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- 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.
Rubic gradingQuestions are logically answered with feasible and acceptable interventions backed by literature.
Responded to assignment questions with knowledge and insight from literature.
Students are articulate and no grammatical errors are noted.Review the opening scenario of Nam Nguyen in the front of this book. After the nurse practitioner completed the interview and physical examination of Mr. Nguyen, he listed the following diagnoses on the problem list: Hypertension Obesity Musculoskeletal pain Tobacco abuse Family history of prostate cancer Family history of cardiovascular disease Family history of diabetes mellitus (DM)
What type of problem list does this one represent?
How is it similar to or different from a problem list that you might generate?
Based on the data in the scenario, identify at least one actual, one potential, and one wellness diagnosis for Mr. Nguyen. Identify the NANDA-I labels and describe the cues that support your choices. The nurse has identified Overweight as a problem for Mr. Nguyen.
What information do you need in order to determine the etiology of this problem? Because you do not have that information, write a two-part diagnostic statement describing Mr. Nguyen’s nutritional status.
Now rewrite the nutrition statement as a three-part statement, including the phrase as evidenced by.
The nurse has identified Acute Pain (knees) for Mr. Nguyen. If the pain were caused by a medical condition, like osteoarthritis, how would you write a two-part diagnostic statement to describe this health status?
| Subject | Nursing | Pages | 4 | Style | APA |
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Answer
Types of Nursing Diagnoses: Nam Nguyen Case Study
A problem list features a document that indicates important health issues that a patient faces such as specific diseases, injuries, and any other factor which currently affects or has affected the patient in the past. The problem list presented by the nurse practitioner after examining Mr. Nguyen is an active problem list (Hidayat & Uliyah, 2018). This is because it only focuses on the health issues that may be affecting his current functioning, as well as other issues that have been identified and will need close monitoring.
The problem list presented is quite similar to one that I may have generated given the fact that this patient has not undergone any physical examination for the past 10 years. Therefore, not much records are available to help in the preparation of an inactive problem list which would highlight the health problems faced in his past and the treatment regimen used. Current health issues have been identified, including behavioural problems such as tobacco abuse (American Nurses Association, 2015). In addition, the family history may also be playing a part in his current situation, which is why these are important additions to the problem list.
In relation to the data from the scenario, different diagnoses may be given for Mr. Nguyen. The actual diagnosis is musculoskeletal pain since this is the current problem which the patient is challenged with. It is the reason why he decided to seek medical attention as it has become too much to a point where it impacts his performance at work (Ferreira et al., 2016).
The potential diagnosis for this patient is risk for stroke related to hypertension, obesity and tobacco abuse. The etiology may be noted through the current problem list prepared during the physical examination (American Nurses Association, 2015). These factors increase the likelihood that an individual may suffer from stroke at any time. In Mr. Nguyen’s case, the fact that his wife has noticed how short of breath he gets at the end of the day is already a danger sign.
Lastly, the wellness diagnosis features readiness for enhanced capability for healthy lifestyle. That will ensure that his BMI is brought down to the right level by avoiding unnecessary cholesterol in his diet. That along with proper exercising is expected to trigger better outcomes for this patient.
The nurse identified being overweight as a problem for Mr. Nguyen. To determine the etiology of this diagnosis, more information is needed on the patient’s lifestyle, environment, and even genetic history. That is because all these factors are possible contributors of the outcome identified (American Nurses Association, 2015). However, since the etiology is unknown, the two part diagnostic statement will be as follows: overweight related to unknown etiology. Once the required information has been obtained, the nutrition status may be rewritten into a three part diagnostic statement as follows: overweight related to a poor lifestyle as evidenced by diet that is high in cholesterol and being generally inactive.
Acute pain for Mr. Nguyen has also been identified. The cause is a medical condition known as osteoarthritis. The two part diagnostic statement to describe this health status will be as follows. Acute knee pain related to damaged joint cartilages that is secondary to osteoarthritis. The term ‘secondary to’ has been used in this diagnostic statement to set apart the medical condition that is causing the problem which is triggering the acute pain.
References
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American Nurses Association (ANA). (2015). Nursing: Scope and Standards of Practice. 3rd ed. Pp. 55-56. Silver Spring, MD: ANA. Ferreira, A., M., Rocha, E., N., Lopes, C., T., Bachion, M., M., Lopes, J., L., & Barros A., L. (2016). Nursing diagnoses in intensive care: cross-mapping and NANDA-I taxonomy. Rev Bras Enferm, 69(2):285-93. DOI: http://dx.doi.org/10.1590/0034-7167.2016690214i Hidayat, A., & Uliyah, M. (2018). Analysis of nursing diagnosis using an expert system in paediatric patients. International Journal of Civil Engineering and Technology (IJCIET), 9 (8), pp. 17-26. ISSN 0976-6308
Appendix
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