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An 86-year-old American Indian male with a history of hypertension, coronary artery disease, and type 2 diabetes presents to the rural clinic to see the Family Nurse Practitioner for reports of abdominal pain and back pain. The patient describes the pain as deep and constant, located around the umbilicus and radiating to his back. Associated symptoms include nausea, dyspnea, and pain in the legs. On physical examination, the patient’s blood pressure is 95/50 mm Hg, and pulse is 98 bpm and regular rhythm. Physical examination reveals active bowel sounds, positive abdominal distension and periumbilical tenderness, pulsatile mass, and an absent right femoral pulse. He lives alone and has a 50 pack-year smoking history. He has a history of medication nonadherence, and mostly follows cultural practices incorporating traditional healing methods and rituals. He lives in a remote location without transportation and has limited financial resources. 1. Describe cultural, environmental, ethical, genetic/genomic, legal, political, psychosocial, socioeconomic, and spiritual factors considered in the clinical management of this patient. Discuss one age-appropriate primary, secondary, and tertiary prevention intervention for this patient based on the case history and presentation.
SCIENCE
HEALTH SCIENCE
NURSING

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