Week 3 Discussion Advance Practice Essay HW
Week 3 Discussion Advance Practice Essay HW
Apply information from the Aquifer Case Study to answer the following discussion questions:
Discuss the Mr. Rodriquez’s history that would be pertinent to his gastrointestinal problem. Include chief complaint, HPI, Social, Family and Past medical history that would be important to know.
Describe the physical exam and diagnostic tools to be used for Mr. Rodriguez. Are there any additional you would have liked to be included that were not?
Please list 3 differential diagnoses for Mr. Rodriguez and explain why you chose them. What was your final diagnosis and how did you make the determination?
What plan of care will Mr. Rodriquez be given at this visit, include drug therapy and treatments; what is the patient education and follow-up?
Do 2 pages
Provide references.
Dr. Medel tells you about your next patient.Dr. Medel tells you about your next patient.
!
Today, you are working at a family medicine clinic with Dr. Medel. Together, you review her clinic schedule for the day and she suggests that you see Mr. Cesar Rodriguez, a 39-year-old uninsured man who recently moved to the U.S. from the Dominican Republic. This is Mr. Rodriguez’s first visit to the clinic. Week 3 Discussion Advance Practice Essay HW
Molly, Dr. Medel’s medical assistant, has already escorted Mr. Rodriguez to the examination room and has arranged for a Spanish-speaking interpreter to be present for the visit, since he speaks and comprehends very little English. Molly tells you that Mr. Rodriguez has been having “worsening abdominal pain over the past several months,” and is “worried that something is wrong.”
Dr. Medel says to you, “How would you begin to think about what might be going on with Mr. Rodriguez?”
You reply, “Abdominal pain can be caused by a wide variety of conditions. I’ll need to get more information about his symptoms to form an appropriate differential diagnosis. At this point I’d have to consider several organ systems as potential etiologies of the pain.”
“Very good,” Dr. Medel responds. “Why don’t you go ahead and talk with Mr.
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Rodriguez and come find me afterward. Lola, our Spanish-speaking interpreter can help.”
Systems Approach to Abdominal Pain
Gastrointestinal
Appendicitis, cholecystitis/cholelithiasis, diverticulitis/diverticulosis, dyspepsia, gastroesophageal reflux disease, gastritis, acute or chronic hepatic failure with resultant complications (e.g., ascites), acute hepatitis (e.g., viral, autoimmune, alcoholic, drug-induced), inflammatory bowel disease, intestinal ischemia, intestinal obstruction, irritable bowel syndrome, pancreatitis, peptic ulcer, perforation/peritonitis (e.g., gastric, colonic, intestinal), gastric outlet obstruction, tumor (e.g., gastric, hepatic, pancreatic, intestinal, colonic).
Cardiac Myocardial infarction, angina pectoris, abdominal aortic aneurysm dissection or rupture.
Psychogenic Anxiety, panic disorder, somatiform disorder, post- traumatic stress disorder.
Pulmonary Pleurisy, pneumonia, pulmonary infarction, tumor.
Renal Nephrolithiasis, pyelonephritis, cystitis, tumor.
Musculoskeletal Abdominal wall muscle strain, hernia (e.g., ventral, inguinal, incarcerated), abscess (e.g., psoas, subphrenic), trauma (e.g., contusion, hematoma).
Metabolic Drug overdose, ketoacidosis, iron or lead poisoning, uremia.
Also consider:Also consider:
TEACHING POINTTEACHING POINT
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medication, vitamin, and herbal supplement side effects foods issues (dietary intolerances, such as lactose, gluten, fructose, or
artificial sweeteners (e.g., sorbitol, xylitol, sucralose)
ELICITING THE HISTORY HISTORY
You and Lola greet Mr. Rodriguez.You and Lola greet Mr. Rodriguez.
!
How to Interview a Patient Via an Interpreter
Talk as you would normally, directly to the patient and not to the interpreter.
The translator should interpret in the first person, without editing it in any way.
Often, the interpreter will sit just behind the patient and in their ear, or off to the side where the interpreter won’t obstruct your ability to face the patient, make direct eye contact, and feel like you’re talking with the patient directly.
TEACHING POINTTEACHING POINT
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Ideally, it should feel like the translator is just a conduit for the conversation between you and the patient. Week 3 Discussion Advance Practice Essay HW
As you walk down the hall, Lola, the Spanish-speaking interpreter, gives you some tips on how to interview a patient with an interpreter.
Then, you and Lola enter the room. You sit directly across from Mr. Rodriguez, with Lola sitting just off to your left and facing him. You sense that Mr. Rodriguez seems anxious about coming to the physician today. You introduce yourself and ask,
“What brings you in today?”
