An African American male patient, age forty-two, was admitted to a skilled nursing unit after surgery for head and neck cancer with lymph involvement, newly diagnosed. Extensive excision of the tumor had been done, and the patient had a newly placed tracheostomy and feeding tube. His history included years of “living on the street” and active drug abuse at the time of admission. The patient was very anxious on assessment, focused on his tracheostomy, pulling on the connections, to “make sure they are working” and complaining of pain “eight-to-ten” on a scale of one-to-ten, with intensity focused in the area of his surgical wounds.
Does this man’s history as recorded in the chart affect every encounter he has with healthcare professionals?
What is presupposed by his “life on the streets”? by his active drug use in the past?