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Adolescent Hispanic/Latino boy living in a middle-class suburb
Building a therapeutic relationship requires effective communication, one of the most crucial components. Finding out if the patient speaks and understands English is vital since, in this case, communication hurdles may arise because the patient is Hispanic. It may be possible to enhance patient outcomes by effectively disseminating complex medical information to various patient populations. The patient’s age is a substantial obstacle to effective communication in this situation; thus, they may have low health literacy. The patient must articulate the agreed-upon plan, and the engagement must be easily understood. Teenagers are typically at the age when risky activities are explored.
Additionally, these patients are more reluctant to speak; maintaining confidentiality is crucial. Consequently, it is necessary to clarify the boundaries of secrecy. For the patient to communicate their requirements privately during the interview, the parent or caregiver should be asked to leave the room (Ball et al., 2019).
How would your communication and interview techniques for building a health history differ with each patient?
To build the trust necessary to help patients to disclose sensitive and personal information, breaking social challenges and working with them to find solutions is very important. The healthcare professional needs to accept people from all cultural backgrounds and avoid stereotyping by realizing that individual variation within groups is frequently more pronounced than the variation between groups (Anderman, Pang, & Newton, 2016). Effective communication establishes a successful provider-patient relationship during the initial consultation with the patient. The patient will comprehend that the physician is accessible, adaptable, and eager to assist with queries while clarifying the care provided. That the goal is to learn what matters to this patient in terms of concerns and expectations, and this is accomplished when the physician demonstrates sincere interest, curiosity, and relationship-building (Ball et al., 2019)
How might you target your questions for building a health history based on the patient’s social determinants of health?
Both parties can better grasp the challenges and issues that should be prioritized for the patient when the healthcare professional builds a relationship with the patient through development and familiarization with the patient’s health history. According to the World Health Organization (WHO 2020), social determinants of health include “a wider variety of elements and institutions that have an impact on the conditions of daily life, as well as the circumstances under which people are born, grow, work, live, and age.”
What risk assessment instruments would be appropriate to use with each patient, or what questions would you ask each patient to assess his or her health risks?
Van et al., Stated that by the time adolescents reach adulthood, they are “12 times more likely to have attempted suicide, seven times more likely to be exposed to alcohol, and ten times more likely to have injected street drugs” than their peers who have not experience multiple forms of abuse. Such as domestic violence or growing up in a home where family members are mentally ill, substance abusers, or have been imprisoned (2014). The answers to the risk-related questions would rely on several variables, including how peer pressure, a loosening of parental bonds, a lack of school attendance, and low self-esteem (Ball et al., 2019).
Identify any potential health-related risks based upon the patient’s age, gender, ethnicity, or environmental setting that should be taken into consideration.
According to Ball et al. (2019), the main problem, a brief statement explaining why the patient has come in for help, can be addressed after the identifiers are out of the way. The practitioner wants to know more about how this worries the patient so much that they are seeking assistance rather than just putting up with it and going about their everyday lives. Finding out how long this issue has been affecting the patient’s life and collecting direct quotes from them are beneficial. The next step is to gather information on the current topic, any prior medical issues, family history, and personal and social history. Understanding the current issue requires a step-by-step analysis of the facts surrounding the primary cause of this patient’s need for assistance. Any previous medical or surgical procedures are included in the past medical history since they help provide a clearer picture of the patient’s overall health. The patient’s family history may contain hints about potential genetic causes for their issues. Carefully consider the patient’s work patterns, family relationships, and interactions with coworkers while asking about their personal and social experiences. Finally, a system review needs to be finished (Ball et al., 2019).
Select one of the risk assessment instruments presented in Chapter 1 or Chapter 5 of the Seidel’s Guide to Physical Examination text, or another tool with which you are familiar, related to your selected patient.
HEEADSS is a screening assessment instrument that would be effective for adolescents. Using this evaluation tool can help the healthcare professional discover the following:
“What’s going on at home?
“Are you working? “How is school going?”
“Describe your friends to me.”
“What sort of after-school activities do you engage in?”
“What are your strengths?”
To encourage the patient to provide more information later, start by asking them open-ended inquiries. However, several technologies have been created focusing on health promotion and prevention to enhance healthcare interactions with young people. These include the Event History Calendar and the Guidelines for Adolescent Preventive Services (GAPS), the current standard of care (EHC). The GAPS was created to provide a screening tool for routine examination of adolescent psychosocial difficulties, health risk behaviors, and biological problems.
References
Andermann A, Pang T, Newton J. (2016). Evidence for health III: producing evidence for improving health and reducing inequities. Health Res Policy Syst 2016;14:18
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby. Low LK. (2003). Guidelines for adolescent preventive services (GAPS) Journal of Midwifery & Women’s Health. 2003;48:231–233.
Van Niel C, Pachter LM, Wade R, Jr. (2014). Adverse events in children: predictors of adult physical and mental conditions. J Dev Behav Pediatr 2014;35:549–51
World Health Organization. (2020). What are the social determinants of health? Geneva: www.who.int/social_determinants/sdh_definition/en/

