Discuss the developmental, age, socioeconomic, and cross-cultural considerations that should be considered during the gathering of subjective

and objective data and the provision of health care. In addition, relate expected or normal findings to the findings described, discuss any additional assessments that might be needed before a judgment or diagnosis can be made, and identify at least one relevant nursing diagnosis for any actual or potential problem identified. Also, identify community resources available to the patient.

M. H. is recovering from a cholecystectomy. During the morning assessment, he complains of pain when the left knee is flexed and the left foot is plantar flexed. The calf circumference is 37 cm on the right and 40 cm on the left. The left calf is tender to palpation.

As this is the first time I am in coming into contact with M.H. I would first review his chart and locate standard information, age, obesity, gender, alcohol/tobacco use, past medical history (looking for any history of hypertension, PVD,DVT, etc.) , current medications, etc., I would then interview M.H. first noting whether or not we were communicating effectively. If he has any hearing or visual impairment I would accommodate for the deficiencies. Then I would ask about any cultural considerations that I need to be aware of, one might be that if M.H. is male he might not be able to be seen by a female nurse. Once I have established that I was ok to proceed I would then do a quick head to toe assessment, and then a focused assessment on the lower extremities. I would confirm the unilateral swelling of the leg, assess pedal and distal pulses, color, and temperature of the skin, I would be careful with my palpation of the affected area for it is a DVT, it could become and emboli and travel up possibly causing a pulmonary embolism. With M.H.s recent cholecystectomy resulting in him being immobile. My first concern would be the formation of a deep vein thrombophlebitis. I would discuss my findings with the physician, Objective data found in my assessment, calf circumferences, etc., and subjective the pain that M.H. has reported in his left knee and foot If the instructed to take preventative action I would administrator low-molecular heparin, and ambulate and mobilize the patient, along with thigh high graduated compression elastic stocking. If the DVT is confrimed I would monitor for pulmonary emboli and monitor the size of the thrombus, I would elevate the extremity while patient is in the bed. I would apply warm, moist soaks to the affected area. Finally I would administer the prescribed anticoagulant medications and educate M.H. on the importance of follow up care to monitor his response to the treatment and the therapeutic levels. I would recommend that if he cannot self monitor his INR levels that he locate a lab near his home to do this for him, also he will need to find a reliable pharmacy to ensure his medications are filled in a timely manner as he needs to be diligent with this medication. Support Resources include P.A.D. Coalition from there M.H. can receive information and support concerning his condition. Nursing Dx: Risk for Ineffective peripheral tissue perfusion r/t immobility aeb extremity pain and edema. References:

Ignatavicius, D. D., & Workman, M. L. (2010). Medical-surgical nursing, patient-centered collaborative care. (6th ed., pp. 817-821). St. Louis, Missouri: W B Saunders Co. Ladwig, G. B., & Ackley, B. J. (2010). Mosby's guide to nursing diagnosis. Mosby. Saving Limbs and Lives, P.A.D. Coalition. http://www.vdf.org/community/ Winkelman, Chris., Workman, M. Linda. & Hausman, Kathy A. (2010). Medical-surgical nursing, patient-centered collaborative care. (Clinical Companion 6th ed., pp. 674 - 675 ). St. Louis, Missouri: Saunders Elsevier