NRS 434V WEEK 4 DISCUSSION QUESTION 1 1. Using the patient information provided, respond to the following questions: (a) What cultural considerations are important for you to remember while you interview Ms. Li? (b) What is the Abuse Assessment screen? (c) If abuse is discovered, what should you do?

a. Patient Information:

b. Patient: Sue Li

c. Age: 20

d. Ethnicity: Asian American

When working with members of the Asian communities, the nurse needs to take into consideration the culture and traditions of that community. With the emergence of many nationalities coming to America blends their culture with that of the American cultures and can cause some confusion for some health care providers. Knowledge of the basic/common practices will assist in the communication and make the process go much easier. The Asian culture is unique in the issue of respect. Within the culture, Asian women will not share in eye contact because they see it as disrespectful. This cultural aspect may at times be misunderstood as a sign of abuse in itself. This submissive display can lead some to initially think that abuse has taken place. Understanding the culture of your patient is vitally important to a complete affective assessment. Asian Americans may show up to the facility with the expectation that the health care provider intuitively know what is wrong with them. The Nurse should always address the person using the correct title followed by the family or surname because this is seen as politeness and formality that is frequently valued by the culture. The health care professional may even lose credibility by asking a fairly standard interview question such as why they are here in the hospital. The impression is that you are the professional and should know exactly why they are here (Jarvis, C. 2008). Ms. Li is 20 years of age, and was probably raised with a lot of western cultures through her life. The understanding of the culture of which she comes from is important to start with. The interview process will determine if she prescribes to the identified culture and/or which aspects she values most. The interviewer must understand that not all Asian Americans will have the same background and cultural aspects they embrace. Sexual ambiguity is also an aspect that needs to be handled delicately. Being of the age of sexual activity, and the fact that she is of the Asian American culture, this topic may not be as easily discussed as others. The patient may not want to share her sexual activity and may want to avoid questions to the fact (Edelman, C., Kudzma, E., & Mandle, C. 2014). For male nurses, there may be a need for a female colleague to assist in this area in order to make her feel more comfortable. The use of the Abuse Assessment Screen is very useful in identifying abuse from a straight forward survey. The survey asks 6 basic questions. 1. When you and your partner argue are you ever afraid of them? 2. When you and your partner verbally argue, do you think they try to emotionally hurt/abuse you? 3. Does your partner try to control you? Where you go, who you see, how much money you cam have? 4. Has your partner ever slapped you, pushed you, kicked you, hit you or otherwise physically hurt you? 5. Since you have been pregnant or (when you were pregnant) has your partner ever bit you, slapped you, pushed you, hit you, kicked you, or otherwise physically hurt you? 6. Has your partner ever forced you into sex when you did not want to participate? If the patient answers yes to any of these questions, the interviewer must thank them for their honesty and ask questions to investigate further (Jarvis, C. 2008). If abuse is discovered, the interviewer must protect the abused/patient and offer help or a way out of the abuse. Building trust is of the highest importance and must begin from the beginning of the assessment. Offering resources in the community to help the patient is necessary to enhance the recovery process. Once the trust has been established, the interviewer must notify the appropriate authorities so that documentation can begin. The role of a mandatory reporter is an aspect of health care that cannot be ignored. We must be the voice for those who have none, or have lost it through the abuse. References: Jarvis, C. (2008). Physical examination & health assessment (6th ed.). St. Louis, Mo.: Saunders/Elsevier. Edelman, C., Kudzma, E., & Mandle, C. (2014) Health promotion throughout the life span. 8th Edition. Mosby. VitalBook file 7. For the middle-aged adult, exercise can reduce the risk of various health problems. Choose three health issues that regular physical exercise and activity can help prevent and manage. Discuss the prevalence of each of these health problems in society today. Describe measures that you would take as a nurse to assist clients with health promotion measures to incorporate exercise and physical activity into their lives. Include the kind of activities you would recommend, the amount of exercise, and the approach you would