STU Healthcare Challenges Associated With Homelessness Discussion Replies

150 words with a peer review article (with a DOI):

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The Homeless Patient Evaluation and Management Plan

Healthcare providers face a difficult task in providing care to uninsured, homeless individuals with medical necessities. In this case, an NP encounters a homeless patient suffering from severe signs that are indicative of pancreatitis. The essay shall delve into the bioethical, medical, psychological, and legal aspects of caring for patients in this circumstance. While discussing the NP’s actions on diagnosis, assessing the severity of the case for hospitalization, performing relevant examinations on treatment, and aftercare education with regard to the patient’s socioeconomically limited background.

In this case, the most pertinent issue for the nurse practitioner involves how best she can provide care for the homeless patient who does not have health insurance for emergency medical needs. The patient’s financial and social status needs to be handled accordingly when dealing with urgencies. The NP recognizes that the patient’s symptoms are life-threatening, as indicated by pancreatitis.

The first consideration would be the patient’s homelessness as well as the non-existence of an insurance policy. Therefore, NPs should explore other ways to help the patient. Therefore, the patients can be connected to local health resources specifically tailored for the uninsured and homeless, like community health centers, free clinics, or social service agencies (Dickins et al., 2020). It may be critical to get medical assistance from nearby hospitals and organizations dedicated to helping people in need.

While responding to questions raised by the patient concerning outpatient management of his condition outside the hospital, the nursing practitioner should be honest and open to convey how serious his symptoms really are, making it clear that pancreatitis can be fatal and needs urgent treatment. Nevertheless, the NP should also provide assurances that alternative modes of financial aid or charitable medical care will be explored in the process.

Upon the patient’s arrival at the hospital, a series of tests will likely be conducted to assess his condition. These may include blood tests to check pancreatic enzyme levels such as amylase and lipase, imaging studies like an abdominal ultrasound or CT scan to examine the pancreas, and possibly additional tests to evaluate complications or organ damage.

When hospitalized, the severity of pancreatitis would most probably evaluated using parameters like blood test results, imaging findings, the existence of organ failure, and the overall clinical state of the individual (Jordan, 2023). Severity can also be measured using other classification systems such as the Ranson criteria or Acute Physiology and Chronic Health Evaluation (APACHE II) score.

While in a hospital, the management of the patient’s condition will entail supportive treatment that includes the administration of analgesic drugs for pain management, intravenous fluid for dehydration prevention, nutrition supplements, and possible use of antibiotics if the patient has infection symptoms (Jordan, 2023). In extreme cases, the patient could need drainage of fluid collections or operation.

Education of patients after resolving pancreatitis is necessary. This would include lifestyle modifications to avoid future attacks, including refraining from drinking alcohol, eating a healthy diet, and taking prescribed medications (Dickins et al., 2020). NP should also stress the importance of medical reviews and offer information on available community facilities for continued care.

Conclusion

The case of the homeless, uninsured patient with suspected pancreatitis underscores the healthcare system’s need for compassion and resourcefulness in addressing the most vulnerable populations. The nurse practitioner’s actions in facilitating prompt care, advocating for the patient’s best interests, and connecting with community resources demonstrate the essential role of healthcare providers in advocating for equitable access to healthcare. It highlights the importance of addressing social determinants of health, even in the face of limited resources, to ensure the patient’s well-being and prevent future healthcare disparities.

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Considering the patient’s homelessness and lack of insurance, what action should the practitioner take?

Some people who are homeless are employed but not earning enough to receive insurance benefits. These individuals typically place a higher value on going to work than on healthcare. The nurse practitioner should consider the stigma surrounding being homeless and difficulty obtaining medical care and securing prescription medications, which are all barriers to healthcare (Spangler et al., 2020). Moreover, the NP should consider conditions commonly associated with homelessness in order to develop a comprehensive plan of care. These conditions include HIV/AIDS, pneumonia, dermatologic infections, behavioral health issues, substance abuse, dental disorders, foot conditions, malnutrition, diabetes, cardiovascular disease, cancer, and various communicable diseases such as hepatitis or tuberculosis. Most of these conditions require specific healthcare plans and treatments that are unavailable to patients who are homeless and receive care in the ED. Additionally, medications and supplies obtained for treatment are often stolen or are sold for money, food, or drugs (Tintinalli et al., 2019).

