The Homeless Patient Evaluation & Management Plan

The nurse practitioner (NP) is working at a health clinic in a homeless shelter during the early evening. A 48-year-old African American man approaches the practitioner and asks to have his blood pressure taken, sayingthat he has not had it checked “in a while”.The man appears to be in some type of distress and experiencing pain. The man walks slowly, using a guardedmanner, and he appears diaphoretic. His mucous membranes also appear pale. The patient’s blood pressureis 210/98. The patient reports that he has not been diagnosed with hypertension previously. The patient revealsthat he has severe abdominal pain that is radiating to his back. The nurse finds a heart rate of 110, respirations30 with shallow inspirations, and temperature 102.2°F. The patient’s skin is cool and clammy.The patient reports a history of alcoholism, homelessness, and lack of access to health care. He says that thesymptoms have been present and worsening over 3 days. The man says he thinks he might have pancreatitisagain, which he had “a couple of years ago”. The NP recommends that the man should be seen at a hospitalfor his condition, but the patient says he does not have health insurance, so he does not want to go.The NP proceeds with a physical examination, finding severe abdominal pain in the epigastric area, yellowedsclera, no abdominal distention, and hypoactive bowel sounds. The clinic is equipped with basic materials butno means to conduct lab or radiologic testing. Discuss the following:Considering the patient’s homelessness and lack of insurance, what action should the practitioner take?When the patient asks why his condition cannot be managed outside of the hospital, how should thepractitioner respond?When the patient arrives at the hospital for further diagnostic work-up, what tests will likely be performed toevaluate the patient’s condition?How will the severity of the pancreatitis be assessed when the patient is hospitalized?How should the patient’s condition be managed when hospitalized?What patient education should be included after the pancreatitis is resolved?

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