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Homeless Community Health Case Study
Nursing Pharmacology
Keiser University
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Homelessness
Community Health Reasoning
George Mayfield, 68 years old
Primary Concept
Health Promotion
Interrelated Concepts (In order of emphasis)
Collaboration Patient Education Communication Addiction
Clinical Judgment
History of Present Problem:
George Mayfield is a 68-year-old African American male with a past history of hypertension, but has not taken his meds
the past year because it was too much bother and he felt fine. He is seen at a clinic that serves the homeless in a large metropolitan community.
George came to the clinic because of a headache that has been persistent the past week and blurred vision. His
clothing is dirty and he has a strong body odor as well as smelly feet. His shoes are shabby and he has lots of callouses on his feet. George is missing many teeth and those that remain are yellow and brown with dental decay. When the nurse
reviewed the health screening questions, George admitted that he has had a productive cough with occasional blood-
tinged yellow mucus the past couple weeks. His initial BP is 188/96.
Personal/Social History:
George is veteran who served in Vietnam. He has struggled with alcohol abuse in the past but denies ETOH use in the
past year. He has been homeless since he lost his job as a mechanic ten years ago and currently lives in his car, a 1980
Cadillac, with Milo, his white poodle. He has never married and has no close friends or relatives with whom he stays in contact. He smokes one pack of
cigarettes a day.
What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
RELEVANT Data from Social History: Clinical Significance:
Patient Care Begins:
What VS data are RELEVANT and must be interpreted as clinically significant by the nurse?
RELEVANT VS Data: Clinical Significance:
Current VS: P-Q-R-S-T Pain Assessment:
T: 97 F/36 C (oral) Provoking/Palliative: Nothing/nothing
P: 90 (regular) Quality: Dull ache
R: 18 (regular) Region/Radiation: head
BP: 182/90 Severity: 7/
O2 sat: 90% room air Timing: continuous
Past history of HTN, not taken his meds because it was too much bother and he felt fine. BP: 188/
Persistent headache and blurred vision
Dirty clothes and strong body odor, smelly and callouses of his feet. Missing many teeth, remaining are yellow/brown with dental decay
Productive cough with occasional blood-tinged yellow mucus1. Struggled with alcohol abuse and smokes one pack of cigarettes a day
Homeless since he lost his job about 10 years ago and lives in his car with his dog
No close friends or relatives
His BP is elevated due to not being compliant with his medications
This may be due to his high blood pressure
The client is not able to provide proper hygiene care because he lives in his car, he smokes a pack of cigarettes a day and struggled with alcohol abuse
The client may be presenting an infection
These play a role with his blood pressure and how his teeth are looking
He is not able to provide proper hygiene care and this is evident with his dirty clothes, smelly body odor, and smelly feet.
The client does not have any kind of support, this may affect the way he takes care of himself
BP: 182/
O2 sat: 90% room air
Continuous headache with rating pain 7/
The client was not compliant with his medication
The client smokes a pack of cigarettes daily
May be due to his high blood pressure
1. List the physical and psychosocial problems that are adversely impacting his health? What are the
physiological OR psychosocial causes of the problem?
Physical Problem(s) Cause and/or Pathophysiology
Psychosocial Problem(s) Cause and/or Pathophysiology
2. Is there a RELATIONSHIP between his social history and physical/psychosocial problems that may have
contributed to the development of another problem?
Physical Problem(s) What then Developed?
Psychosocial Problem(s) What then Developed?
2. What are the priority physical/psychosocial problems and resultant assessments?
PRIORITY Problems: PRIORITY Nursing Assessments:
High Blood Pressure
Yellow tinged and missing teeth
Itchy feet
Due to not taking his BP medication
He smokes a pack of cigarette daily and does not provide proper oral care
May be due to a fungal infection
Homeless, lives in his car
No job
Not being able to provide proper self care
He may not be able to buy food therefore proper nutrition will be lacking
High BP 1. Due to not having a job, he was not able to buy his meds plus maybe the stress of not having a job he took buying his meds as not being necessary
Homeless 1. When he lost his job about 10 years ago
Self-care
Control his BP
Productive cough
Assessing the whole body and document about it. Provide oral and body care if possible
Ask about the past medications that he was taking
Ask about when exactly did the cough started
What are the nursing interventions at the primary, secondary and tertiary level of care?
(Nursing roles to consider are the following: educate, advocate, manage, collaborate, leadership)
Primary Prevention Level:
Keep disease or injury from occurring. (Educate)
Secondary Prevention Level:
Detect and treat existing disease or injuries. (Screen and treat)
Tertiary Prevention Level:
Reduce the disease or injury to lowest level to minimize disability. (Rehabilitation).
High Incidence Problems in Homeless Population:
Start by considering all the information you have regarding this client who is homeless. What are the
problems most frequently seen in a homeless population?
We can educate the patient about the importance of taking his meds to prevent any type of complications
We can educate the client about community resources where he may go to may be take a shower, provide oral care, and get a meal
If meds are giving, teaching the patient how to take them to treat the high blood pressure
If the client goes to the community sources, tell him the importance of self care
Make sure that the client is taking his meds and following the proper hygiene
Hygiene problems
Medical problems, because they are not able to pay for medications or may not be compliant with them
Homeless Community Health Case Study
Course: Nursing Pharmacology
University: Keiser University
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