimize disability. (Rehabilitation). proper footware and give options to put him and his dog in housing make sure to reschedule appointments to revisit to monitor changes

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? nutrition is a big issue, along with depression, skin integrity due to not bathing, and wearing worn down shoes.

Copyright © 2018 Keith Rischer, d/b/a KeithRN.com. All Rights reserved.

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

public health department

complete assessment and intake of information

Forensic

medical examiners office

evalutating victims of assult, collect and secure evidence

Clinic

hospitals, schools, private practice

checking in on their physical, mental and emotional health

School

being a caregiver

first aid

Occupational

communicatiing stressors to qualified personnel

listening to what is bothering them

Faith-Based

churches or support groups

evaluating their emotional and mental health

Home Health/hospice

in home health care

checking in on their physical, mental and emotional health

Senior Center

give meals and living space and home repair services

checking in on their physical, mental and emotional health

Homeless shelter

give temporary homes to people

assessments, teaching, prevention of illness, nutrional

Transcultural: Describe how the cultural factors relate to the care of this patient in the categories listed below. Race/Ethnicity: people could treat him differently because he is african american, homeless, a veteran, and not married Environmental Health

living in his car, with no support system except for his dog

Vulnerable Population:

war veteran, homeless in big city population, not married, no close friends or family,

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