Your patient is a 51-year-old Hispanic women. Gender assigned at birth is female, preferred pronouns are she/her. Ms. Nunez reports fatigue, difficulty swallowing, increased sensitivity to cold, weight gain of twelve pounds in two months, and weakness over the past four months.
Your patient is married. She does not work. She lives in a household of an extended family. She crossed the boarder from Mexico several months ago with her husband and four children. She does not medical insurance and does not have a car. They arrived by Cab for today’s appointment. She is accompanied by her sister who speaks English. She is learning English, but it is limited. In Mexico, she completed the 10th grade. She is looking for a better life for her family.
The patient is escorted to an exam room, I introduce myself and properly identify and apply a wristband to the patient. The patient is asked about allergies and medication. She reports that she has no allergies, and currently takes a blood pressure medicine. She also reports she has been to a dermatologist because her skin has been dry and she was instructed to use over the counter moisturizers that aren’t working very well.
After interviewing the patient, the physical assessment begins. Vital signs are obtained: blood pressure 118/82, heart rate 51 beats per minute, 16 respiration’s per minute, temperature 98.5 degrees Fahrenheit, weight of 184 pounds.
You note that the patient has symptoms that could relate to her thyroid gland and recognize you need to do a good HEENT exam. During your physical exam, you find that the thyroid is fuller on the left than the right with inspection.
Answer the following questions:
1. As the primary nurse you will need to do a cultural assessment on this patient. Identify at a minimum three domains that you would explore further when gathering a cultural history on your patient and describe why these are important for you as the nurse caring for this patient?
2. How would you approach the thyroid exam on this patient?
3. Is there any other systems that you would want to assess? Describe what systems you would assess and why. Support with an outside resource.
4. What findings would you consider abnormal when assessing the thyroid gland?
5. Are there any red flags in this scenario?
6. Who do you think that would a possible referral for this patient. Take into consideration and describe how health literacy and social determinants of health may interfere with this referral.
Healthy People 2030 is a great reference if you want more information on social determinants of health.
at https://health.gov/healthypeople
Case studies should be completed in Word format with a cover and reference page. The body of the paper should be 1-2 pages, double spaced, using APA 7th edition criteria. Ensure to use proper citation.
Reference
Business Bliss Consultants FZE. (November 2018). Physical Examinations for Assessment | Case Studies. Retrieved from https://nursinganswers.net
Links to an external site.
Rubric
401 Case Study (1)
401 Case Study (1)
Criteria Ratings Pts
This criterion is linked to a Learning OutcomeHow would you approach the thyroid exam on this patient.
Describe how you complete the physical exam on the thyroid gland.
10 to >7.0 pts
Competent
7 to >3.5 pts
Proficient
3.5 to >0 pts
Novice
10 pts
This criterion is linked to a Learning OutcomeAre there any other symptoms you would want to assess in this patient? Describe additional systems to assess and support your decision with an outside resource.
10 to >7.0 pts
Competent
7 to >3.0 pts
Proficient
3 to >0 pts
Novice
10 pts
This criterion is linked to a Learning OutcomeDescribe what findings you would expect to find as normal? and are there any red flags in this scenario?
10 to >7.0 pts
Competent
7 to >3.0 pts
Proficient
3 to >0 pts
Novice
10 pts
This criterion is linked to a Learning OutcomeUses APA format, correct grammar, spelling and appropriate citation. Uses one scholarly article from an outside source.
5 to >4.0 pts
Competent
4 to >3.0 pts
Proficient
3 to >0 pts
Novice
5 pts
This criterion is linked to a Learning OutcomeIdentification of three cultural domains that will be assessed further by the primary nurse.
10 to >5.0 pts
Competent
5 to >3.0 pts
Proficient
3 to >0 pts
Novice
10 pts
This criterion is linked to a Learning OutcomeSocial determinants of health is discussed in regards to referral success.
5 to >4.0 pts
Full Marks
4 to >3.0 pts
Proficient
3 to >0 pts
Novice
5 pts
Total Points: 50
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