George Mayfield, 68 years old Primary Concept Health Promotion Interrelated Concepts (In order of emphasis) • Collaboration • Patient Education • Communication • Addiction • Clinical Judgment History of Present Problem: George Mayfield is a 68-year-old African American male with a past history of hypertension, but has not taken his meds the past year because it was too much bother and he felt fine. He is seen at a clinic that serves the homeless in a large metropolitan community. George came to the clinic because of a headache that has been persistent the past week and blurred vision. His clothing is dirty and he has a strong body odor as well as smelly feet. His shoes are shabby and he has lots of callouses on his feet. George is missing many teeth and those that remain are yellow and brown with dental decay. When the nurse reviewed the health screening questions, George admitted that he has had a productive cough with occasional bloodtinged yellow mucus the past couple weeks. His initial BP is 188/96. Personal/Social History: George is veteran who served in Vietnam. He has struggled with alcohol abuse in the past but denies ETOH use in the past year. He has been homeless since he lost his job as a mechanic ten years ago and currently lives in his car, a 1980 Cadillac, with Milo, his white poodle. He has never married and has no close friends or relatives with whom he stays in contact. He smokes one pack of cigarettes a day. What data from the histories are RELEVANT and must be interpreted as clinically significant by the nurse? RELEVANT Data from Present Problem: Clinical Significance: History of hypertension Patient has not taken his meds the past year because it was too much bother and he felt fine. Headache with blurred vision Patient came to clinic with a headache that has been persistent the past week and blurred vision. Productive Cough Patient admitted that the cough occasionally produces blood-tinged yellow mucus the past couple of weeks. BP Initial BP is a little on the high side. Patient has history of hypertension. Smokes One pack per day. Poor hygiene Clothing and shoes are dirty and shabby. Patient has body odor as well as smelly feet. He has lots of callouses on his feet. Patient is missing many teeth and remaining teeth are yellow and brown with dental decay. RELEVANT Data from Social History: Clinical Significance: Homeless Veteran Struggled with alcohol abuse Lost job Lives in his car with dog Never married/no close friends or family Clothing is shabby and has poor hygiene Homeless for last 10 years. Served in Vietnam. Patient denies ETOH use in the past year. Was a mechanic and lost job 10 years ago making him homeless. Lack of adequate sleep and comfort. Does not have any friend or close relatives with whom he stays in contact with. Strong body odor as well as smelly feet. Lots of callouses on his feet. He is missing many teeth and the remaining teeth are yellow and brown with dental decay.