Week 5 what Are The Determinants of Health
An individual health is influenced by their choices that can be good or bad. And these choices or factors are referred as determinants of health. The determinant of health fall under sub categories of policymaking, social factors, health services, individual behavior, and biology genetics. Determinants of health reach beyond the boundaries of traditional health care and public health sectors; sectors such as education, housing, transportation, agriculture, and environment can be important allies in improving population health (Healthypeopley2020, 2014). As a future advanced practice nurse, it will be my responsibility to teach my patient regarding health determinants. Being a knowledgeable about their health determinants my patients can better manage their health and/or can prevent the disease process by following health lifestyle.
The patient and/or their family can easily modify their determinants like individual behavior. The health determinants like individual behavior play an essential part in illness free healthy outcome. Many public health and health care intervention focus on changing individual behaviors such as substance abuse, diet, hand washing, and physical activity (Healthypeople2020, 2014). During this week rotation, I witnessed a Ms. S.P., thirteen-year old girl that arrived to clinic for cold like symptoms. When I looked at the chart, I was shocked to see that this girl weight is over three hundred pounds. Ms. S.P. has already been diagnosed with hypertension, diabetes, and obesity. I was curious to know what made this child being so overweight than her cold symptoms. As a provider, I can see this little girl is at the risk of developing chronic disease. I talked to the parents and asked what was their opinion and what are they doing to prevent the chronic disease. During my conversation, I found out overeating was the main root of the problem. Parents stated she used to not eat and a very picky eater. When Ms. S.P. started eating, it was all junk food and parents never tried to stop her because they were thinking their little girl is at least eating something.
According to American Diabetes Association (ADA) (2014), American Indians and Hispanic populations are 2.2 times more likely to develop diabetes and 95% of those will have type 2 diabetes. During my conversation, I understood that parents also would like to do something but do not know where to start. Parents education provided to provide more vegetables than junk food, avoid beverages that are full of sugar such as sodas or juices rather encourage to drink lots of water, choose lentils, beans, lean meat, non-fat dairy milk over the fast food, help you child to stay active, and avoid sedentary time. Parents educated that it will take time to make healthy habits; however, choosing a small change in every day life can lead to a success. To help your child maintain a healthy weight, balance the calories your child consumes from foods and beverages with the calories your child uses through physical activity and normal growth (Centers for Disease Control and Prevention, 2017).
Week 6
During my clinical rotation, one important thing that I learned from my preceptor is when to refer a patient to specialist. My preceptor and I have sent many of our patients to different specialists such as cardiac, dermatologist, orthopedic, and/or ophthalmologist. This week, we saw an eleven year old Ms. R.N., who arrived with complain of red eyes. Patient was diagnosed with conjunctivitis. Patient and mother refused vision change. However, this was the fifth time patient been diagnosed with conjunctivitis. Fluorescein eye stain was tested on patient and was negative for any abnormal finding. I asked my preceptor what was the reason for doing Fluorescein eye stain on this patient. My preceptor educated me that often he has found that if there is something stuck in the cornea or any other eye part; that could be the reason patient behind patient eye irritation. Because patient has conjunctivitis so many time within three month, there should be something else going on. And that is the reason he did Fluorescein eye stain to make sure he is not missing anything. Although Fluorescein eye stain was negative. Referral to the ophthalmologist was sent and mother was educated to follow him.
