Juana Negron

Immunizations

Flu shoot, Td Booster,

Screening

Alcohol misuse, depression, hypertension, obesity, tobacco use and cessation, HIV infection, intimate partner violence, PAP smear, Lipid disorder, Abnormal glucose/diabetes, Hep C virus infection, colorectal cancer (colonoscopy), breast cancer(mammogram)

Health Promotion/Disease Prevention Concerns – please address all that are relevant for this patient:

• Injury Prevention

Traffic Safety, Burn Prevention, Falls Prevention, Choking Prevention, Safe sleep environment, Poisoning prevention, firearm safety, Drowning/water safety

• Diet
  • Please identify any relevant dietary issues for this patient

Cooked unhealthy food, tried to loose weight but failed, tried several kinds of diet but never had success

• While thinking about diet, consider any specific health issues this patient has and how diet should be modified to address them (you may have to look some up since you haven’t studied them yet)

Borderline hypertension, obesity, smoker, anxiety, asthma

• Based on your assessment, outline a plan to address any dietary modifications you think are indicated for this patient

For smoking, eating 3 servings of fruits and vegetables per day and drink green/black tea helps protect themselves from lung cancer.

 

For asthma, add vitamin D-rich food, such as milk and egg. It can reduce number of asthma attacks.  Beta-carotene-rich vegetables, such as carrots and leafy greens, and also magnesium-rich foods, such as spinach and pumpkin seeds can provide a better quality of life for asthma patients.  Increasing magnesium levels can also have higher lung flow and volume.

Foods that help to fight inflammation for arthritis pain are broccoli, Brussel sprouts, cabbage, fatty fish, garlic, tart cherries, and Vitamin-C.

 

For anxiety, don’t skip meals because it will result in drops in blood sugar that cause the patient to feel anxious. A diet rich in whole grain, vegetables, and fruits is a healthier option than eating a lot of simple carbohydrates found in processed food.

 

For hypertension, follow the DASH diet, which stands for Dietary Approaches to Stop Hypertension.  It is a diet rich in fruits, vegetables, low fat or nonfat dairy, which is also beneficial to weight loss.  For breakfast, the patient can start with 1 whole-wheat bagel with 2 tablespoons of peanut butter with no salts, 1 medium orange, 1 cup fat-free milk, decaffeinated coffee.  For lunch, the patient can have spinach salad made with 4 cups of spinach leaves, a sliced per, ½ cup of mandarin orange, 1/3 cup slivered almonds, 2 tablespoons red wine vinaigrette, 12 reduced-sodium wheat crackers, and 1 cup fat-free milk.  For dinner, the patient can have a 3 oz. cooked herb-crusted baked cod, 1/2 cup brown rice pilaf with vegetables, ½ cup fresh green beans, steamed, 1 small sourdough roll, 2 teaspoons olive oil, 1 cup fresh berries with chopped mint, and herbal iced tea.  For snack (anytime of the day), 1 cup fat-free, low calorie yogurt, and 4 vanilla wafers.

• Exercise
  • Determine whether this patient is likely to be getting adequate exercise as per current guidelines

The patient is not doing any exercise other than her job activity and walking her dogs, she is not meeting the current exercise guideline.

• If the patient is not meeting current guidelines, please suggest a plan to meet them that is specific to this patient’s goals and concerns

Activities that involve short, intermittent periods of exertion, such as volleyball, gymnastics, baseball, and wrestling, are generally well tolerated by people with symptoms of asthma.  Swimming and yoga are also well tolerated by people with asthma.  Use pre-exercise asthma medicine before beginning exercise.  Perform warm-up exercise, and maintain an appropriate cool-down period after exercise.  When it is cold outside, use a mask to cover nose and mouth when exercise. Patient should start slowly and do low intensity exercise.  Don’t start off with high intensity exercise due to increase risk when suddenly become much more active than normal.  Start with 30 minutes of swimming for 4 to 5 days in a week.  Then follow up every month to check on progress.

