Cultural, Spiritual, Nutritional, and Mental Health Disorders
University:
St. Thomas University
Cultural, Spiritual, Nutritional, and Mental Health Disorders
Paper Instructions
For this Discussion, you will take on the role of a clinician who is building a health history for one of the following cases. Your instructor will assign you your case number.
- Case 1
- Case 2
- Case 3
Subjective Data
Chief Complaint
(CC) “I came for my annual physical exam, but do not want to be a burden to my daughter.” “I am here for my annual physical exam and have been having vaginal discharge.” “Annual physical exam”
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. 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. 23-year-old Native American male comes in to see you because he has been having anxiety and wants something to help him. He has been smoking “pot” and says he drinks to help him too. He tells you he is afraid that he will not get into Heaven if he continues in this lifestyle.
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. Current Meds prenatal vitamins and takes Tylenol over the counter for aches and pains on occasion Current Meds denied
Allergies No allergies to food or medications.
Family Hx
She has a strong family history of diabetes. Gravida 1; Para 0; Abortions 0. He has a family history of diabetes, hypertension, and alcoholism.
Review of Systems (ROS)
- General weight loss of 25 lbs over the past year; no recent fatigue, fever, or chills. No fatigue, fever, or chills. No recent weight gains of losses, 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 No pain or injury
Respiratory
CV no chest discomfort or palpitations
GU no urinary hesitancy or change in urine stream
Integument multiple bruises on his upper arms and back. multiple piercings, and tattoos. Old scars related to “cutting” history of eczema – not active
MS/Neuro falls x 2 within the last 6 months; no syncopal episodes or dizziness no syncopal episodes or dizziness, no change in memory or thinking patterns; no twitches or abnormal movements. no syncopal episodes or dizziness, no change in memory or thinking patterns; no twitches or abnormal movements
Objective Data
PE B/P 188/96; Pulse 89; RR 16; Temp 99.0; Ht 5,6; wt 110; BMI 17.8 B/P 128/76; Pulse 83; RR 16; Temp 99.0; Ht 5,6; wt 128; BMI 20.98 B/P 158/90; Pulse 88; RR 18; Temp 99.2; Ht 5,7; wt 208; BMI 32.6
General 23-year-old male appears well developed and well-nourished. He is anxious – pacing in the room and fidgeting, but in no acute distress.
HEENT Atraumatic, normocephalic, PERRLA, EOMI, arcus senilus bilaterally, conjunctiva and sclera clear, nares patent, nasopharynx clear, edentulous. Atraumatic, normocephalic, PERRLA, EOMI, conjunctiva and sclera clear; nares patent, nasopharynx clear, good dentition. Piercing in her right nostril and lower lip. Atraumatic, normocephalic, PERRLA, EOMI, sclera with mild icterus, nares patent, nasopharynx clear, poor dentition – multiple carries.
Lungs CTA AP&L CTA AP&L CTA AP&L
Card S1S2 without rub or gallop S1S2 without rub or gallop S1S2, +II/VI holosystolic murmur; without rub or gallop
Abd benign, normoactive bowel sounds x 4 benign, normoactive bowel sounds x 4 benign, normoactive bowel sounds x 4; Hepatomegaly 2cm below the costal margin.
GU external genitalia intact, no lesions or masses. White copious discharge with an amine odor; no cervical motion tenderness; adnexa intact.
Ext no cyanosis, clubbing or edema no cyanosis, clubbing or edema no cyanosis, clubbing or edema
Integument multiple bruises in different stages of healing – on his upper arms and back. intact without lesions masses or rashes. intact without lesions masses or rashes.
MS
Neuro No obvious deformities, CN grossly intact II-XII No obvious deficits and CN grossly intact II-XII No obvious deficits and CN grossly intact II-XII
Once you received your case number, answer the following questions:
- Discuss the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient you selected.
- Utilizing the five assessment domains, which ones would you utilize on your patients in conducting a comprehensive nutritional assessment.
- Discuss the functional anatomy and physiology of a psychiatric mental health patient. Which key concepts must a nurse know in order to assess specific functions?