Sending a referral might look alike an easy task but it is not, because the other specialty has to go through complex process, trying to figure out what is causing the problem or what is the root of problem. The provider has to document properly in specific patient charts mentioning what is the solid reason for referring this patient to specialty and why the specialist should see this patient, and what primary care provider did before sending this patient to specialty. A research study found that each referral is different due to the variety of each specialty, their expectations, and the components of fundamentals. One of the study showed that fundamental of components are consist of an account of the patient’s current condition, a working diagnosis or problem statement and history of presenting concern, key test results or tests awaiting results, a potential management plan, and any special characteristics of the patients such as being a resident of an aged care facility (Lawrence, Spencer, Sinnott, & Eley, 2015). Author further suggested a way for the specialist to make sure that they received an appropriate information is by using the SBAR that stand for situation, background, assessment, and recommendations. As we are aware of miscommunication can cause an errors, it becomes an important task that all the relevant information is provided to the referred specialist regarding the patient. The clinic that I am currently doing my clinical rotations has a referral coordinator who makes sure that all referral went going through the right process and patients are keeping up with them. The referral coordinator will call the patient to ensure open communication with the clinic, patient, and referred specialist. My preceptor also showed me a way where he puts a referral notes in patient charts so that he can follow up with patient when they come back to him. Probably that is the reason why so many patients like my preceptor because he involve the patients in the their plan of care.
Week 7 Cardiovascular Accident
According to American Heart Association (2017), high blood pressure is also called silent killer because it has no obvious signs and symptoms to indicate that something is wrong. During this week, my preceptor encountered a 69 year-old female that presented to the urgent care clinic with sign and symptoms of left-sided facial and arm weakness. Patient son mentioned that his mother has not been feeling well for past few days brought patient to the clinic. Patient’s son has to convince her mother to get herself checked up in the clinic and get medical advice for her symptoms. Patient is a Hispanic female with no medical history, surgical history involved C-section thirty-eight years ago and tubal ligation. The last time, patient visited the doctor office was about four years ago for positive flu. Patient stated that for past few days she has been having a severe headache and been using over the counter Tylenol and ibuprofen with some relief.
In addition, patient mentioned that lately she has been going through a lot of stress and depression. She recently lost her husband and is going through depression phase. Patient refused using any medications for depression. Patient reported she also has to babysit her daughter and son children that are 9 year old, 7 year old, and 3 year-old. Patient reported she has been having severe headache for two days that progress to left sided facial and arm weakness this morning.
On arrival, patient vital signs were taken manually in sitting position that were 198/104 right arm, pulse of 106, RR 19, Temp 97.9, and O2 sats 98% on room air. When asked, patient reported she usually runs in 120’s/low 70’s. Patient denied smoking or drinking alcohol in the past or present. Keeping Transient Ischemic Attack (TIA) in mind, four doses of baby aspirin was given and EMS was called. Patient and son were educated on TIA. Few days later, so called and thanked my preceptor for saving her mother life. Patient had a mini stroke; and also, was diagnosed with hypertension and hyperlipidemia. My preceptor further educate me that many times people with high blood pressure do not even know that they have it, as high blood pressure develops slowly and can cause many problems such as stroke, heart disease, kidney disease, and even death (American Heart Association, 2017). Patient education is very important on how to prevent stroke by following a healthy lifestyle such as quit smoking, limit your alcohol intake, check and control your blood pressure and cholesterol levels, treat underlying problems such as diabetes, heart problems, and take your medications as it is prescribed by your primary care physician (Centers for Disease Control and Prevention, 2016).
Reference
Centers for Disease Control and Prevention. (2016). Preventing Stroke: Control Medical
Conditions. Retrieved from
https://www.cdc.gov/stroke/medical_conditions.htm
American Heart Association. (2017). Why High Blood Pressure is a “Silent Killer”.
Retrieved from http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/UnderstandSymptomsRisks/Why-High-Blood-Pressure-is-a-Silent-Killer_UCM_002053_Article.jsp#.Wlf-RmQ-cb0
Lawrence, S., Spencer, L. M., Sinnott, M., & Eley, R. (2015). It Takes Two to Tango:
Improving Patient Referrals from the Emergency Department to Inpatient Clinicians. The Ochsner Journal, 15(2), 149–153.
Centers for Disease Control and Prevention. (2017). Tips for Parents-Ideas to Help
Children and Maintain A Healthy Weight. Retrieved from https://www.cdc.gov/healthyweight/children/index.html
Healthypeople2020. (2014). Determinants of Health. Retrieved from
https://www.healthypeople.gov/2020/about/foundation-health-measures/Determinants-of-Health