Darielle Connor

Case Study

Calandra James

 

Immunizations

• (All childhood immunizations intact, too old for HPV in childhood but we assume she has had the vaccine if needed/warranted)
• Patient will need :
  • Flu Vaccine (November visit, time of new flu season)
  • Zoster
  • Td booster if she hasn’t had one in the last 10 years.
  • Varicella (if she hasn’t received it prior or didn’t have chicken pox as a child)
  • Pneumococcal 13-valent conjugate (PCV13)(if she hasn’t already received it)
  • Pneumococcal 23-valent polysaccharide (PPSV23) (one year after PCV13 if she hasn’t already received it)

Screening

• All USPSTF recommendations
  • Alcohol misuse
  • Depression
  • Hypertension
  • Obesity
  • Tobacco use and cessation HIV infection
• BRCA gene screening? (her mother had breast CA)
• STI screening (chlamydia and gonorrhea, she is sexually active)
• Lipid disorder (BMI 25.8)
• Diabetes (BMI 25.8)
• Hep C virus
• Colorectal CA
• Breast CA
• Lung CA
• Osteoporosis

 

Screening Tests (I would make sure to order these if she hasn’t had them recently)

• Mammogram
• Colonoscopy
• Low-dose CT lung scan (40 pack-year smoking Hx)

Health Promotion/Disease Prevention Concerns

• Injury Prevention
  • Helmet and bike safety measures
  • Traffic safety
  • Water safety
• Other Prevention
  • Primary prevention of breast CA
  • Fall prevention (vitamin D)
• Diet
  • Counseling for diet/activity for CVD prevention
  • “joyless” diet that can lead to falling off the wagon and relapsing to bad habits.
  • Healthy weight loss – lost weight too quickly.
  • Calandra eats very cleanly, but not in a sustainable manner. She lost 75 pounds in one year, which is considered to be much too quick for long term weight loss. She should introduce some rewarding meals back into her diet as a treat, maybe once on weekends or during the week. She should also try to cook once in a while and maybe make it an activity with her partner. While her diet seems well planned, she is eating a lot of peanut butter and should maybe cut back to every other day, substituting a different spread for the other days like something low-fat yogurt based or olive oil based (less saturated fat). Her yogurt should be low-fat as well and fruit should be low glycemic. Diabetes runs in her family and we need to be mindful of her high-glycemic food intake. I also want her to eat more low-sodium, or to at least be mindful of it. She doesn’t have HTN but she could develop it based on her age. More variety as well, more fish, beans, and vegetables. She also needs to eat less prepared foods as they may have preservatives and chemicals that can be carcinogenic.
  • “You’re doing amazing with your diet and exercise, but if it’s okay I want to talk to you more about your eating habits. Why do you think you’ve gained 15 pounds in the last year? I think it has to do with your initial weight loss as it was very fast and that doesn’t usually prove to be sustainable. That’s okay and you’re still doing so well! Keep up the good work and lets work on a more enjoyable diet plan for you. I think that while we want to maintain your weight loss, we need to make sure you are happy and being good to yourself. I think lets start out with making food your friend again, less restriction as that has a tendency not to be sustainable long term and you’re already not enjoying it.”
• Exercise
  • I think her current exercise regimen is great. She seems to be very active for her age, is within the guidelines provided by the CDC, and she should keep up the good work.
• Harm Reduction
  • Counseling for skin cancer prevention
  • Counseling for STI prevention
  • Counseling for diet/activity for CVD prevention

Brief Intervention

• Obesity
  • Her BMI is considered to be overweight and she is describing dissatisfaction with her diet.
  • I would make sure to talk about how well she’s doing, but that diabetes runs in her family and that she is considered to be overweight. While being overweight isn’t as terrible as being obese, if she doesn’t get a handle on her hard to sustain diet, she may start eating badly and it could lead to more weight gain.
  • Ask permission to discuss her weight in a non-judgmental fashion. Assess her BMI, which is considered in the overweight category, and explore her unhealthy eating habits. Advise her on her risk of diabetes for to family Hx and risk of developing more unhealthy eating habits like her severe restrictions. Agree on a more realistic diet plan so that she can enjoy retirement and have a better relationship with food.
• Not necessarily intervention, but encouragement and motivational interviewing for her ability to quit drinking alcohol and smoking, recognizing her addictive behavior and wanting to do something about it. “Calandra, I just want to tell you that it’s really amazing that you were able to do so much to improve your health! Quitting both smoking and drinking is so so difficult and you make it look easy! What kind of things did you do that helped you to quit successfully? Have you noticed how much better you feel and how good you’ve gotten at exercising? How about we apply some of these tactics, and realizations of your abilities, to your long term weight management plan? Great job!”

 

Sources:

 

Principles of Screening.pdf

AFP – 1 pg Adult Screen USPSTF.pdf

 CDC Adult Immunization Schedule.pdf

CHI – PreventingSexually Transmitted Infections.pdf

Summary of Recommendations for Clinical Preventive Services.17.pdf

Motivational Interviewing Techniques.pdf

 CHI Healthy Eating Choices.pdf

FDA Using the Nutrition Facts Label Senior Guide.pdf

 4_Nutrition – Very Briefly.pptx

Writing an Exercise Rx.Fa16.pptx

 Wadden – Lifestyle Modification for Obesity.pdf

 5 As in Obesity.pdf