Submission Instructions
Must us CASE 3
Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.
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Sample Answer
Cultural, Spiritual, Nutritional and Mental Health Disorders Case 3
Native Americans/ American Indians have been known to have a lower life expectancy as compared to other ethnic groups in the United States of Africa. Most of their meals have a lot of sugar thus predisposing most of them to obesity, diabetes, hypertension and other chronic illnesses related to obesity(Adakai et al., 2018). They also have a limited access to healthcare professionals and their living conditions predispose them to some conditions.
The patient in case 3 smokes pot and drinks alcohol all which have been associated with several mental health disorders such as anxiety. Obesity is also known to increase the incidence of depression and anxiety in individuals(Fulton et al., 2022) .The patient has a family history of alcoholism, which also predisposes him to taking alcohol. His religious beliefs that his lifestyle choices will prohibit him from going to heaven can make him anxious and even raise his blood pressure.
The five domains outlined by nutrition care process for nutritional assessment include, food or nutrition related history, biochemical data, medical tests and procedures, anthropometric measures, nutrition focused physical findings, and patient history. The patients’ history will a crucial domain in this case as it will highlight his weight changes over the years, social habits such as alcohol consumption that can affect his nutritional status and any family history of malnutrition.
The patient nutritional history would help me to understand the meals he consumes on a daily basis, the frequency of the meals and any supplements he is currently taking which could have predisposed him to obesity(Reber et al., 2019).
Physical examination which will include the general appearance of the patient, his skin, hair, nails, vital signs and eyes should be examined to rule out conditions such as hypothyroidism that can lead to weigh gain. Anthropometric measures such as weight, height and BMI can help me categorize the patients’ nutritional status and his needs(Reber et al., 2019).
The patient has a BMI of 30.2 indicative of obesity abdominal circumference will also be taken under anthropometric assessment. Medical tests such as liver function tests, random blood glucose levels, kidney function tests and cholesterol levels can also give a picture of the nutritional status of this patient.
Several changes are usually observed in the brain of patients with psychiatric illnesses. Gray matter volume in some parts of the brain such as the caudate region is usually reduced while the volume increases in amygdala and other regions in patients with Major Depressive Disorder. These imbalances have been linked to depressive moods. Neuropeptide S produced by the brainstem mostly in the locus coeruleus, trigeminal nerve nucleus and lateral parabrachial nucleus is also imbalanced in psychiatric illnesses.
These peptides are responsible for behaviour, food seeking and generation of adipocytes in the setting of obesity. This peptide has been linked to stress, fear and cognitive abnormalities(Markiewicz-Gospodarek et al., 2022). A nurse assessing a psychiatric patient should have mastered how to perform a mental status examination (MSE). Any abnormalities noted during an MSE can further be investigated by assessing the cranial nerves or muscle tone and bulk.
References
- Adakai, M., Sandoval-Rosario, M., Xu, F., Aseret-Manygoats, T., Allison, M., Greenlund, K. J., & Barbour, K. E. (2018). Health Disparities Among American Indians/Alaska Natives—Arizona, 2017. MMWR. Morbidity and Mortality Weekly Report, 67(47), 1314–1318. https //doi.org/10.15585/mmwr.mm6747a4
- Fulton, S., Décarie-Spain, L., Fioramonti, X., Guiard, B., & Nakajima, S. (2022). The menace of obesity to depression and anxiety prevalence. Trends in Endocrinology & Metabolism, 33(1), 18–35. https //doi.org/10.1016/j.tem.2021.10.005
- Markiewicz-Gospodarek, A., Kuszta, P., Baj, J., Dobrowolska, B., & Markiewicz, R. (2022). Can Neuropeptide S Be an Indicator for Assessing Anxiety in Psychiatric Disorders? Frontiers in Public Health, 10, 872430. https //doi.org/10.3389/fpubh.2022.872430
- Reber, E., Gomes, F., Vasiloglou, M. F., Schuetz, P., & Stanga, Z. (2019). Nutritional Risk Screening and Assessment. Journal of Clinical Medicine, 8(7), 1065. https //doi.org/10.3390/jcm8071065
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