Posted: July 25th, 2024

March 2nd

Please respond to the following 2 posts with 2 APA references each.

Response 1

Today I will be discussing a summary of a patient encounter who is a 28 year old Middle Eastern female presenting to the clinic for prenatal care, and how my encounter progressed and what assessment techniques I used. To begin I want to emphasize that I am a strong believer that every patient is unique in their own way. For example, there is a major difference in building history with a patient who has had multiple previous pregnancies, compared to a soon to be mother with her first pregnancy. My patient is a soon to be mother who is worried and concerned about her child’s wellbeing and what she can do to decrease the probability of the child having complications. It is fundamentally important to practice active listening with all your patients, but I believe that it is essential to closely collect data with first time mothers to prevent prenatal complications, gestational complications, maternal complications and post-partum complications. As I listened to my patients needs, I noticed that I had previously heard these needs and concerns and correlated the patient’s cultural and traditional background to my previous patients. Thereafter I adopted an approach to the encounter more suitable for the culture itself. According to Subki & Agabawi et.al (2021), Middle Eastern women have a family structure that is distinctive to the culture itself that sets standards to the type of care that is expected. These standards include comfortability, and empowerment of the patient-provider encounter. Taking this into consideration, the closest model I found to my approach is the Health Action Process Approach Model also known as HAPA. The HAPA model has phases to its approach. The first phase is the motivation phase “that leads to a behavioral goal intention/motivation, followed by the (b) volitional phase that leads to the actual health behavior” (p. 5). I used this model because the model best fits the patient’s cultural expectations, and covers both the patients and the provider’s goal as mentioned above. I proceeded to carefully collect health history data including basic demographic information, general medical history medications and allergies, mental health history, substance use, family health history, social history, occupation and finances, safety and personal habits. These are all determinants and social determinants that can alter ones care.

After gathering all medical data pertinent to the patients visit, I proceeded with the Antenatal Risk Questionnaire. According to Ayoub & Shaheen et.al (2020), Middle Eastern women are twice as more likely to have antenatal and postpartum depression than any other race. I chose ANRQ because this questionnaire gathers sensitive indirect information that could provide data for the patient’s current needs such as the one she in for today, and, could provide data that can be viable for the future. The questionnaire is composed of 12 items, and assesses 7 psychosocial risk domains. According to Subki & Agabawi et.al (2021) these domains include emotional support, “past history of depressed mood or mental illness and treatment received, perceived level of support available after birth of the baby, partner emotional support, life stresses in the past 12 months, personality (anxious or perfectionistic traits) and history of abuse (emotional, physical and sexual)” (p.4). I had slightly reworded the questionnaire so it does not sound intrusive to the patient’s cultures expectations or her husband.

Five targeted questions asked

· Do you feel that you have support from your husband and or family members when the child is born?

· Have you had a time in your life that you felt worried about something for 2 weeks or more?

· Do you currently have any stressors in your life and how would you define them?

· How do you and your partner solve any given obstacle?

· Do you or your partner have any ongoing concerns?

Response 2

As an advanced practice registered nurse it is important to take into consideration all factors that can influence your patient’s health. Factors include economic conditions, environment, education status, and social conditions that can influence health. By assessing social determinants of health you are able to better treat and diagnose your patients. Pt. M.M. is a 32-year-old female patient who presents to the clinic because she had a positive at-home pregnancy test. Pt. last menstrual cycle was December 19, 2022. Ultrasound was conducted and a fetal heart rate of 161 BPM is present. Pt. is about 10 weeks pregnant, and her due date is set for September 25, 2023. Pt. states she is worried about her pregnancy because she drinks alcohol about five times per week, smokes one pack of cigarettes a day, and smokes marijuana on a daily. For example, if the patient does not have proper access to education or health care, this factor can influence both her and her baby’s health outcomes.  

It is important for this patient to be educated on abstinence from alcohol, tobacco, and illicit drug use. Pregnancy smoking can cause birth defects, preterm birth, and infant sleep-related deaths (Healthy People of 2030, (2023). As an advanced practice registered nurse it is your duty to listen to your patient and screen your patients properly for alcohol/tobacco/drug use in order to refer them out to treatment if needed. To communicate properly with your patient it is important to develop a relationship with the patient because the first meeting sets the tone for a successful partnership between you and the patient. It is also important to establish a positive patient relationship consisting of courtesy, comfort, connection, and confirmation (Ball et al., 2018). One questionnaire I would use is the CAGE questionnaire which was developed in 1984 by Dr. John Ewing. The CAGE questionnaire is a proper screening tool for substance dependence in my opinion because it is short and does not require too many questions; therefore, it will not irritate the patient. The CAGE questions are scores of 0 for a “no” and 1 for a “yes”. If your patient’s score is two or more, it is considered clinically significant (Basu et al, 2016).

Five targeted questions:

· Have you ever felt the need to cut down on your drinking or marijuana use?

· Has anyone gotten annoyed or complained about the amount you drink or use marijuana?

· Do you ever feel guilty about your alcohol and marijuana usage?

· Have you ever felt the need to have a drink or smoke marijuana first thing in the morning to steady your nerves?

· Are you able to afford stable/safe housing and food?

I would offer my patient the American Pregnancy Helpline number just in case she finds herself unable to quit drinking alcohol and smoking. The American Pregnancy Helpline is able to provide complimentary and confidential information and support for women who are pregnant and using substances. They are also able to provide women with proper resources regarding what they are suffering with. The helpline is able to connect women to treatments (American Pregnancy Association, 2022).