Asian Patient Culture Jong's refusal to wear a CPAP machine is not surprising. They are fairly obstructive and it would take anybody some time to get used to the idea. However, this is tied to other issues as well. In general, Mr. Jong has not been taking care of himself; he is in denial about his reduced ability to live independently. The CPAP machine is simply another manifestation of his loss of independence and this is clearly difficult for him. The first thing to remember is that in Asian cultures respect for elders is a strong value. This is the approach that will need to be used to gain his consent -- to treat him with respect, and show how the machine will help him to breathe better. It might be best to explain that it is temporary as well, to reduce the threat. But respect for the patient's elder status is critical to gaining his trust in this situation. Without that, things like logic and reason will not be effective. His daughter can likely help to convince him that this is for the best -- she will better understand the approach that she needs to take.

2. His daughter's request for natural products is in line with many Asian culture. As an older person, Mr. Jong probably has a preference for Traditional Chinese Medicine (TCM), and believes as much in the power of those natural remedies as anything else. The daughter likely has knowledge of what products might help, and can seek out a TCM practitioner to provide them. Ultimately, most of those natural products have not been proven effective, but they are harmless, too. If there is a placebo effect, that will be beneficial.

The key approach here is to respect Mr. Jong's tradition and his views about medicine. The hospital is not in a position to provide these products, but Mr. Jong likely has a supplier already and the daughter can be called upon to help in this regard. The important thing is that he is allowed these products, but within the context of using them with Western medicines. Show respect for his traditions, but insist that he takes them in conjunction with the Western medicines that are recommended by his physicians.

3. The TCM will be one complementary therapy that is recommended. He will need help rehabilitating after his hip surgery. More important, he will need physical therapy and dietary assistance when he is released. He is not eating properly -- this is causing low energy levels, which in turn are reducing his energy to shop and cook. Foods that boost energy, along with specific exercises, are important for any elderly person to keep their energy levels high. It will also be recommended that somebody pays him a visit regularly, to ensure that he is getting his exercise, and possibly to prepare some healthier meals for him in order that he eats better.

4. It is possible that this is scar tissue, caused from using the same site exclusively for injection, known as lipodystrophy....

To avoid scarring, injections should be rotated around different sites. Mr. Jong was probably unaware of this, or was simply more comfortable injecting there. The nurse should use a different injection site and coach Mr. Jong on the value of rotating injection sites to avoid such scarring in the future. He should use different injection points within a given site, use different sides of his body, and ensure to use a new needle with each injection as well, to reduce such scarring in the future.
5. He probably does not need to wear gloves, but should ensure that he washes his hands thoroughly prior to injecting in order to reduce the risk of infection. Gloves will not hurt, however. If his daughter injects him, she should wear gloves, however.

6. Mr. Jong is hypoglycemic, so should not be given insulin at this time. He needs to take in more sugars --food, juice, or glucose tablets. Only when his blood sugar increase should he be given insulin.

7. We do not yet know when Mr. Jong is being discharged, so there is no way to tell when he should have a snack. He needs to eat now, for example. This decision cannot be made without knowing when he will be discharged, which in his present condition is not now.

8. The IV is to deliver 500ml over 8 hours, so the rate would be 62.5 ml/hr

9. The IV might be burning because it is touching a nerve, so it is best in this situation to listen to the patient and investigate the IV. Find out if it was burning since insertion, too. The best course of action here is to ensure that the IV is not touching a nerve, because a properly-inserted IV should not be burning. It is also possible, since he has been there for three days, that the site of the IV simply needs to be changed. . Veins tire of having IVs inserted, and after three days it is good practice to change the site anyway.

10. Mr. Jong might have been dreaming, which is why he thought he fell, thought he was reaching for a phone, but was startled by the nurse. It might be best to log the incident. If it was just a dream, it is no big deal but this could also be a sign of some form of dementia. In particular, if such incidents occur when Mr. Jong is not sleeping (or during sleep hours) it is good to have evidence of a pattern of such episodes. In particular, he might be susceptible to vitamin deficiencies because of his poor dietary habits, which is something that can be remedied with a healthier diet. However, a singular incident is not much with which to make any concrete decisions, so it is best to simply record the incident.

11. Mr. Jong is exhibiting signs of moderate anxiety. Given his situation, this is not surprising. Not only has he been in hospital for several days, but he is also coming to terms with the reduction in independence, and with that perhaps even his own mortality, in a way that he has not had…