Culturally Competent Care for Patient with Hypertension

SDOH Case Study

Introduction

Social determinants of health (SDOH) are a necessary consideration in providing complete, holistic, quality care. This paper provides comprehensive plan of care for Sequoia Rain Song, a 54-year-old Native American woman. The plan considers her health literacy needs as well as the SDOH that affect her case, and presents appropriate interventions backed by clinical reasoning.

Sequoia’s Data

Health History

Sequoia Rain Song has no documented history of surgeries or hospitalizations. She has reported occasional episodes of fatigue, which have impacted her job performance as a guide at a Native American heritage museum. She has also gained weight over the past year and has given concern about her energy levels.

Medications

There is no specific mention of medications. However, given her hypertension (BP: 138/84) and high cholesterol levels (total cholesterol: 202 mg/dL, LDL: 160 mg/dL), it is possible she might be on antihypertensive and cholesterol-lowering medications, but further information is needed for confirmation.

Physical Assessment Findings

During Sequoia Rain Song’s physical assessment, several key findings were noted. Her vital signs revealed a blood pressure of 138/84 mmHg, a heart rate of 90 beats per minute, a respiratory rate of 20 breaths per minute, and an oxygen saturation of 99% on room air. Her temperature was recorded at 37.7°C, and her body mass index (BMI) was calculated to be 28, which falls into the overweight category.

The laboratory tests from one week prior to her wellness visit showed that her complete blood count (CBC) was within normal limits. Her blood glucose level was 93 mg/dL, blood urea nitrogen (BUN) was 15 mg/dL, and creatinine was 1.2 mg/dL, all within their respective normal ranges. Electrolyte levels were also normal, with sodium at 135 mEq/L, potassium at 3.8 mEq/L, and chloride at 101 mEq/L.

The total protein level was slightly elevated at 8.0 g/dL. Liver function tests indicated an aspartate aminotransferase (AST) level of 25 units/L and an alanine aminotransferase (ALT) level of 48 units/L, with the ALT being slightly above the normal range. Lipid profile results showed a total cholesterol level of 202 mg/dL, an LDL cholesterol level of 160 mg/dL, and an HDL cholesterol level of 40 mg/dL, indicating dyslipidemia with elevated LDL and total cholesterol and low HDL levels.

Social Determinants of Health and Culture

Economically speaking, Sequoia is in a challengingly difficult position because of the fact that she earns minimum wage working as a guide at a Native American heritage museum. This means she has a very limited income, which is necessarily going to have an impact on her ability to seek or to think about getting any necessary healthcare services she may need. It is going to impact her purchasing decisions, particularly when it comes to obtaining healthy, nutritious food, and other helpful items for maintaining a healthy lifestyle, since pre-packaged (but not good for you) items are more readily available and generally cheaper to buy (Lacko et al., 2021).

Her healthcare access is also an SDOH that impacts her, as access to care for her is definitely on the restricted end of the spectrum. Although Sequoia makes it a point to visit the clinic annually for her wellness check, her access to additional healthcare services is not wide open, considering her financial situation. This limitation is going to be a barrier in terms of getting timely medical advice, especially as she limits her healthcare appointments to one per year. This is not a good way to manage chronic conditions effectively.

Details about Sequoia’s dietary habits are not explicitly clear, but cultural dietary practices may play a substantial role in her life. As a Native American, traditional foods might be a natural part to her diet, and this would certainly affect her nutritional intake. It would be necessary to know more about her dietary habits before settling this question, and knowing more would be helpful in creating dietary recommendations that are culturally appropriate and realistic for her to follow. Some cultural competence would be needed in this area, of course (Powers et al., 2020).

Sequoia’s support system is not great and is going to be another factor that needs to be addressed. She is widowed and has two adult children, which does suggest she may have some family support. She is looking forward to the arrival of her first grandchild, which can be taken as a positive development that can give some emotional well-being. However, the absence of a spouse and the possibility for loneliness could be a factor that causes depression or isolation and that could also contribute to stress in her life.

