Jane Vuong is a 24-year-old single Vietnamese woman living in the United States on an academic visa. She has been attending the local university for two years, studying cellular biology as an undergraduate. She comes from an affluent Vietnamese family. Her parents are paying for her education. They want her to return to Vietnam with her doctorate and take over the research lab owned by her uncle. Jane is a straight-A student who spends much of her time studying. She makes extra money by working part-time in the molecular biology laboratory in the university campus research center. She takes the subway or rides her bicycle to get around.
Jane enjoys working out by doing Quan Khi Dao at the local martial arts school. One day while there, she feels a severe tightness in her chest and says she is having difficulty breathing. Susan, a regular attendee in the class, brings Jane to the emergency department where you work. You note that Jane is having trouble speaking, appears anxious, and her lips are dusky. You are able to hear a wheezing sound when she breathes. She denies a history of asthma but says that she has some allergies which she generally treats with herbs. Susan takes you aside and tells you that she has noticed over the past month that Jane has seemed out of breath after taking the stairs up to the martial arts studio, and that she no longer rides her bike to the studio.
Because of the severity of Jane’s symptoms, the doctor decides to admit Jane for evaluation and observation. The physician orders supplemental oxygen, a chest X-ray, blood tests, and a regular diet. Jane’s anticipated stay is two days.
Once on supplemental oxygen, she is better able to communicate, and you begin to do a general assessment and take a history. Here are some of your findings:
• Diet: Jane states that she is proud that she only eats a traditional Vietnamese diet of fresh vegetables, chicken, rice, and noodles. Much of the food she eats is prepared with nuoc mam (fish sauce), soy sauce, sour lemons, bean sprouts, and scallions. She prefers to eat banh khuc (rice ball), banh cuon (rolled rice pancake), and pho bo (beef and noodle soup). You note that she is very slender, verging on being underweight.
• Religion: Jane states she is a Mahayana Buddhist. She goes to the Buddhist temple early each morning for meditation and communion with her dead ancestors. She says her meditation brings blessings from her ancestors, and they watch over her and help her succeed and stay healthy.
• Health history: Jane admits she has had a dry cough for several months, which she attributes to allergies. She says her allergies have kept her from riding her bike to work. She continues to smoke one pack of cigarettes daily and says smoking does not bother her. She laughs during your assessment and says she could never quit because her roommate smokes too.
Six months earlier she tested positive for hepatitis B. The diagnosis surprised her because she did not show any symptoms. She denies drug use but admits to being sexually active. She reports having five sexual partners in the past six months. She states, “I meet guys at the college bar and we have weekend flings. I like it this way, so I don’t have to be involved in any type of long-term relationship, which can make life really complicated.” When asked if she uses protection, she shrugs and says, “Sometimes.” She claims that no one told her that hepatitis B was sexually transmitted, but she is not worried because she says she is over it now.