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Didactic Coursework

Health Promotion & Disease Prevention Case Study

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5 years ago

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Health Promotion & Disease Prevention Case Study, November 2017

Case Study: Alexi Burr

 

Immunizations:

Alexi Burr should have the following immunizations:

  • Influenza vaccine
  • Td booster if her last Td/Tdap was 10 or more years ago
  • Since she is at average risk, no other vaccinations are necessary

 

Screening:

Alexi Burr should be screened for the following:

  • Alcohol misuse
  • Depression
  • Hypertension
  • Tobacco use and cessation (the case study never mentioned anything about this but we should always check for tobacco use)
  • HIV infection
  • Intimate partner violence
  • Cervical cancer

 

Additionally, I would not screen for breast cancer as of yet. Even though she has significant family history of breast cancer as both her maternal grandmother and maternal aunt had breast cancer, Alexi Burr is only 34 years old. The USPSTF, American Cancer Society, and American Academy of Family Practice recommend starting screening at the age of 40-50 and the patient is younger than that range. However, if the patient decides that she wants to be tested for BRCA1 or BRCA2 since it is unknown whether those were present in her maternal grandmother or aunt, she can do so.

 

Injury Prevention:

  • Traffic safety

 

Diet:

  • Issues
    • Does not eat on a regular schedule, rather she only eats healthy when she remembers to eat due to focusing on her children’s meals
    • Lost 20 pounds due to poorly controlled/delayed seeking treatment of ulcerative proctitis
    • Dinner is inconsistent ranging from home-cooked meals to food picked up unhealthy chains to prepared foods from the local supermarket
  • Assessment/Plan
    • Although the patient had past medical history of anorexia nervosa as a teenager, she recovered from it with psychotherapy and a stay in a rehabilitation unit at age 16. She is now 34 and her main concern is the ulcerative proctitis and finding the time to cook food and to eat at regular times, meaning she should not forget that she has to eat.
    • For breakfast, she currently has a piece of toast with almond butter and a cup of coffee. For lunch, she eats salads from the university cafeteria. Dinner is inconsistent.
    • Since she has ulcerative proctitis, diet is key in reducing her symptoms. Her diet should be rich in vitamins, minerals, and substances that promote healing. She should be careful with fiber as eating too much fiber could increase bloating, gas, and bowel movements. To reduce or fight inflammation, she could eat antioxidant-rich foods like blueberries, dark chocolate, and steamed artichokes. Limiting diary intake and caffeine may also reduce diarrhea. She should reduce caffeine, dried beans or peas, dried fruits, nuts, refined sugar, spicy food, and raw vegetables. She could also consider taking supplements to ensure that she is not deficient in nutrients like iron, calcium, vitamin D, potassium, and magnesium.
    • For breakfast, Alexi Burr may want to reduce or limit her intake of coffee. Salad for lunch should be okay. Dinner should be as home-cooked as possible. She could eat grains and pasta, soft cooked meats like chicken, eggs, pork, or fish and cooked vegetables like spinach, carrots, and eggplants. If she does not have time to cook, she should avoid food from fast-food chains and aim to pick up prepared foods from what I mentioned above.
    • Alcohol can induce diarrhea. Alexi Burr drinks as many as four glasses of wine per Friday night so she could consider limiting her alcohol intake.

 

Exercise

  • Issues
    • Too busy with two children and busy schedule
    • Sits for long hours at work
    • Does not meet the adequate 150 minutes of moderate-intensity aerobic activity per week
  • Assessment/Plan
    • While she is lecturing, instead of standing for hours, she can pace around occasionally to reduce the number of hours that she is stationary
    • Although she walks from one end of the campus to the other daily, she could try to squeeze 30 minutes of time to visit the university gym daily for aerobic exercises like running on the treadmill or include weight training.
    • On the weekends, she can bring her children to the park and play sports like soccer or games like tag with her children and husband so that she does not have to reduce time with her children to partake in exercise.

 

Brief Intervention for Alcohol Substance Use:

  • Issues
    • Drinks on most weekends when going to the bar on Friday evenings with colleagues
    • May drink as many as 4 glasses of wine, making her unable to drive home
    • Her “one night to blow off steam” may have become routine and she may be dependent on such alcohol intake
  • Brief Intervention Outline
    • I would first start with the CAGE substance abuse screening tool and ask her the following:
      • C = Do you feel that you need to cut back on your drinking?
      • A = Have you ever been annoyed that people have criticized your drinking?
      • G = Have you ever felt guilty about your drinking?
      • E = Do you ever drink in the morning (eye-opener) to get rid of shaking or hangovers?
    • To identify the level of intervention needed, I would also use the AUDIT test, which include the following questions:
      • How often do you have a drink containing alcohol?
      • How many drinks containing alcohol do you have on a typical day when you are drinking?
      • How often do you have 6 or more drinks on one occasion?
      • How often during the last year have you found that you were not able to stop drinking once you had started?
      • How often during the last year have you failed to do what was normally expected from you because of drinking?
      • How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session?
      • How often during the past year have you had a feeling of guilt or remorse after drinking?
      • How often during the last year have you been unable to remember what happened the night before because you had been drinking?
      • Have you or someone else been injured as a result of your drinking?
      • Has a relative, friend, doctor, or another health worker been concerned about your drinking or suggested you cut down?
    • Based on her score on the AUDIT, I would consider ordering a test for elevated liver enzymes, ask her about additional behavioral problems at work or at home, and educate her about safe drinking levels. Excessive drinking is also associated with her condition of ulcerative proctitis, thus she may want to limit her intake of alcohol to reduce further irritation caused by drinking alcohol.

 

Based on what I listed above, I believe that the patient’s diet and intake of alcohol should be addressed first, followed by her exercise regimen, immunizations, screening, and injury prevention. Her diet and intake of alcohol directly impact her current condition of ulcerative proctitis therefore, we want to reduce the number of hemorrhoids and bleeding that she experiences. Although she is not overweight or obese, she should try her best to incorporate a regular regimen of exercise that meets the weekly requirement. Her immunizations, screening, and injury prevention are not as time-sensitive as these things do not have to be rushed.

 

References:

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