Her living environment is also not specifically detailed, but it is probably going to be affected by socio-economic and cultural background. She may live in a community with limited resources or one that is geographically isolated, which could be yet another impact on her access to healthy food, healthy mindset, recreational activities, and healthcare services. Cultural and economic factors are likely to be determining factors in the state of her living conditions and lifestyle.

Sequoia’s educational background is not given, but it can be inferred that her health literacy may be affected by her level of education. This level can influence her understanding of health information and her ability to make good, informed health decisions.

Religious beliefs and practices are also contributors to health in Sequoia’s life. As a Native American, she may hold traditional cultural beliefs and practices that influence her health behaviors and attitudes towards medical interventions. More should be understood on this front as part of culturally competent care (Stubbe, 2020). These beliefs will be factors in how she perceives her health and wellness, the types of treatments she is willing to consider, and her overall approach to healthcare.

Health Literacy Needs

Sequoia’s health literacy needs should be assessed to make sure she understands her health status and the necessary interventions and the reason for them. She should be aided, if necessary, in being able to understand medical information, follow treatment plans, see the reason for them, and make informed health decisions that will improve her ability to apply self-care.

Ineffective Health Maintenance Related to Insufficient Resources

Physiologic Response

Sequoia\\\\\\\'s economic constraints and limited resources hamper her ability to maintain effective health practices that would otherwise help with her elevated blood pressure and elevated cholesterol levels. Without the financial means to access adequate healthcare, nutritious food, or medications, Sequoia is at a higher risk of developing chronic health conditions. Her blood pressure of 138/84 mmHg and LDL cholesterol level of 160 mg/dL are indicative of this reality.

Psychological Response

The stress and anxiety stemming from her economic instability and health concerns may be factoring into her overall fatigue and decreased energy levels. Any constant worry about making ends meet could be part of a cycle of stress-induced health deterioration. Mental stress can make fatigue worse, inhibiting healthy lifestyle progress.

Ineffective Peripheral Tissue Perfusion Related to Hypertension

Physiologic Response

Hypertension impacts Sequoia\\\\\\\'s health, what with reduced blood flow to peripheral tissues, which increases the risk of cardiovascular diseases. For example, hypertension can cause damage to blood vessels, or lead to heart disease and stroke. Untreated hypertension can lead to major health problems.

Psychological Response

Sequoia\\\\\\\'s awareness of her hypertension may also cause anxiety, which in turn can worsen the situation. The knowledge that she has a condition that requires ongoing management could weigh heavily on her if she has no knowledge of how to cope with this stress or manage her health well.

Activity Intolerance Related to Fatigue

Physiologic Response

Sequoia’s fatigue limits her ability to perform daily activities, which affects her job performance and quality of life. The persistent feeling of tiredness limits her physically and compels her towards a more sedentary lifestyle than is good for her and contributes to her weight gain.

Psychological Response

The psychological effects of persistent fatigue are that Sequoia may experience feelings of frustration, helplessness, isolation, and decreased motivation due to her inability to function at her desired level. This emotional burden can further lessen her quality of life, and contribute to a decline in mental health. The frustration of not being able to keep up with her responsibilities and enjoy life fully could contribute to feelings of hopelessness and a negative outlook on her health.

Evidence and Presenting Complaint

Sequoia Rain Song\\\\\\\'s primary concerns revolve around weight gain, occasional fatigue, and anxiety about her energy levels. These issues have arisen over the past year and have impacted her at her job. Her subjective complaints are substantiated by objective findings: her blood pressure is elevated at 138/84 mmHg, her LDL cholesterol level is high at 160 mg/dL, and her BMI stands at 28, indicating that she is overweight. These factors suggest that Sequoia is experiencing ineffective health maintenance.

Regarding peripheral tissue perfusion, Sequoia does not report specific symptoms indicating poor perfusion. However, her hypertension is an obvious objective indicator that she may be experiencing compromised peripheral tissue perfusion (Dutton & Elliott, 2022). Hypertension can reduce blood flow to peripheral tissues; the absence of direct complaints about perfusion issues does not diminish the importance of addressing her hypertension to prevent such future problems.

