need to respond to this reflective post: This week I saw a 56-year-old African American male that initially presented to the clinic a few weeks ago to set up primary care. At his initial visit, he had not had a physical or blood work done in over 4 years, had a history of peripheral vascular disease, diabetes, and hypertension and a 3 pack a day smoker. At his first visit, he stated he needed to find a new doctor and a refill on his blood pressure medication (amlodipine 5 mg daily) that he had been taking but has stopped taking for years now. The patient was a very poor historian and had low health literacy. At his follow up appointment this week he presented to review his labs drawn a few days prior. I reviewed his lab work, discussed his history with him, and did my assessment.The patient is self-pay, so we only ordered the basic labs that he could afford CBC, lipid panel, CMP, and HgbA1c. His triglycerides were 211, LDL-cholesterol 129, HgbA1c 8.8, BUN 37, and Creatinine 2.13. After reviewing these lab results with the patient, I educated him on the importance of dietary changes, glucose control/medication adherence, lowering his blood pressure, and smoking. I discussed the importance of cutting back on smoking, uncontrolled diabetes, PVD, and hypertension, which places him at a high risk for cardiovascular problems such as a stroke and heart attack as well as kidney failure and loss of toes/limbs. The patient was surprised and stated he did not know his smoking and poor health management could lead to all these issues. He said he never knew such complications could happen. He had also not had any preventative care in years and was unaware that this was necessary, he stated he thought he was mostly healthy and that cost of healthcare had prevented him from following up with his health check. I did discuss and provided education regarding the importance of routine care and screening.One major challenge I noticed was this patient had very poor health literacy. From history, he did not graduate from high school; he is self-employed as a plumber and makes just enough to cover his monthly costs. According to Hahn and Truman, adults with lower educational attainments are associated with higher rates of liver disease, diabetes, and circulatory disease and the mortality rate from such diseases is also increased in this demographic (2015). According to the same study, income level is also closely related to health outcomes because those with higher incomes often have greater access to healthcare, healthy food, safer environments, and other resources necessary to maintain a healthy lifestyle (Hahn & Truman, 2015). This makes me to ensure my patients are educated on their level about their health and ensure they understand in detail the diagnosis, plan of care and basic lifestyle modification. I will pay closer attention to education level and occupation in terms of health literacy and remember to consider cost and affordability when prescribing medications, referrals, or ordering diagnostics. This also increases my search of options for health insurance available to patients in this type of situation. The struggle for affordable healthcare especially for the uninsured makes me think of options for insurance coverage and local resources for my future patients. Health Science Science Nursing NSG 5540 Share QuestionEmailCopy link Comments (0)
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