• Harm Reduction

Smoking and diet are already discussed in other sections.  I will still discuss about the patient’s job at Ground Zero because that is where she developed asthma.  We will discuss the precautions that she will need to take when working in harsh environment.  The patient also has anxiety because she is concerned about her landlord selling the building, and also her son’s financial difficulties.  She will need to be counseled on that.

 

Brief Intervention

• Obesity

I will use the 5As for obesity.  They are Ask, Advice, Access, Agree, Arrange/Assist.  For Ask, I will ask permission to discuss weight and explore readiness for change. I will ask question such as “Can we discuss your weight and the effects it may be having on your health?”  For Assess, I will assess health status, obesity indicators, and explore causes of weight gain.  I will ask if the patient can tell me about her past weight gain and loss, her daily diet and physical activity, family history of overweight/obesity, and any medical conditions.  For Advice, I will advice patient of health risks of obesity, benefits of modest weight loss, need for long term management, and treatment options.  I will ask “What do you know about the effects of overweight and obesity in health risks?”  For Agree, the patient and I will agree on appropriateness of weight loss, expectations, targets, behavioral changes, and treatment plan details.  I will ask “Is this a good time for you to pursue weight loss? What is your expected weight?”  For Arrange/Assist, I will assist the patient in identifying and addressing barriers, provide resources, referring, and arranging follow-up.  I will ask “Would you like me to refer you to someone who can help you with diet and exercise?”

 

• Smoking Cessation

I will use the 5A’s for smoking cessation. They are Ask, Advise, Access, Agree, Arrange/Assist.  For Ask, I will ask the patient “are you currently smoking?  How ready are you to start smoking cessation on a scale of 1 to 10?” and we will explore the patient’s readiness to change.  For Advice, I will ask permission to give advice and information.  I will talk about the health risks and benefit of smoking, including long and short term.   I will advise medications and other tools to help. I will ask “Can I give you advice on how to start with smoking cessation? Do you know what kind of risks are involved with smoking? Can I tell you some short and long term benefits?”  For Access, I will access the patient’s health status and addiction to nicotine using the heavy smoking index (HSI).  I will ask “How many cigarettes, on average, do you smoke? How soon after waking do you smoke your first cigarette?”  For Agree, I will discuss and set a quitting date with the patient.  We will also agree on what medication will be used and when to start them.  We will also identify behavioral changes to be made and formalize a plan together.  “When would you like to start quitting? What do you want to start the medication that we’ve discussed about?” For Arrange/Assist, I will provide prescription, refer patient to support group, internet, and other regular check-in option. Follow-up will be arranged as well. I will ask “Would you like me to refer you to any one that can help you with smoking cessation?” There are also 5 R’s to motivate the patient: Relevance, Risks, Rewards, Roadblocks, and Repeat.  Relevance is the reason that push the patient to quit smoking, such as pregnancy, family member’s health, and employment. Risks is to advise the effects of continued smoking. Rewards is the benefit of quitting such as better health and huge saving.  Roadblocks is to explain potential barriers such as other smokers around you, past history of unsuccessful attempts, and weight gain.  Repeat is to repeat relevance, risks, rewards, and roadblocks.

• Substance Use

Not applicable to the patient.

 

Although there are a list of issues that should be addressed, the most important issue that should be considered now is the patient’s BMI.  The patient has a BMI of 30.9 and a waist circumference of 40 in are considered as obese. Obesity can lead to heart disease, stroke, high blood pressure, diabetes, osteoarthritis, asthma, and breathing problems.  Once the patient drops her BMI, she will be less risk of her current health issues such as anxiety, asthma, and borderline high blood pressure.  Once the patient starts following the diet and exercise plan, she will be healthier with less chance of having other diseases.

 

 

 

 

Reference:

https://www.healthline.com/health/asthma/asthma-diet

http://newsroom.ucla.edu/releases/fruits-vegetables-and-teas-may-51210

http://blog.arthritis.org/living-with-arthritis/diet-foods-arthritis-pain/

https://www.health.harvard.edu/blog/nutritional-strategies-to-ease-anxiety-201604139441

https://www.webmd.com/asthma/guide/exercising-asthma#2