Reference no: EM133911126

Case Study: Aung a Refugee from Burma

Event: Scene 1

Aung is a 32-year-old Chin refugee who presented in the emergency room during the evening shift. This is his second visit to the ER in the past month due to reports of abdominal pain.

The nurse, Anna, introduced herself to the patient. The patient avoided eye contact but extended a gentle handshake. Aung stated he could understand English. However, during the examination, the patient remained quiet, responding yes or no only to questions asked. Between questions, the patient seems to wait patiently for the next question despite prolonged delays. In frustration, Anna spoke in a louder tone, wondering if Aung could hear? Aung nodded yes, and Anna encouraged him to ask questions adding she could not "read his mind." In an attempt to place the patient at ease, the nurse suggested he call her by her first name.

In order to facilitate communication, the My Accessible Real-Time Trusted Interpreter "Marti" technology was utilized. When asked if the patient could speak Burmese, the patient affirmed he was Chin, and identified his preferred dialect - Hakha. During the examination, Anna was reminded multiple times by the interpreter to direct her questions to the patient.

During the questioning, the following information was obtained. Aung reported the reason for coming to the emergency room was due to continued abdominal pain and being able to obtain a ride with a friend. Aung stated he was taking one medication for high blood pressure - Ramipril 5 mg every morning. When Anna questioned if he was still taking the Prevacid prescribed previously, he stated "no" that he stopped taking the medicine because he felt better at the time. When the abdominal discomfort returned he resumed taking the medicine but could not afford to refill the prescription. He tried antacids and antibiotics from a Burmese grocery store as a result. When asked if he tried traditional practices, he confirmed that a friend had tried "coining and cupping" treatments. Anna noted the skin abrasions across his shoulders and neck. Aung could not identify a particular food choice that led to abdominal discomfort. When asked if he added salt to his food, he responded no. However, when questioned about adding Monosodium Glutamate, specifically MSG, Hin-cho-hmok (Ajinomoto) to his food he stated "oh yes."

During the examination, Aung also admitted to smoking a half to one pack of filtered cigarettes per day and drinking four to five bottles of beer daily. He stated that drinking was a habit from camp-life due to boredom. Aung lives by himself in an apartment and is employed full time.

Physical Assessment:

Vital Signs: BP 162/90; Pulse 92; Resp 14; SaO2 94 (room air); Temp 98.6

Pain: 3 on a scale of 10. No apparent distress.

Neuro: A and O all spheres. Pleasant. PEARLA. Sclera clear.

Resp: BS clear - all bases

Abdomen: +3 all quadrants. Soft. Tenderness in the mid epigastric region.

Skin: Icteric. Multiple abrasions noted on the shoulders and neck. Oral examination indicated the need for dental work due to decay.

Laboratory Tests: Abdominal series; Chemistry 12; CBC; liver function tests; coagulation studies.

Scene 2:

Assessment:

The tests did not reveal physical causes for the pain although reflux was not ruled out. The physician considered the fact that there may be psychological factors associated with the feelings of pain. The patient denied feeling depressed but acknowledged that he missed and worried about the family left behind in the camp.

Question

1. What additional information do we need to know to make appropriate care decisions for the client? Provide your rationale as to why you are making these recommendations and/or taking these actions.

2. What are the potential risk management issues you have identified with Aung's case?

3. Which interdisciplinary resources would you consult with related to the care management of Aung?