Sequoia also experiences episodes of fatigue, and this subjective data is corroborated by an elevated heart rate of 90 beats per minute, which could indicate underlying cardiovascular strain contributing to her fatigue. This combination of subjective and objective data supports the diagnosis of activity intolerance. The fatigue and elevated heart rate suggest that her cardiovascular system may be under strain.

Assessment Prioritization

In the case of ineffective health maintenance, her elevated blood pressure of 138/84 mmHg is a medical concern that requires immediate attention. Her economic instability, given that she earns minimum wage, is likely affecting her ability to maintain her health. Finally, her BMI of 28 (overweight) could affect both physical and mental health.

For ineffective peripheral tissue perfusion, hypertension is the main medical concern. Her limited access to healthcare services could be a barrier to managing her hypertension. Her elevated LDL cholesterol level of 160 mg/dL raises the risk of cardiovascular disease.

With regards to activity intolerance, Sequoia\\\\\\\'s reports of fatigue that hampers her job performance shows the need to address her energy and stamina. The stress related to her financial stability and job responsibilities could be adding to her fatigue and activity intolerance. Her elevated heart rate of 90 beats per minute suggests cardiovascular issues.

Interventions and Outcomes

To address Sequoia\\\\\\\'s ineffective health maintenance, a hypertension management plan is needed and should include lifestyle alterations, such as dietary changes, more routine exercise (low to moderate intensity). Antihypertensive medications may be an option, too. The goal should be to have blood pressure within the normal range, and thus lessen the risk of cardiovascular disease. It would also help to address her financial issues by connecting her with social services for financial assistance. This could help to reduce her stress and let her focus more on her health. A personalized weight management plan with a balanced diet and regular exercise would also help bring down her BMI.

For ineffective peripheral tissue perfusion, she needs to monitor her blood pressure and adjust treatment as necessary. Dietary changes that focus on reducing LDL cholesterol and perhaps statin therapy if necessary will help lower her LDL cholesterol levels (Wang et al., 2020).

Sequoia\\\\\\\'s activity intolerance means an assessment of underlying causes of her fatigue is needed. Recommendations might include sleep hygiene and managing stress. This intervention would help bring up her energy. Counseling for stress could help her with learning effective coping strategies. Reducing her stress levels will lead to better overall health and well-being.

Activity Intolerance

The first step in addressing her fatigue is to assess the underlying causes, like factors such as sleep quality, nutrition, stress, or chronic conditions. She may need to make lifestyle changes to improve her sleep hygiene or maintain a more balanced diet. She also needs to address the stress related to her financial state. Financial counseling could help her manage stress her money, and could help with managing her stress, too. Likewise, her elevated heart rate is another concern that needs to be addressed, and recommendations could include medication to control her heart rate, along with guidance for exercise. She will need to normalize for better health.

Clinical Reasoning

To address Sequoia\\\\\\\'s ineffective health maintenance we can apply Orem\\\\\\\'s Self-Care Deficit Theory, which supports self-care in nursing (Hartweg & Metcalfe, 2022). My own personal experience in managing patients with limited resources supports this recommendation, as the development of care plans is essential in promoting self-care. Knowledge of chronic disease management, lifestyle interventions, and resource coordination would help in the development of the plan.

For ineffective peripheral tissue perfusion, Roy\\\\\\\'s Adaptation Model is good with seeing the need for interventions that help patients adapt to physiological changes (Callis, 2020). It would be advised to follow clinical guidelines for hypertension management and cholesterol control so that the care plan lines up with best practices in the field.

For managing activity intolerance, Neuman’s Systems Model focuses on stress reduction and energy conservation, and applies here (Gozum & Ilgaz, 2022). Knowledge of fatigue assessment and management techniques is impotant for creating a holistic plan to improve her activity tolerance. The nurse should follow guidelines for managing chronic fatigue and thus see to it that the interventions are based on the latest evidence.