Diversity and Health Assessments: In May 2012, Alice Randall wrote an article for The New York Times on the cultural factors that encouraged black women to maintain a weight above what is considered healthy. Randall explainedfrom her observations and her personal experience as a black womanthat many African-American communities and cultures consider women who are overweight to be more beautiful and desirable than women at a healthier weight. As she put it, Many black women are fat because we want to be (Randall, 2012). Randalls statements sparked a great deal of controversy and debate; however, they emphasize an underlying reality in the health care field: different populations, cultures, and groups have diverse beliefs and practices that impact their health. Nurses and health care professionals should be aware of this reality and adapt their health assessment techniques and recommendations to accommodate diversity. In this Discussion, you will consider different socioeconomic, spiritual, lifestyle, and other cultural factors that should be taken into considerations when building a health history for patients with diverse backgrounds. 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 Case 2 Subjective Data CC: “I am here for my annual physical exam and have been having vaginal discharge.” History of Present Illness (HPI): 32-year-old pregnant lesbian – her pregnancy has been without complication thus far. She has been receiving prenatal care from an obstetrician. She received sperm from a local sperm bank. Drug Hx: Current Medications: prenatal vitamins and takes Tylenol over the counter for aches and pains on occasion Family Hx: She a strong family history of diabetes. Gravida 1; Para 0; Abortions 0. Review of Systems (ROS) General: no fatigue, fever or chills. Head, eyes, ears, nose & throat (HEENT): Neck: no pain or injury Respiratory: CV: GI: GU: Integument: multiple piercings, and tattoos. Old scars related to “cutting”. Neuro: no syncopal episodes or dizziness, no change in memory or thinking patterns; no twitches or abnormal movements Objective Data PE: B/P 128/76; Pulse 83; RR 16; Temp 99.0; Ht 5,6; wt 128; BMI 20.98 HEENT: Atraumatic, normocephalic, PERRLA, EOMI, conjunctiva and sclera clear; nares patent, ornasopharynx clear, good dentition. Piercing in her right nostril and lower lip. Lungs: CTA AP&L Cor: S1S2 without rub or gallop Abd: benign, normoactive bowel sounds x 4 GU: external genitalia intact, no lesions or masses. White copious disch…
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