“Well, I’ve been having this abdominal pain, and it just seems like it won’t go away. It started probably a year ago. It used to happen a few times a week, now it hurts every day. It usually burns right here.” (He points to the epigastric area of his abdomen).
“Is there anything that makes the pain better or worse?”
“It’s hard to say. Sometimes eating or drinking makes it better, or sometimes worse. Sometimes eating spicy foods makes it worse.”
“What worries you the most about your symptoms?”
“I don’t know,” he says nervously. “I just want to make sure nothing is wrong.”
Thinking about some of the common causes of abdominal pain, you conduct a focused review of systems:
General:General: Denies weight loss, fevers, chills, or night sweats. He has had no recent illnesses. Aside from a recent move to the US from the Dominican Republic, he has not travelled recently.
GI:GI: Denies any dysphagia, regurgitation, nausea, vomiting, anorexia, early
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satiety, hematemesis, hematochezia, melena, diarrhea or constipation. GU:GU: Denies dysuria, hematuria, or change in frequency. CVS/Respiratory:CVS/Respiratory: No chest pain or shortness of breath.
References
American Association of Medical Colleges. Guidelines for use of medical interpreter services. https://www.aamc.org/download/70338/data/interpreter-guidelines.pdf. Accessed April 21, 2017.
MEDICAL AND FAMILY HISTORY HISTORY You now direct your attention to Mr. Rodriguez’s medical history.
“Do you have any chronic medical problems?”
“I don’t really have medical problems, just the stomach pain.”
“Have you ever been hospitalized or had any surgeries?”
“I’ve never been hospitalized. Never been operated on.”
“Do you take any medicines or supplements?”
He tells you, “Just ibuprofen if I’m tired and sore after work, probably most days of the week. I drink some tea that’s good for the stomach, ‘Yerba Buena,’ but it doesn’t really help.”
“Does anyone in your family have any medical conditions?”
“My father had high blood pressure, my mother had diabetes.”
“Does anyone have pain similar to yours?”
“I don’t know if anyone has these stomach problems like me.”
https://www.aamc.org/download/70338/data/interpreter-guidelines.pdf
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You ask Mr. Rodriguez a few more questions and discover that he works as a farm laborer. He has no known drug allergies. He smoked a few cigarettes daily, but quit six months ago. He drinks three to four beers per week. He denies other drug use.
You congratulate Mr. Rodriguez on quitting smoking and you thank him for answering all of your questions. You review in your mind what you’ve learned from Mr. Rodriguez so far, and find yourself still wondering about why he seems a little anxious. Before you go to get Dr. Medel, you inquire,
“It seems like this has really been bothering you. Is there anything else we haven’t talked about that seems important?”
“Well, I guess I would have come sooner, but I don’t have any health insurance and haven’t had the money to come to the doctor. I want to feel better, but I hope it’s not something serious.”
ACCESS TO CARE TEACHING You reply, “Well, I’m glad you came in today, and I’ll be sure and share your concern with Dr. Medel. Thanks for telling me.”
You ask him to change into a gown, taking off all of his clothes except his underwear. You reassure him that you will return with Dr. Medel momentarily, and you and Lola leave the exam room while Mr. Rodriguez changes. Week 3 Discussion Advance Practice Essay HW
In the hallway, you comment to Lola that you are concerned about why Mr. Rodriguez waited to come see a doctor.
Question Which factors, in addition to finances, may have contributed to Mr. Rodriguez not seeking medical care in the recent months? Select all that apply.
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The best options are indicated below. Your selections are indicated by the shaded boxes.
A. He may be an undocumented immigrant.
B. Undocumented immigrants in the US are at a higher
risk of exploitation than legal residents.
C. Lack of concern about his overall health.
D. His impression that allopathic care is not considered
holistic.
E. He may view the U.S. healthcare system as unfriendly
and intimidating.
SUBMITSUBMIT
Answer Comment The correct answers are A, B, D, E.The correct answers are A, B, D, E.
Potential Cultural Barriers to Seeking Medical Attention
There may be a variety of reasons for an individual’s reluctance to seek medical care, making it imperative that the physician explore and address these issues with each patient individually and not rely on assumptions about his or her reasons.
While all patients should be directly asked the reason for their reluctance to seek medical care, the patient’s occupation (farm worker) should raise a flag. Undocumented immigrants may fear that if they seek medical attention, the healthcare system may report them to the government, placing them at risk of deportation. This fear is not unfounded, and providers should be sensitive about disclosing patients’ undocumented status. Week 3 Discussion Advance Practice Essay HW
