Discuss the role of ethnicity, culture, and socioeconomic status as each relates to the development of chronic disease for this case

Case Study Part I
Millie Larsen is an 84-year-old African American female who is both a widower and grandmother. She is moderately obese (BMI of 32), and she has continued to smoke one pack of cigarettes a day for the past 40 years. She awakens one morning with weakness on her left side.
She is having difficulty with word choice, and her speech seems to be slurred. When she attempts to walk to the bathroom, she stumbles a few times and falls once.
Her daughter Dina, who lives next door
and is visiting for breakfast, suspects that she has suffered a stroke and calls 911. Emergency personnel arrive within minutes of her call and transport Ms. Larsen
to the emergency room (ER) of the nearest hospital.
The EMT team calls ahead to the ER, informing the department of a potential cerebral vascular accident (CVA) victim. Upon arrival, Ms. Larsen continues to
deteriorate by becoming more disoriented and increasingly agitated with the staff and her daughter. She continues to have slurred speech and difficulty finding
words. The physician orders a non-contrast head CT. It has now been 90 minutes since the onset of the symptoms. The triage nurse has managed to obtain the
following medical information from Dina about Ms. Larsen:
Past Medical History
 Hypertension
 Hypercholesterolemia
 Smokes one pack per day x 40 years (40 pack years)
 Osteoporosis
 Type II diabetes mellitus
Home Medications
 Indomethacin (Indocin) 25 mg three times a day
 Aspirin 81 mg daily
 Lisinopril (Prinivil) 20 mg daily
 Simvastatin (Zocor) 40 mg daily
 Metformin (Glucophage) 500 mg twice a day
Other pertinent information that was revealed during the interview with Dina is that Ms. Larsen lives in her own home in a small rural community. Ms. Larsen is
a recent widower who lost her husband of 55 years to cancer about three months ago. Ms. Larsen lives alone in their small home with a pet cat named Snuggles.
Dina is Ms. Larsen’s only support system and is concerned that her mother is not always diligent at following the healthcare provider’s recommendations in
controlling her longstanding Stage II hypertension and diabetes. In addition, Dina has attempted to encourage her to stop smoking on several occasions.
Current Vital Signs: BP: 168/88, Pulse: L arm, 110 irregular, RR 20; Temp 37.9°C oral; Random blood glucose: 89; Pain level: 2 out 5 using the numerical rating
scale. Heinrich II Fall Risk Score = 8.
Approximately 60 minutes since Ms. Larsen arrives at the ER, she has settled back in the holding area awaiting a bed in the step-down area of the hospital. The nurse calls Dina back to visit with her mother. Dina finds her mother lying in bed with the head of the bed elevated, a nasal cannula in place, and an IV infusing into her right arm, and she is connected to telemetry. The nurse informs Dina that the results of the head CT point to “no bleed” and was interpreted by the neurologist on the stroke team, who will be in shortly to discuss the plan of care for Ms. Larsen. In a few minutes, the stroke team meets with Dina, and the neurologist discusses the plan to begin ischemic stroke protocol. In addition, Ms. Larsen will be admitted to the hospital as soon as a bed becomes available.
Dina is confused and concerned. She has many questions as the team begins the next phase of treatment for Ms. Larsen.
Imagine you are a graduate nurse working in the emergency room and helping to prepare Ms. Larsen’s admission to the hospital. You will evaluate some of the key elements of Ms. Larsen’s history and background that may have led to her current medical condition.
Specifically, the following critical elements must be addressed:
I. Introduction
A. Discuss the role of ethnicity, culture, and socioeconomic status as each relates to the development of chronic disease for this case, including how these factors may increase the risk of an individual developing chronic disease.
B. Based on your patient’s case, demonstrate how cellular changes can affect the cardiovascular system and other systems of the human body.
Explain how early interventions may affect the processes of reversible and irreversible cellular injury to the vascular region.
II. Assessment
A. Prioritize key elements of the patient’s health history that are important for designing a plan of care. Provide rationales that support the
prioritization of the elements.
B. Based on your understanding of physiology, determine the elements of the physical exam that would be used to collect assessment data for a focused exam related to the patient’s loss of blood supply to her vascular region.
C. Explain the expected physical assessment findings of the patient’s focused exam and how it might compare to someone with normal physiology.

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