Social Determinants of Health

 

What are two questions you would ask this patient?
I would ask this patient if he is experiencing a headache. At this time, it is important to try to determine whether or not the patient is experiencing a hemorrhagic versus ischemic stroke, as treatment will be different. Hemorrhagic strokes often present with headaches and loss of consciousnesses. They are treated with surgery to stop the bleeding as opposed to TPA or other reperfusion methods for ischemic strokes. They are also often caused by severe hypertension. A CT scan will be obtained to concretely determine the type of cerebrovascular accident that is occurring but it is an important time saving assessment to anticipate what services the patient may need in the immediate future. My second question would be if the patient has a history of CVA or TIA. The onset of symptoms will be when the patient fell asleep, as the exact time of onset cannot be determined. This would make him ineligible for TPA but given his history, he has numerous risk factors for an ischemic stroke and may require surgical intervention to restore cerebral perfusion (McCance & Huether, 2019).
Identify the subjective data for this patient.
Symptoms noticed at 5am after going to bed at 11pm, right handed, history of CAD, HTN, HLD, and MI at age 50, episode of amaurosis fugux (blindness) in his right eye one month ago that lasted for 5 minutes, bilateral leg pain 3 months ago during 15 minute walk, currently takes baby aspirin a day, ace inhibitor, and statin, history of ETOH and smoking but quit after MI.
Identify the objective data for this patient.
Slurred speech, left sided weakness, unable to move left arm and leg, blood pressure is 195/118, pulse 106, respiratory rate 18, temperature 99.8, O2 sat is 97% on room air, although his pupils are equal and reactive, and the ocular movements are intact, he is unable to turn his eyes voluntarily toward the left side, the neck is supple, there is no jugular vein distension, and there are no bruits, the lungs are clear heart sounds regular without murmurs, and abdomen is normal, the limbs are not well perfused distally, the neurologic examination reveals that he is alert and oriented, although he does not recognize he is sick, he shows loss of awareness and attention with respect to objects or stimuli on his left side, he has mild dysarthria but, his speech is fluent, and he understands and follows commands very well, there is mild weakness on the left side of the face and left sided homonymous hemaianopsia, but there is no nystagmus or ptosis, and no tongue or uvula deviation, he is not able to move his left arm and leg, has hyperreflexia, and the left great toe is upgoing.
What Social Determinants of Health would be relevant for this patient?
Social determinants of health include economic stability, education, food, health care system, neighborhood and physical environment, and community, safety, and social context. Health outcomes are often driven by a vast amount of determinants outside of the healthcare system. Addressing social determinants of health improves patient outcomes and reduces health disparities (Drake & Rudowitz, 2022). This patient has a spouse for a support system, EMS access, ER access, provider availability, access to medications, environmental walkability, and language fluency. It would be noteworthy to evaluate access to healthy foods given his past medical history of CAD, HTN, HLD, and MI.

 

Sample Solution

First, it is never just to intentionally kill innocent people in wars, supported by Vittola’s first proposition. This is widely accepted as ‘all people have a right not to be killed’ and if a soldier does, they have violated that right and lost their right. This is further supported by “non-combatant immunity” (Frowe (2011), Page 151), which leads to the question of combatant qualification mentioned later in the essay. This is corroborated by the bombing of Nagasaki and Hiroshima, ending the Second World War, where millions were intently killed, just to secure the aim of war. However, sometimes civilians are accidentally killed through wars to achieve their goal of peace and security. This is supported by Vittola, who implies proportionality again to justify action: ‘care must be taken where evil doesn’t outweigh the possible benefits (Begby et al (2006b), Page 325).’ This is further supported by Frowe who explains it is lawful to unintentionally kill, whenever the combatant has full knowledge of his actions and seeks to complete his aim, but it would come at a cost. However, this does not hide the fact the unintended still killed innocent people, showing immorality in their actions. Thus, it depends again on proportionality as Thomson argues (Frowe (2011), Page 141).
This leads to question of what qualifies to be a combatant, and whether it is lawful to kill each other as combatants. Combatants are people who are involved directly or indirectly with the war and it is lawful to kill ‘to shelter the innocent from harm…punish evildoers (Begby et al (2006b), Page 290).However, as mentioned above civilian cannot be harmed, showing combatants as the only legitimate targets, another condition of jus in bello, as ‘we may not use the sword against those who have not harmed us (Begby et al (2006b), Page 314).’ In addition, Frowe suggested combatants must be identified as combatants, to avoid the presence of guerrilla warfare which can end up in a higher death count, for example, the Vietnam War. Moreover, he argued they must be part of the army, bear arms and apply to the rules of jus in bello. (Frowe (2011), Page 101-3). This suggests Frowe seeks a fair, just war between two participants avoiding non-combatant deaths, but wouldn’t this lead to higher death rate for combatants, as both sides have relatively equal chance to win since both use similar tactics? Nevertheless, arguably Frowe will argue that combatant can lawfully kill each other, showing this is just, which is also supported by Vittola, who states: ‘it is lawful to draw the sword and use it against malefactors (Begby et al (2006b), Page 309).’
In addition, Vittola expresses the extent of military tactics used, but never reaches a conclusion whether it’s lawful or not to proceed these actions, as he constantly found a middle ground, where it can be lawful to do such things but never always (Begby et al (2006b), Page 326-31). This is supported by Frowe, who measures the legitimate tactics according to proportionality and military necessity. It depends on the magnitude of how much damage done to one another, in order to judge the actions after a war. For example, one cannot simply nuke the terrorist groups throughout the middle-east, because it is not only proportional, it will damage the whole population, an unintended consequence. More importantly, the soldiers must have the right intention in what they are going to achieve, sacrificing the costs to their actions. For example: if soldiers want to execute all prisoners of war, they must do it for the right intention and for a just cause, proportional to the harm done to them. This is supported by Vittola: ‘not always lawful to execute all combatants…we must take account… scale of the injury inflicted by the enemy.’ This is further supported by Frowe approach, which is a lot m

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