Reference no: EM133400608

Juan Santiago, 41 years old, makes an appointment with a provider he's never seen before for an annual physical examination. When he arrives for his appointment, the nurse escorts him back to the examination room and begins the assessment process. The patient explains that he has never had a complete physical before because he has always been healthy and never had health insurance. He has recently graduated from college and accepted a new job that offered full benefits, so he decided it was time he takes care of his health. His wife, two daughters, and one son have all had their physical examination and he realized he needed to do this too. He is obviously anxious about what will happen but does not ask any questions and avoids making eye contact with the nurse. During the nurse's collection of Mr. Santiago's health history, he reveals he smokes approximately 20 cigarettes per day, drinks 2-3 alcoholic beverages per week, and up to recently has worked as a landscaper in a very physically demanding job. He describes his new job as involving "a little bit of walking but mostly desk work."

During the physical examination, the nurse notes a wound the size of a quarter on the anterior aspect of his left foot, which is erythematous, warm to touch, and has a small amount of purulent drainage seeping from the side of the wound. Mr. Santiago reports the wound has been there for more than 6 weeks and won't heal despite the over-the-counter antibiotic cream he has been applying daily. The nurse questions the client about his weight and Mr. Santiago admits he has lost approximately 10 pounds in the past month but denies any change in his diet.

1. Describe primary, secondary, and tertiary care requirements for this patient.

2. What referrals to other health care providers might be appropriate to assist in the treatment plan for this patient?

3. What type of assessment of health literacy would the nurse conduct with this patient before providing written information?

4. What factors will influence care delivery to this patient and how will that alter the nurse's approach to providing care for this patient?