When the patient asks why his condition cannot be managed outside of the hospital, how should the practitioner respond?

Medication nonadherence has been shown to be a factor contributing to higher rates of emergency department visits, increased hospital lengths of stay, and increased healthcare costs in homeless populations. For these reasons, the patient’s condition should be managed in the hospital setting. The patient’s condition also needs follow up but because of his unstable housing, he might not be able to follow up after discharge (Spangler et al., 2020). The patient’s comorbidity also makes difficult to treat his condition outside of the hospital setting.

When the patient arrives at the hospital for further diagnostic work-up, what tests will likely be performed to evaluate the patient’s condition?

Further diagnostic work-up can include a CT scan and ultrasound of the abdomen and lab work such as serum lipase, white blood cells (WBC), hematocrit (Hct), serum calcium, blood glucose, serum lactate dehydrogenase, AST, blood urea nitrogen (BUN), C-reactive protein and arterial PO2 levels (Spangler et al., 2020).

How will the severity of the pancreatitis be assessed when the patient is hospitalized?

Acute pancreatitis (AP) involves various clinical features from mild cases with only transient abdominal symptoms to severe fatal cases. It is important to identify patients with AP who are at risk for developing persistent organ failure early in the course of the disease (Spangler et al., 2020). Blood tests to look for elevated levels of pancreatic enzymes, stool tests in chronic pancreatitis to measure levels of fat that could suggest your digestive system isn’t absorbing nutrients adequately, and computerized tomography (CT) scan to look for gallstones and assess the extent of pancreas inflammation (Spangler et al., 2020). Another way to assess severity is abdominal ultrasound to look for gallstones and pancreas inflammation, endoscopic ultrasound to look for inflammation and blockages in the pancreatic duct or bile duct and magnetic resonance imaging (MRI) to look for abnormalities in the gallbladder, pancreas and ducts (Tintinalli et al., 2019).

How should the patient’s condition be managed when hospitalized?

While in the hospital, the patient may be given intravenous (IV) fluids for rehydration and replacement of key electrolytes, such as calcium, magnesium, and potassium. In order for the pancreas to heal it needs to rest, and the best way to do that is to avoid solid food (Spangler et al., 2020). Your doctor may insert a nasogastric tube through the nose or mouth and into the stomach to deliver liquid nutrients. This may also help to relieve nausea and vomiting, two common symptoms of acute pancreatitis. The progress will be assessed with periodic blood tests and CT scans. Once tests show that the pancreas is recovering, the patient may be allowed to resume eating by mouth, starting with clear liquids and eventually a low-fat diet of solid foods. Recovery time depends on the severity of the disease (Tintinalli et al., 2019).

What patient education should be included after the pancreatitis is resolved?

Mild pancreatitis usually resolves with simple supportive care, which entails monitoring, drugs to control pain, and intravenous fluids (Tintinalli et al., 2019). You may not be allowed to eat anything during the first few days if you have nausea or vomiting. Moderate to severe pancreatitis requires more extensive monitoring and supportive care. This is because severe pancreatitis can lead to potentially life-threatening complications, including damage of the heart, lung, and kidneys. People with pancreatitis of this severity may be closely monitored in an intensive care unit (Dunphy et al., 2019).

Suggestions for dietary changes include eating a low-fat diet. Take vitamins A, D, and E, and add calcium to the diet (Dunphy et al., 2019). It might be recommended the patient takes digestive enzymes to take with each meal and snack. It is very important the patient stops drinking, especially if his illness was caused by alcohol. The NP can provide information about alcohol abuse programs and support groups such as Alcoholics Anonymous.