use to gain cooperation from the client. Support your response with evidenced-based literature. Exercise can impact a person’s health in many ways. For the middle aged adult, various health problems begin to take their toll on an individual’s lifestyle. By simply introducing exercise these health problems can begin to be minimized considerably. Cardiovascular, digestive, and pulmonary health can all be affected by the efforts of exercise. The US Surgeon General’s Report on Physical Activity and Health has verified scientific evidence that links physical activity to the reduction of the risks of cardiovascular complications. “The prevailing view in these reports is that more active or fit individuals tend to develop less coronary heart disease (CHD) than their sedentary counterparts” (Myers, J., n.d.). It is suggested that an average of 30 min of activity 3 out of 7 days of the week will greatly reduce the risks of cardiovascular disease in adults (Myers, J., n.d.). Digestive health can be improved to include reduction of diabetes and colon cancer by the introduction of exercise in one’s daily life. Exercise can improve blood flow to the digestive system which can reduce the risks of constipation and avoidance of a sluggish digestive tract, reducing the risk of colon cancer and the addition of accompanying gases, bloating and cramps (Melone, S., n.d.). Here in the central valley of California, respiratory problems are common place in the medical community. It is well known that exercise can worsen some respiratory conditions like asthma and emphysema. However, by practicing the right types of exercises, a person can improve the function of their lungs by strengthening the muscles that control breathing. Dr. Noreen Kassem believes that a 4 step program can improve breathing for those who suffer from respiratory illnesses. Step 1- Warm up your lungs and body before beginning any exercise by slow walking, jogging on the spot and doing stretches. Do not stop a strenuous workout suddenly, but slowly taper off by coming to a slow walk if you are running or jogging. Step 2- Sit upright on a firm surface or cross-legged on a floor mat. Keep your back straight and hold one nostril closed with your finger. Inhale deeply through the other nostril, while keeping your mouth closed. Exhale through your mouth and repeat 15 to 20 times with each nostril. This helps to improve nasal breathing which cleanses and warms the air before it reaches the lungs. Mouth breathing can trigger the brain to think carbon dioxide is being expelled too quickly, causing goblet cells in the lungs to produce mucus, hindering breathing. Step 3- Lie on an exercise mat on your back with your hands resting on your lower abdomen. Inhale deeply through your nose so that you feel your abdomen rise. Hold this breath for a count of two, and then release by exhaling through your mouth. Repeat 20 to 30 times. This exercise helps to improve the respiratory muscles of the chest, ribcage, back and abdomen for more efficient breathing and improved lung health. Step 4- Stand up straight with your arms at your sides and inhale through your nose in three short breaths, almost as though you are sniffing. While inhaling lift your arms from your sides to your shoulders and up over your head. Exhale through your mouth while lowering your arms back to your sides. Repeat this exercise 10 to 12 times. This exercise helps open up the lungs to facilitate respiration. (Kassem, N., 2011) As a nurse it is very difficult to encourage our patients in the health promotion that will help them avoid potential harm health wise. Taking into account the patient’s personal views on health and promotional efforts for prevention of illness and risk factors is the first step. Discussing the illness of members of their own family would be a great place to start. Since they could have some “skin in the game”, this will help in the adherence to any exercise programs suggested. Asking about the patients daily and weekly activities will also assist in the exercise plan for the patient. Working in the schedule to partake in walks after dinner or before work can help as well. Most patient think that because they walk at work, this is all the exercise they need, or that it will fulfill the 30 min a day three days a week. By finding a way to make it easy and also fit in with their daily lives is very important in the education process. We need to find a way to make the patient understand that this is better for them in the long run, and will save them money in the financial realm as well. By no means is this easy, but by making the exercise easy and adjustable to their busy lives, will help all involved. Reference: Myers, J. (n.d.). Exercise and Cardiovascular Health. Circulation, 2e-5. Kassem, N. (2011). How to Exercise to Improve the Health of Your Lungs. Retrieved February 18, 2017, from Melone, S. (n.d.). How Does Exercise Improve Digestion? Retrieved February 18, 2017, 

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