J.G is a 25-year-old male patient who is of African descent. He was born in Africa, and the family then moved to the United States at the young age of two years. He is fluent in Swahili, English, and French. He has graduated from high school and is currently on the final year of his college education. Apart from studying in college, he has a part-time job as an assistant accountant at his father's accounting firm here in the United States. He resides in Boston with his father, mother and younger siblings and reports to be suffering from recurrent headaches and vomiting.
Reason for seeking care
J.G presented to the accident and emergency with a two-week history of severe and persistent headache with isolated cases of vomiting.
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Presenting illness
J.G was well until two weeks ago when he developed a global headache that was gradual in onset throbbing in character. He reports that it radiated to the neck and shoulders. It was associated with the hotness of body and associated vomiting that was projectile, non-foul smelling, was composed of food contents, it was non-bloody a was about 100mls. He denies any factors that led to an increase or decrease in the severity of the headache. J.G also reports weight loss of about 6 kgs in the past one month with no cough or night sweats. He, however, says that he has had reduced appetite and is very uncomfortable when there is a lot of light shone on him that he has to close his eyes until the source of light is withdrawn.
Perception of health
J.G defines good health as a state of wellbeing that involves proper nutrition, enough sleep, optimal hydration and sleep as well as good psychological wellbeing. He defines poor health as a lack of any of the factors defined in his opinion of good health. He says that he considers himself about 65 percent healthy because keeping a healthy lifestyle for him is a huge struggle.
Past medical history
The patient is currently under no medications. He reports that he is not aware of any drug or food allergies. He was immunized as a child according to the immunization schedule in Kenya up to the age of 18 months and has had vaccines against influenza, yellow fever, and rabies. He is a cigarette smoker since he was 16 years- 2pack years and takes alcohol occasionally. He has no history of any other substance use. The patient has had a history of past surgery- appendectomy and also has a history of blood transfusion during the appendectomy procedure.
Family medical history
J. G's parents are both alive and well as well as his siblings. His paternal grandmother is also alive, is 94 years of age and lives in a nursing home. She, however, has had diabetes mellitus type 2 for 32 years. The paternal grandfather is deceased at 78 years. The maternal; grandfather and grandmother are also both deceased at 67 and 82 years respectively both from Pneumonia. All his paternal uncles-4 and aunts-2 have type 2 diabetes through the father is not affected. The maternal side of his family generally records good health outcomes with no familial disease.
Review of systems
All systems were reviewed. The patient had bilateral upper limb weakness and had a squinting gaze. He was wasted with prominent zygomatic and temporal bones. Skin looked dry and sagging. Disparate systems were all normal.
Developmental considerations
The patient has no disorders in development. His speech is intact, his language clear and appropriate. He was consistent with information throughout our interaction.
Cultural considerations
The patient has to gain support as well as consent to continue with treatment from the mother and father. He also had to say a short prayer before interacting with the physician or nurse.
Psychosocial considerations
The patient is alert and oriented in time place and person. I was able to establish rapport. His behavior and appearance were appropriate for the situation.
Collaborative resource
The mother and father would be a good collaborative resource.
Physical examination
On examination, the young man lay supine in the bed with no obvious respiratory distress. He has no jaundice, no pallor, no cyanosis, no lymphadenopathy, no edema. Capillary refill was below 3 seconds. He, however, was wasted and had oral thrush. He had a fever with a temperature of 38.2 degrees Celsius, was hypotensive at 98/52mmhg, was tachypnoeic at 21 breaths per minute and tachycardic at 107 beats per minute. His oxygen perfusions were however normal at 92 percent and had no visible clinical signs of respiratory distress. He had normal hair distribution, no scars or any unusual markings. His eyes had revealed photophobia, and he had no problems with hearing or smell. There was also no reddening on his throat, and the uvula was central. The neck was stiff. The respiratory system exams revealed good air entry with vesicular breath sounds. There was a resonant percussion note in the lung fields. In the cardiovascular examination, the trachea was central, and the apex beat at the midclavicular line 5 th intercostal space. There were no added heart sounds at all the valve areas. The gastrointestinal system was also non-remarkable with no organomegaly or abdominal distention. The neurological and musculoskeletal system revealed weakness bilaterally of the upper limbs both at grade 4. There was a positive kernings and brudziski’s sign.
Needs assessment
The patient’s health teaching needs from the history and examination involve teaching on the maintenance of a healthy lifestyle to ensure optimal health and the need to seek medical care promptly as soon as specific symptoms set in. An article on the benefits of creating healthy habits such as stopping smoking of cigarettes advice that individuals identify their bad lifestyle habit make a plan on how to begin the process of stoppage, stay on track, think about the future benefits of the plan and be patient in making sure the goal is achieved (Lally & Gardner, 2013) . Another article on bacterial meningitis outcomes indicates that prompt presentation to the health care providers, fast diagnosis and treatment dramatically increases the prognosis of patients with meningitis (Bodilsen et al., 2018) . This may only be possible if patients are aware of the symptoms that are associated with meningitis. It, therefore, advocates for community awareness of the early signs and symptoms of meningitis.
Reflection
The interview with J.G took place in a consultation room. I ensured that he was comfortable and relaxed. We met at around 10 in the morning. I was able to establish a good rapport with him before starting the interview to ensure that he developed trust. The patient was very friendly and answered all questions with respect no matter how private they were. From the interview, I learned that more information is gained when the patient is allowed to speak freely. The barrier to our communication was his cell phone that kept ringing every few minutes interrupting the interview, but he eventually turned it off. It is a great experience to interact on a one on one basis with patients and feel what it is like to be with a patient as opposed to when I am reading. Prospectively, I look forward to developing confidence and knowledge that will enable me to have enough knowledge to conduct the assessment.
References
Bodilsen, J., Brandt, C. T., Sharew, A., Dalager-Pedersen, M., Benfield, T., Schønheyder, H. C., & Nielsen, H. (2018). Early versus late diagnosis in community-acquired bacterial meningitis: a retrospective cohort study. Clinical Microbiology and Infection , 24 (2), 166-170.
Lally, P., & Gardner, B. (2013). Promoting habit formation. Health Psychology Review , 7 (sup1), S137-S158.
