James Monsoor iHuman Second Degree Burns To Hands

Which of the following are risk factors and circumstances that may lead to homelessness? Select all that apply.

Trafficking and abuse
Family dynamics and support systems
Age
Mental health
Gender
Immigration
Economics
Teenage runaway
Addiction
Single parent

Which of the following is not considered a barrier that a homeless person may encounter when seeking medical care?

Access to care
Medication compliance
Free transportation
Storing medications
Security of meds/supplies

Which of the following is not a proximity for a homeless person who is a veteran?

Community shelters
Housing services
Food pantries
Homeless hotlines
Veteran resources
Free charitable healthcare clinics
College applications

Which of the following describes the role of the community/public health nurse (CPHN) in working with homeless individuals? Select all that apply

Providing the individual with money
Locating resources to support the patent
Providing nursing care
Offering shelter resources
Collaborating with social services

Which of the following are common attitudes and stigmas about homelessness, veterans, and ethnicity?

Dirty
Have an addiction
Violent, dangerous, gang member
Terrorists or criminals
All of the above

EHRs Findings

Second degree burns on hands bilaterally
Homeless
Abnormal CBC, CMP, and UA
Hypertension
Pain 5/10
PTSD
Veteran

ORDER JAMES MONSOOR IHUMAN SECOND DEGREE BURNS TO HANDS NOW

History Findings

Pain (7/10)
Medication on-compliance
Financial hardships
Homeless shelter access

Missed History Questions

Let me close the curtain/door before we get started
Do you have high blood pressure?
Do you have any other symptoms or concerns we should discuss?
Have you been taking your medications as prescribed?
Do you have easy/adequate access to pharmacies for medications?
Do you have easy/adequate access to transportation necessary for daily living and healthcare needs?
How much of your medication did you take?
When did you last take your medications?
Do you have any questions about your medications?
Do you have access to healthcare providers?
Let me clean my equipment with disinfectant wipes
Let me place my supplies on a clean surface

Physical exam findings

Hypertension
Serosanguinous drainage- right thumb
Blister present on right thumb

Physical exams

Cognitive status
Height
Wight
Blood pressure
Pulse – 100bpm
Respiration

Case Findings & Problem Category

Second-degree burns on hands bilaterally – No change

Abnormal CBC, CMP, and UA – Acute, Acute

Hypertension – Acute

Pain 5/10 – Acute

Financial hardships – Acute

Medication non-compliance – Acute

+2edema in hands – Acute

Serosanguinous drainage- right thumb – Acute

Blister present on right thumb – Acute

Limited motion in hands bilaterally – Acute

Reflection

Paragraph one: Did you feel comfortable and knowledgeable in Mr. Monsoor’s simulation? What did you learn? What additional information is needed to better care for Mr. Monsoor? What specific questions would you like to ask him?

Yes, I felt extremely knowledgeable and comfortable in Mr. Monsoor’s simulation but I identified areas that needed improvement in clinical reasoning and knowledge. The simulation reinforced the significance of holistically assessing patents to be able to identify risk factors and formulate accurate diagnoses to prioritize care. Considering that it was an encounter with an Arab American veteran, I also learned the importance of cultural competence in relating how personal and cultural beliefs influence decision making and personal health beliefs. To better care for Mr. Monsoor, additional information about his social support network, medical history, dietary habits, and barriers to care is necessary. Therefore, I would ask him questions such as;

Who do you rely on for support or times of difficulty?
Other than hypertension, have you been diagnosed with any other chronic illnesses? Are you taking any medications for them?
Tell me about the food you eat
How many meals do you have in a day?

Paragraph two: Imagine Mr. Monsoor was in your community. What resources does your community have for those who are homeless? Do you believe they are adequate to serve this population? Why or why not?

In my community, although there are several well equipped resources to address homelessness, the effectiveness and access of these resources is inadequate. Housing and shelter assistance programs such as Homekey is state-funded and guarantees access to permanent supportive housing through the California Department of Housing and Community Development. People Assisting the Homeless (PATH) offers transitional housing, supportive housing, and job training to help individuals transition from homelessness to housing. There are also community health centers such as JWCH (John Wesley Community Health) Institute for Community Health which offer mental health services, primary care, and substance abuse treatment to low-income and homeless individuals.

Paragraph three: What did you learn from this simulation that you could apply to your nursing practice? How will your new knowledge of resources in your community change the way you practice nursing?

I learned that access to care is greatly influenced by a variety of factors such as the social determinants of health (SDOH). For instance, it was clear that Mr. Monsoor’s unemployed status limited his access to important resources and services including healthcare, housing, and food. Having an underlying diagnosis such as PTSD compounded to this challenge as it impacted his emotional and physical health, and ability to make decisions. Individuals with PTSD struggle with a wide range of symptoms such as hypervigilance and intrusive memories which interfere with maintaining employment, forming and maintaining relationships, or assessing support services. Ultimately, this leads to social isolation. With this knowledge, I am well equipped to approach my nursing practice from a trauma-informed and holistic perspective. Therefore, for all patients I attend to, I will ensure that I assess their psychological, physical, emotional, and social needs and tailor interventions to address those needs. Knowing the essence of community resources, I will collaborate with social services to link patients to resources such as housing assistance, mental healthcare, and employment support programs based on needs.