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During my last attachment, one of my patient from my cubical, Madam Low, 68 years old Chinese lady, unmarried and she currently lives with her brother before the admission. She works as a cashier in hawker center but she quit her job 2 months ago because she was upset with her employer. Madam Low did not receive any higher education because when she was in primary 2, she had move with her family from Malaysia to Singapore and after that she did not go back to school because her family could not afford her school fees. She was admitted to hospital due to her high blood pressure and her blood pressure was 200/102mmHg before receiving treatment. Madam Low had diagnosed hypertension since 2011. High blood pressure or hypertension refers to the condition in which the blood is pumped around the body at too high a pressure. Hypertension is often called the silent killer. This is because, even when severe, it may not give rise to any symptoms. Occasionally, you may have headaches or giddiness when the hypertension is severe. However, these symptoms are not specific to hypertension; they are also present in other diseases. Sometimes, hypertension is only discovered when complications set in, for example, a stroke or heart attack.  Hypertension is a fairly common problem in Singapore. Slightly less than 1 in 4 Singapore residents aged 30 to 69 years have hypertension. The older you are, the more likely you are to have hypertension. In the 60 – 69 years age group, more than 1 in 2 persons have hypertension. The normal blood pressure is less than 130/80mmHg. (Health hub, 2017)After having some conversation with her, I think that due to her social factors which is education that had affect her health. Social factors are things that can affect lifestyle such as religion, education or wealth. Social factors can affect the status of a person’s level of both health and fitness. In Madam Low case, the social factors that affect her health status is her low education. People in higher education will have better economic and social opportunities and outcomes such as high paid job than someone who does not receive high education. Education is a key factor especially Madam Low is a functionally illiterate and she only knew some Chinese words such as her name. She could not read and comprehend a simple block of text and she could not understand other language except mandarin. A person’s level of education directly affects their personal health as example Madam Low could not understand English so she cannot read the prescription or written instructions so she did not take the medicine regularly. Madam Low also could not understand doctor’s order and she needs a translator to translate mandarin to her. During the conversation with doctor, Madam Low was afraid and embarrassed to ask doctor about her doubt. Madam Low did not have the basic health literacy and she does not know how to take care herself properly or prevent illness. Health literacy is a basic understanding of health information such as filling medical forms, locating a doctor or a specialist or managing an illness. She also likes to consume unhealthy meals such as nasi lemak and curry chicken which contain high cholesterol and she did not know that those foods were unhealthy. According to Healthy people 2010 report found that “inequalities in income and education underlie many health disparities in the Unitied Status,” in other words there are people with less education had many health problems. The Healthy People 2010 findings a case study in 25 to 65 years old with less school education found they has higher rates of smoking, higher rates of obesity, less access to healthy foods, exercise equipment and areas to exercise and higher death rates. (Healthy People 2010, November 2011) According to The Silent Epidemic –The Health Effects of Illiteracy, patients with reading problems may avoid outpatient doctors’ offices and clinics because they are intimidated by paperwork, according to Joanne Schwartzberg, director of aging and community health at the American Medical Association. The exact relation between literacy and health is still unclear, but people with low literacy are more likely to report having poor health, and are more likely to have diabetes and hypertension, than those with adequate literacy. Patients with poor literacy skills often are ashamed of their problem and are adept at hiding it. In one study, more than two thirds of patients with low literacy in public hospitals said they had never told their spouses about their problem. Nearly a fifth said they had never told anyone. (Marcus, 2006)  In conclusion, from my interactions with Madam Low, I learned that social factors can affect the patient’s medical conditions. In Madam Low’s case because she did not receive any education about hypertension and it has affected her health because she had diagnosed hypertension for the past 7 years and she did not know how to manage her disease. I think as a student nurse we should make some action to manage it because hypertension is a chronic disease. Chronic diseases are long-term medical conditions that are generally progressive. (Health Hub, 2017) As example educated patient to have a healthy diet such as limit the cholesterol intake and exercise regularly because lack of exercise is associated with a low HDL – cholesterol level. 

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