Health and Medicine-What are the cultural, ethical, and spiritual concerns you need to keep in mind?

Discussion Topic below: Plse include at least 5 scholarly articles/sources. Course:PMHNP 11 A 72-year-old Asian American female patient broke her hip and was in rehab for six weeks. While she was living at the nursing home, she had restraints applied due to her attempts to remove the dressing on her hip. Her husband is with her during the intake.

The husband is a Latino from Peru. The social worker at the rehab reported the husband exhibited fainting episodes. At times, he cried and engaged in verbal aggression with the staff. The husband reported to the social worker he felt disconnected, out of his body, and out of control. He is worried about being able to take care of his wife. Chief Complaint:

The patient stated the following: “It has been difficult to come to see you in the office. My spiritual beliefs will not allow me to take medication every day.” History of present illness: The social worker reports that the woman has had difficulty accepting the loss of her 50 year old daughter due to an automobile accident a year ago. The patient does not have the motivation to complete usual daily activities, such as shopping. She has difficulty staying asleep, averaging approximately five hours of sleep per night. Her appetite is fair. She had a fall six weeks ago due to losing grasp of the bathtub handlebar, resulting in a hip fracture. She does not take pain medication for this injury.

Psychiatric ROS: The patient denies any history of mania. Howe er, the possibility of hypomania should be explored. Past Psychiatric History: The patient has never been treated for a mental health condition in an inpatient or outpatient setting. No history of suicidal ideation or attempts reported. Substance Use Hx: The patient does not drink alcohol, smoke cigarettes or use illicit substances.

Family Psychiatric Hx: The patient’s father has a history of Bipolar I and alcohol use disorder. Past Medical History: The patient did not report any allergies. She had a left hip fracture due to a fall in the bathroom six weeks ago. She was hospitalized and had a partial hip replacement. During that time she became delirious due to an untreated urine infection. Social Hx: The patient lives with her husband. She has been married for 47 years and gave birth to three children, two sons and a daughter. The sons do not live in the area. She worked in the cafeteria at a local elementary school for 20 years. MSE: The patient was cooperative and interacted well with good eye contact. Her affect is congruent with her mood. The patient’s speech is within normal range and volume. She is oriented times three.

There is no evidence of dementia. The mini-mental status exam is normal. No abnormal perceptions during the intake. The patient reports visual hallucinations (sees her deceased daughter) that occur early in the morning when she first wakes up. The hallucinations do not frighten her. The hallucinations have occurred on an intermittent pattern over the last three months. Her thought process is logical and organized. Her thought content reveals no unusual content other than her seeing her deceased daughter. The patient denies thoughts of suicide or homicide.

Using the DSM 5 and your course knowledge answer the following prompts.

What are the therapeutic concerns regarding the need to establish a relationship with this patient? What factors will you consider regarding the plan of care? Address the potential for the patient to become uncooperative (e.g., needing restraints). Keep in mind the ANA position statement with the use of restraints

. What are the cultural, ethical, and spiritual concerns you need to keep in mind?

How would you arrive at a diagnosis (including a differential diagnosis) and the possible need for medication as well as genetic testing (include specific medication options, and labs) Regarding the husband’s symptoms, what cultural syndrome should you consider from the article: “Cultural Assessment and Treatment of Psychiatric Patients