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Case B 14-year-old biracial male living with his grandmother in a high-density public housing complex.
To start, we should always keep in mind how personal their experience with us can be. They can be coming to us with many issues as far as health both physical and mental, socioeconomic issues, potential unsafe living situations, and many other stresses that life can throw at people. These are all important things that should be discussed besides the chief complaint. We must assess home situations, access to care, social situations, etc. It is important to make sure that we are being personable and not just going through the motions.
We should always knock before coming into the room, introduce yourself and get your patient’s name, make sure that the room has good lighting and is a temperature that is comfortable to the patient, discuss what has brought them in, and discuss what their understanding of the problem is (Ball, Dains, Flynn, 2019). This will show the patient that you care and that you seem them as an individual rather than just another patient for the day. This also instills confidence and makes them more likely to open up to you about different issues. It is always important to include the patient in their care rather than just discussing only your thoughts with them while dismissing their thoughts. Including the patient in their care is known as patient-centered care and is an important part of providing safe and high quality care (Santana, Manalili, Jolley, Zelinsky, Quan, Lu, 2018). That is the reasoning behind using the listed techniques.
I think for the risk assessment instrument, I would use IHELLP. It stands for income, housing, education, legal status, literacy, and personal safety. Since my patient is only 14 and living with a grandmother in a public housing complex, I would have concerns about access to care and resources as well as their living situation and education. This would allow me to explore things like employment status, whether or not the patient has any health coverage or is on any kind of assistance, whether or not they are in safe housing, if they have any substance use disorders, proper education, and safe living situations (Berman, Patel, Belamarich, Gross, 2018). I would be interested in the patient’s chief complaint as well, but we must assess home situations also. We must ensure that our patients are in good hands and properly cared for both in and outside of the office or hospital setting.
It is difficult to narrow it down to just five targeted questions, but if I had to ask only five, they would be the following.

Do you feel safe at home?
How do you cope with stress?
How do you feel about your time spent in school?
Do you feel you have good access to care and resources?
How do you view your health and what are your expectations for care?

I would hope that this would give me an idea of what the patient’s life is like as far as education, safety, concerns, resources, how they see themselves, and what their goals are as far as health. There would be much more to discuss. Sometimes patients of this age can have an especially difficult time expressing themselves or feel nervous about discussing certain topics or even seeking help. Great care would be needed as well as a delicate approach and close attention to all verbal and non-verbal cues.
Resources
Ball, J. W., Dains, J. E., & Flynn, J. A. (2019). Seidel’s Guide to Physical Examination (9th Edition). Elsevier Health Sciences (US). https://mbsdirect.vitalsource.com/books/9780323481953
Berman, R. S., Patel, M. R., Belamarich, P. F., & Gross, R. S. (2018). Screening for Poverty and Poverty-Related Social Determinants of Health. Pediatrics in review, 39(5), 235–246. https://doi.org/10.1542/pir.2017-0123
Santana, M. J., Manalili, K., Jolley, R. J., Zelinsky, S., Quan, H., & Lu, M. (2018). How to practice person-centred care: A conceptual framework. Health expectations : an international journal of public participation in health care and health policy, 21(2), 429–440. https://doi.org/10.1111/hex.12640

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Description of the patient case: 
The patient is a 26-year-old Male, who presented to our ER for worsening right elbow bursitis. The patient was seen in the ER 2 days prior for the same issue, underwent a drainage procedure with documented removal of only 1cc, and was started on PO Keflex. Fluid was also sent for culture. Since the last time in the ER, the patient reported worsening pain and spreading redness around the elbow. The patient also reported some intermittent numbness and tingling in the fingers of the right hand.  The patient decided to come back in due to concerns about a possible worsening infection.  The patient denied any fevers/chills or other systemic symptoms.  The patient denied tobacco or alcohol use. 
Factors that might have influenced the pharmacokinetic and pharmacodynamic processes of the patient
The patient was not responding to the trial of oral antibiotics.  Keflex 500mg PO QID instructed to take one tablet by mouth four times a day for 5 days.  Once inpatient, the patient was started on IV vancomycin.  Following the initial dose of Vancomycin 1.5gm IV loading dose, he had a mild vancomycin infusion reaction with a pruritic rash on the abdomen that resolved with PO Benadryl dose.  Following doses of vancomycin were tolerated better with Benadryl pre-treatment and slowing infusion rate.
One factor to consider in this case was the rate of the IV infusion.  “Red Man Syndrome” is used to describe the adverse effect of vancomycin infusion.  This anaphylactoid reaction is caused by vancomycin degranulation of mast cells and basophils resulting in histamine release independent of IgE (Rivera & Ryan, 2022).  Another factor that may be worth noting is gender.  According to Alvarez-Arango et al. (2021), White patients were found more likely to experience Red Man Syndrome than non-White patients.  Red Man Syndrome was also identified as more likely to affect male rather than female patients (Alvarez-Arango et al., 2021).  
A personalized plan of care
According to Rosenthal & Burchum (2021), one patient may experience adverse effects from a medication, while others may not.  Asking the patient to report symptoms during and after the initiation of medication can help with identifying adverse reactions and implementing a plan to treat symptoms.  In assessing the risk-to-benefit ratio of medication, one must consider the severity of the side effects (Rosenthal & Burchum, 2021).  In this case, vancomycin 1gm IV q12hrs (15mg/kg dosing) was continued.  The infusion rate was extended to 120 minutes.  The patient was also pretreated with Benadryl 50mg by mouth to prevent infusion reaction.
                                                                                                       References:
Alvarez-Arango, S., Michelle, O. S., Sequist, T. D., & Burk, C. M. (2021). Vancomycin infusion reaction — moving beyond “Red man syndrome”. The New England Journal of Medicine, 384(14), 1283-1286. doi:https://doi.org/10.1056/NEJMp2031891
Rivera, C. G., & Ryan, K. L. (2022). Call to Pharmacists: End Use of “Red Man Syndrome.” Annals of Pharmacotherapy, 56(1), 102–103. https://doi.org/10.1177/10600280211021417
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.