Chapter 3 Cultural Competence in the Health History and Phy

Chapter 3:
Cultural Competence in the Health History and Physical
Examination
Copyright © 2016 Wolters Kluwer • All Rights Reserved
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Cultural Assessment #1
Customized or tailored to the client’s unique background.
Health history and physical exam interrelated.
With growing diversity comes the need for nurses to develop
knowledge and skills in cultural assessment.
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Cultural Assessment #2
Assessments form the foundation for the plan of care.
Tend to be broad and comprehensive.

Cultural assessment usually integrated into the overall
assessment.
Health History #1
The purpose of the health history is to collect subjective data .
This is combined with the objective data from the physical
exam for both well and ill clients.
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Question #1
Is the following statement true or false?
Subjective data refers to things that people say or relate about
themselves, whereas objective data result from the physical
examination and the laboratory findings.
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Answer to Question #1

True
Rationale: Subjective data come from the client and is
information only they can give and confirm; objective data are
observable and confirmed through sources other than the client.
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Health History #2
Major data categories to be considered when conducting a
culturally competent health history:
1. Biographic data and history
2. Genetic data
3. Review of medications and allergies
4. Reason for seeking care
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Health History #3
Major data categories to be considered when conducting a
culturally competent health history (cont.):
5. Present health and history of present illness
(culture-bound syndromes)

6. Past health
7. Family and social history
8. Review of systems
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Question #2
Is the following statement true or false?
Most cultures recognize the difference between prescribed
medications and over-the-counter medications including herbs.
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False
Rationale: It is important to note all prescription and over -the-
counter medications, including herbs, that clients might
purchase or grow in home gardens. Because of cultural
differences in peoples’ perceptions of which substances are
considered medicines, it is important to ask about specific items
by name.

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Physical Examination #1
Accurate assessment and evaluation of clients require:
Knowledge of normal biocultural variations among healthy
members of selected populations
Assessment skills that will enable you to recognize variations
that occur in illness
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Biocultural variations in:
Measurements
Height, body proportions, weight (see Table 3-5)
Vital signs, including pain
General appearance

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Skin
Mongolian spots
Vitiligo
Hyperpigmentation
Cyanosis
Jaundice
Pallor
Erythema, petechial, ecchymoses
Addison’s disease, uremia, albinism
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Body secretions
Apocrine glands
Eccrine sweat glands
Head
Hair (texture, color)
Eyes (structure, color, visual acuity)
Ears (size, shape, cerumen, hearing loss)
Mouth (pigmentation, cleft lip/palate, leukoedema)
Teeth (developmental, hygienic, nutritional indicators)

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Musculoskeletal system
Bone composition
Bone density
Bone curvature
Body composition
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Question #3
Where is the most reliable location to assess for petechiae in a
person with darkly pigmented skin?
Palms of the hands
Soles of the feet
Lining of the mouth

Upper chest and shoulders
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C. Lining of the mouth
Rationale: In dark-skinned clients, petechiae are best visualized
in the areas of lighter melanization, such as the abdomen,
buttocks, and volar surface of the forearm. When the skin is
black or very dark brown, petechiae cannot be seen in the skin.
Petechiae are most easily seen in the mouth, particularly the
buccal mucosa, and in the conjunctiva of the eye.
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Laboratory Tests
Biocultural variations occur with some lab test results, such as:
Hemoglobin
Hematocrit
Cholesterol
Serum transferrin
Blood glucose

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Clinical Decision Making and Actions
The three major modalities to guide nursing judgments,
decisions, and actions are:
Cultural care preservation or maintenance
Cultural care accommodation or negotiation
Cultural care repatterning or restructuring
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Question #4
Which is an example of cultural care accommodation?
Arranging the client’s dressing changes to avoid scheduled
prayer times
Providing the client with foods that are aligned with his/her
religious dietary concerns
Explaining to the client the need to reduce fat content from his
or her ethnic high-fat diet
Arranging for an interpreter to facilitate communication

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A. Arranging the client’s dressing changes to avoid scheduled
prayer times
Rationale: Cultural care accommodation or negotiation refers to
professional actions and decisions that help people of a
designated culture to adapt to or to negotiate with others for
beneficial or satisfying health outcomes with professional care
providers.
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