1. Critical thinking – mod 5 Nguyen – Planning    

   QUESTION

   Meet Nam Nguyen, a construction worker supervisor, who arrives at the Family Medicine Center for his first physical exam in more than 10 years. His knee pain has caused him to seek help because it affects his work. But as you will see, Nam will discover that he has other serious health problems that require him to be more vigilant about his health. As you read and work through the exercises in Caring for the Nguyens, you will also come to know Nam’s wife, Yen Nguyen; his grandchild, Kim Phan; other members of his extended family; and his friends as they deal with health issues and life changes.
   Mr. Nam Nguyen is a new patient at the Family Medicine Center. He arrives at the center for a scheduled physical exam and completes the following admission questionnaire:
   The Diagnosis
   During the visit, the clinic nurse records the following information in Mr. Nguyen’s chart:

   Height 5 ft 4 in.
   Weight 165 lb. (75 kg)
   BP 162/94 mm Hg
   Pulse 84 beats/min
   RR 20 breaths/min
   Temp 98.2°F oral
   Presenting Complaint: Patient states he is here to become established as a patient at the center and that he has not had a physical exam in more than 10 years. Wife accompanies. He is currently experiencing bilateral knee pain that is affecting his work performance. “I supervise construction workers. To check on things, I have to climb up and down ladders, lift things, and crawl around a lot.” Has not missed any work but has been using increasing amounts of acetaminophen and ibuprofen “to get through the day.” The medications provide only limited relief. States pain occurs daily even if not at work and is achy and dull. Feels best when he is off his feet. Desires pain relief and checkup. Explains that both parents have heart disease, his father had cancer, and his mother has diabetes. Wife expresses worry that he may be developing heart problems “because he’s so tired after work and he gets short of breath easily.”
   The nurse explains to Nam that he will be seen by the nurse practitioner shortly. She asks him whether he would like his wife to be present for the exam. He answers yes.
   Zach Miller, MSN, FNP-BC, is on duty at the center today. Zach has 10 years of experience as an RN in the emergency department and urgent care clinic. He has been a family nurse practitioner (FNP-BC) for 5 years. Zach enters the room and introduces himself to Mr. and Mrs. Nguyen. To begin the exam, Zach reviews the information Mr. Nguyen supplied on the admission form and then asks Nam about his family history.
   Zach:
   Are your parents still living?
   Nam:
   Yes, they’re both alive. My father is 80 years old and my mother is 76.
   Zach:
   I’d like to hear a little more about your family history. Tell me about your father’s cancer. How old was he when he was first diagnosed? Has he had treatment?
   Nam:
   He was probably about 60 when he first found out about it. I know he had some kind of surgery and takes medicines, but I don’t know the details. He seems all right though.
   Zach:
   Your father also has high blood pressure and heart disease. Please tell me a little more about that.
   Nam:
   My father and mother both have high blood pressure and heart disease. They both take medicines for their blood pressure. My father had a small heart attack about 10 years ago. My mother has never had a heart attack that I know of, but she sometimes has chest pain.

   Zach:
   Your mother also has diabetes?
   Nam:
   She’s had that for a long time. A lot of people in my family have diabetes, especially on my father’s side—but nobody in my mother’s family. Yet my mother is the one with the diabetes!
   Yen:
   A lot of people in my family have diabetes too. But so far I’m okay, I think.
   Zach:
   Have you had a health exam lately, Mrs. Nguyen?
   Yen:
   Not in about a year, but I’m going to schedule an appointment here.

   The Nguyens and Zach continue to review the health information. After reviewing the history and discussing current complaints, Zach performs a complete physical exam.

   Questions
   As the clinic nurse, you have written the following nursing diagnostic statement: Overweight r/t inappropriate food choices and serving size as evidenced by body mass index (BMI) of 28.5.

   Write at least three short-term and three long-term goals for Mr. Nguyen based on this diagnostic statement.
   Remember that your goals must be realistic and consider Mr. Nguyen’s other health problems.

   Rubic Grading
   Please avoid linking to literature.
   25.0 pts
   Level 4
   Critical thinking skills
   Questions are logically answered with feasible and acceptable interventions backed by literature.

   20.0 pts
   Level 4
   Content
   Responded to assignment questions with knowledge and insight from literature.

   5.0 pts
   Level 4
   Grammarly and Scholarly Composition. Students are articulate and no grammatical errors are noted.

   Reference

   Treas, L. S., Wilkinson, J. M., Barnett, K. L., & Smith, M. H. (2018). Basic Nursing: Thinking, Doing, and Caring(2nd ed.).

   Gulanick, M., Meyers, J.L Nursing care plans: Diagnoses, intervention, and Outcomes (9th edition)

    

    

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