Managing Care in a Culturally Considerate Manner

Patient Profile
R.M., a 68-year-old male from Fiji, came into the emergency department with complaints of increased
headache, dizziness, and blurred vision. His blood pressure in the emergency room was 201/120. He
received IV labetalol (Normodyne) and IV furosemide (Lasix) and was admitted to the cardiac unit for
observation.
Subjective Data
States I dont feel well, but I dont want all this medicine. I heard that garlic could help my
high blood pressure and make it all better.
Asks I want all of my family with me in my room-cant my family all come in?
Wife is at bedside; several family members are in the hall.
Objective Data
Physical Examination
o

Temperature: 98.3F; respirations: 22; pulse: 88; blood pressure: 210/120

Oxygen saturation: 95% on room air

Height 510, 198 lb

Remainder of physical exam unremarkable

Diagnostic Studies
o

ECG reveals left ventricular hypertrophy

Chest x-ray shows cardiomegaly

Discussion Questions:
1. What further cultural assessment would you obtain?

Medication/Blood

Comfort

Rituals

Support- family involvement Is usually important

Class- language, food preference, gender care, personal space, eye contact, body
language

2. How would you address his statement about the use of garlic?

It is used to lower cholesterol levels but also runs the possibility of increased bleeding

Herbs should not be used when treating a serious medical condition such as heart
disease

It is not enough to lower to bp to safe levels. Some herbs pose as toxic even when used
in small doses and can adverse effects when mixed with other medications/herbs

3. While attempting to draw R.M.s lab work, two children, his sister, several grandchildren,
nieces, and nephews were all asking for information. Culturally speaking, list three ways to
deescalate the situation?

A. In private, ask the patient what level of comfort.whom would they like in the
room...you can also draw labs while in private to keep patient calm

B. Check policies with hospital because different depts. Only allow a certain amount of
visitors

C. Assess the situation, use a low tone and calm voice. Pay attention to nonverbal

4. How would you respond to the patients request to have all of his family in the room?

I would allow it as long as they kept noise to a minimum in order to reduce stress on the
patient so that his BP would lower. I would also have to incorporate rest times so that the
patient sleeps while not being disturbed,
Case Progression
Two days after the health care provider initiated medication therapy, R.M.s blood pressure
has decreased to 148/90. He is being discharged on metoprolol (Lopressor) 100 mg orally
twice daily and furosemide (Lasix) 80 mg orally daily, with instructions to follow a low-salt
diet.

5. What resources might be useful to you in providing discharge instructions?

Sources on why adhering to the medication is important

Maintaining a healthy diet and fitness plan

Reducing alcohol/smoking

Referral to dietician

Printed patient education materials in their language

6. Outline specific patient teaching points for a low-salt diet, including culturally appropriate
foods.

7. If you were R.M.s nurse, how would you describe yourself so that you provide care in a
culturally sensitive manner?

Culturally competent nurses understand, appreciate, and work with individuals from
cultures other than their own. Be culturally sensitive especially when using body
language, gestures and facial expressions

*Systolic 90-140
*Diastolic 60-90
*Less than 2g of sodium for sodium diet restriction
*Know food specifics for diets