Respond to 3 classmate post. Always agree with them. One reference/citation for each response. Essay must have 3 paragraph with subtitle one for esch classmste response. Classmate1:
“In the absence of linguistically and culturally accessible care, refugees and immigrants may have difficulty developing trust in, and respect for, physicians and western medicine. Without some means of communicating medical history, current needs, and personal health practices and beliefs, this population is prone to medical mistakes. Possible errors include patient-provider miscommunication, resulting in possible misdiagnosis; patients’ noncompliance due to incomprehension of instructions; and patients’ inappropriate usage of medical services, such as dependence on emergency room treatment.” (Burgess, 2004)
First off, assessing the dietary history of the patient including “habits, restrictions, and cultural dietary norms; food allergies; and known current and past nutritional deficiencies” (CDC, 2012) will aide in planning the nutritional education plan. In order to properly educate and allocate resources, the provider must understand the need of the patient and their expectations. There are many programs available to help aide a person or family in regards to nutrition. For infants and children under five years of age, the WIC program provides healthy foods for this population on a monthly basis. They have to choose food within certain guidelines in order for it to be covered under the program. Another option is the EBT food benefits program, where families are allotted a certain dollar amount every month to buy food items. Also, local food pantries are available for additional services as needed. Additionally, setting the patient up with a nutritionist without language barriers would be a great asset to this patient population as well. Classmste 2:
Immigrants from various countries have been coming to the United States for a long time. Different cultures and different background makes us the melting pot of the world and as practitioners their is a responsibility for their health and nutrition and understanding the problems that may arise when caring for these populations. Even though malnutrition and undernutrition can be a factor for some new immigrants to the country, for patients who have adapted to the developed countries lifestyle, obesity and diabetes are a couple of the disorders one could develop. These problems can occur as a result of high calorie food, decreased exercise, and a lack of nutritional education. Overweight and diseases like diabetes can occur after assimilation into the United States adult and child immigrants from Latin America, Caribbean, Middle East, Africa, Asian Countries and Eastern Europe. Therefore, the advanced practice nurse has a very important role to try to incorporate the patients culture while still having a nutritional diet (“Guidelines for Evaluation”, 2014).
Many times risks of cardiovascular disease, diabetes, and obesity are related to the acculturation of immigrants. For example, Latin American food is high in fiber and low in fat but often times when coming into the United States they turn to fast foods and high fat American diet. The practitioner can suggest returning to cultural foods that the family is used to eating. Another culture that is affected by acculturation is Asian-Indian populations. This culture tends to have an increase risk of diabetes, hypertension, and cardiovascular disease the longer they are in the United States. This population tends to eat much flatbreads, potatoes, rice and carbohydrates after coming to the U.S. Therefore again, returning the population to traditional food might help them improve their nutritional status (Kulkarni, 2004). The practitioner will hopefully be able to communicate effectively with the patient or a translator to find out which foods will work well for the patient and their health.
A study was conducted to see how practitioners can incorporate technology into their teaching plan for patients who have immigrated from other countries. It has been found that patients who are not talk health education in their own language do not comprehend the information well which makes sense. Therefore, clinics have been using touchscreen tablets to help give health education to their immigrant patients. I think this can be a very valuable tool that can help educate patients on nutrition in their native language. I can see this method becoming more popular as time goes on (Thompson, Joshi, Hernandez, Jennings, Arora, & Ellen, 2012).
Classmate 3:
Malnutrition is a serious health concern in underprivileged and immigrant populations. There are three different types of malnutrition including; protein-energy malnutrition (most severe), micronutrient deficiencies, and obesity (Edelman, Kudzma, & Mandle, 2014). The signs and symptoms of malnutrition in children are a weight that is below 70 percent of the median weight for height and a mid-upper arm circumference of less than 155mm (Edelman, Kudzma, & Mandle, 2014). The child will most likely have underdeveloped buttocks, thighs, and upper arms, with sunken eyes, visible ribs, protruding shoulder blades, and a protruding abdomen (Edelman, Kudzma, & Mandle, 2014). The temperament of the malnourished child may be irritable or anxious and they may cry easily (Edelman, Kudzma, & Mandle, 2014).

Addressing malnutrition in immigrant client may be difficult if there is a language barrier, use of an interpreter will assist with communication. Assessing whether or not the child has an appetite is very important because if they don’t show any interest in eating when they are severely malnourished, serious health problems can arise. If this is the case, than hospitalization may be required to provide adequate supplementation. A study by Salehi et al. (2015), found multiple health issues in the immigrant population in Toronto, Canada. “Specifically, there is a higher prevalence of nutritional anemia, inadequate immunity to vaccine-preventable diseases, growth abnormalities, malnutrition, dental caries, enteric parasites and psychiatric disorders among the children of recent arrivals” (Salehi et al. 2015, pg. 38). These problems are compounded by the commonly low socioeconomic status of the immigrant population.

As an APN it is imperative to be able to assess for malnutrition as well as other health disparities, and know how to provide resources for this population such as food stamps, food banks, free health clinics, and dental care. An interesting article by McLellan (2014), discusses the use of ready to use foods (RUF) that are distributed by organizations such as UNICEF for the treatment and prevention of malnutrition. McLellan (2014) states, “working on empowering communities with the tools and knowledge to build food security is admittedly harder and more labor intensive than the distribution of RUF. However, doing so creates sustainable solutions that in the long- term are more successful” (pg. 8960). I think that this is a great idea, providing the education and resources to people who need help so that they can help themselves, not just be taken care of. The APN needs to be innovative in providing education and resources that will continue to provide help over time, not just right now.

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