Case Study Elements- Alexi Burr

Immunizations

• •  Influenza, Td booster (depending on when she had her last dose)

Screening

• • Colorectal Screening (Colonoscopy)

– Pt is not in the age range for a colonoscopy but has a history of ulcerative proctitis which puts her at increased risk of colorectal cancer.

• • BRCA Gene Risk Assessment

– Her maternal grandmother was an Ashkenazic Jew from Russia who had breast cancer and puts her at increased risk of a BRCA mutation. Based on the results of the genetic testing, it could then be decided how soon patient should be screened with mammograms.

• • Breast Cancer Screening (Mammogram)

-Patient could be screened at an earlier age of 40-49 due to her family history of breast cancer; both her maternal grandmother and aunt had breast cancer.

• • Cervical Cancer Screening (Pap Smear)
  • STI screening

-Patient is married but would still offer screening tests to patient to see if she would be interested.

• • Blood Pressure Screening

-Patient has a maternal grandfather with a history of 2 strokes and a paternal grandfather with a history of high blood pressure. Patient doesn’t have any personal significant factors that put her at risk besides her family history but it would still be a good idea to get her screened as she is well over 18 years of age and should be regularly screened for high blood pressure.

• • Mental Health Screening (Depression and Anxiety)

-Patient has a past medical history of anorexia which she recovered from with psychotherapy. Also has a family history of anxiety and chronic depression.

• • Substance Abuse Screening

-Patient notes she goes out and drinks on the weekends only, but has noted sometimes she has as many as 4 glasses of wine on these occasions.

• • Genetic Testing

-Father has the Sickle Cell trait, so it is possible she could be a carrier. Testing could be done if patient wanted to be sure.

• •  Intimate Partner Violence Screening

Health Promotion/Disease Prevention Concerns

• •  Injury Prevention

– Traffic Safety

– Choking Prevention, Drowning Prevention/Water Safety, Poison Prevention, Burn Prevention, Fall Prevention and Safe Sleep Environment

• • • • • Patient has children so it would be good to know about these types of preventions.
  • Diet

-Patient has a history of anorexia as a teenager which she recovered from with psychotherapy and a brief stay in a rehab unit. I would be very careful and think about maintaining a healthy relationship with food and learning about any triggers patient may have. Patient seems to have some healthy eating habits, but has a hard to finding time to make her own lunch for focusing her children’s meals. Sometimes she also forgets to eat.

-Breakfast: Should consider adding some protein, fruits, and possibly some healthy carbs that could help her increase weight a little. Healthy carbs could also help her feel full if and when she forgets to eat lunch.

• • • • • Toast with almond butter

-Can continue to with piece of toast with almond butter and a cup of coffee

o Could consider switching to Decaf coffee

o Recommend maybe switching to whole grain or wheat bread if she isn’t already doing so to limit refined grains

-Add fruits

o Patient notes she already consumes a lot of fruit and vegetables, so it would reasonable to also include that in her breakfast.

-Add Greek yogurt to get some protein  Overnight oats:

o Contains fiber

o Can add fruits such as berries

o Contains healthy carbs that could help increase weight

-Lunch: Salads are a great option, and patient could consider adding a source of protein to make sure meal is balanced in terms food groups. I would also maybe consider the option of meal prepping on the weekends or making meals for the kids that the patient could also eat so she isn’t making more than one type of meal.

• • • • • Salads:

-Consider adding a protein like grilled chicken

-Can also consider adding a fruit option like strawberries

• • • • • Protein with a portion of vegetables and healthy carbs:

-Grilled chicken or fish with frozen vegetables that can be quickly prepared in the microwave. Be sure to choose a sodium free or low sodium frozen vegetable option to stay on the healthy side. Patient could also consider putting chicken in an air fryer if she wants to cook quicker and in bulk for the week. Patient can add sweet potatoes as an option for carbs.

-Could also consider of side of berries

-Dinner: Patient notes dinner is “all over the place.” Sometimes her husband cooks, and others they pick up fast-food or prepared foods from the food counters at the local supermarkets. I would suggest trying to pick up healthier options off the menu, which it seems the patient tries to do.

• • • • • Salads from restaurant:

-Consider adding a protein and fruit topping

• • • • • Entrée at restaurant that follows the healthy eating plate or can meal prep:

-Protein: Fish, chicken, poultry, beans.

-Whole grains: whole grain pasta or brown rice

-Vegetables: a variety

• • • • • If it is food from the prepared foods counter at a local supermarket, I would suggest making sure you get all the food groups: protein, whole grains, then vegetables and fruits
  • Exercise

-Goals: Aim for 150 minutes of aerobic physical activity a week and at least 2 days of strength training. Patient does not have a lot of time to work with because of kids, but she doesn’t necessarily need to lose anymore weight. I think the most important thing would be maybe to work her way up to some weight training to build muscle and bring her weight up slightly.

o Beginning

-Can consider timing how long the walk is from one of campus to other.

-Depending on how much walking she does during the week, she could consider taking walks on the weekends with her family for about 15-30 minutes a day or she could possibly try to walk on her own and slowly increase to a brisk walk for about 30 min. She could also consider adding resistance bands on the weekends if walking on the weekdays amounts to 150 minutes of moderate intensity aerobic exercise. She could also do a combination of walking and resistance bands on the weekends depending on how much time she has.

o Increase Activity

-Patient could work her way up to maybe some weight/strength training on the weekends instead of walking due to her limited time.

• • Harm Reduction

-N/A

o Already addressed above.

Brief Intervention

• • This patient is not obese, doesn’t smoke or have any substance abuse issues.
  • She does have about 4 glasses of wine on Friday nights she goes out with her friends. I would probably ask if we can talk about her drinking habits. I would also talk about the dangers of drinking too much while also noting that an occasional glass of wine is okay.