Case Study: Juana Negron.

Immunizations

Assuming Jauna has gotten all her childhood vaccines, Juan should get her flu vaccine, and if it’s been more than ten years then she should get a Tdap Booster as well. Also, since she is over 50 years, she should get the Zoster vaccine too.

Screening.

Given that Jauna is 52 years old, has a history of smoking for over 30 years, developed asthma after working at ground-zero, and a family history of colon cancer, and breast cancer she should be screened for lung cancer via low dose CT, get a colonoscopy done to check for colon cancer, mammogram to check for breast cancer, as well a pap smear, and HPV testing for cervical cancer. Jauna, noted her brother has hypertension, and she has borderline “high-blood pressure”, so she also should be screened for hypertension as well. Given her “high-blood pressure” I would also order a lipid profile to check her cholesterol levels as well. I would add that since she has arthritis and is going through menopause she should also get screened for osteoporosis.

Additionally, she is quite anxious, and worried because her son is facing financial difficulties, and worried about her landlord selling her apartment. She should be screened for depression, and alcohol misuse. Also, I would screen her for HIV.

Injury Prevention

Based off Jauna history I believe she can benefit from three injury prevention method.

1. Poisoning Prevention – She works for pest control, and even though she doesn’t get much exposure to non-toxic agents she should learn about safety, and what to look for if she ever interacts with any type of poison, and how to prevent any injury.
2. Safe sleep environment – Jauna has noted she has been struggling getting good sleep, and good sleep is vital to function properly. I would talk to her in using earplugs when sleeping, and if need be, look into taking Ambien in helping her get sleep.
3. Fall prevention – Give that Ms. Juana suffers from arthritis she would benefit from how to avoid falling, and when to take breaks if her arthritis is bothering when walking. Even using a cane can be a huge help for her.

Diet:

Ms. Juana notes she had tried several diets, but we don’t know which ones she has tried, and if any of those diets have been studied. Ms. Juana hasn’t provided much detail into her diet, other than she loves eating and cooking, and mentions Puerto Rico food isn’t the healthiest. Since Puerto Rican food tends to be carb heavy. I would recommend that Juana look into a low- carb diet that has been proven in helping reduce weight. Utilizing a low-carb diet like Atkins she will be able to eat food that is flavorful, and healthy. She mentions she loves cooking, meal-kit company HelloFresh offer low calorie options, that can deliverer recipes to her that she can cook. I would also encourage Ms. Juana to incorporate more fruits in her diet to satisfy any sweet tooth cravings. Ms. Juana has mentioned she has lost weight before, but has gained it all back, because of the lack of will-power.” Given Juana has borderline high blood pressure, she should watch her stalk intake, and eat less salty food. She would benefit incorporating more greens into her diet like spinach, kale and salads that are great for weight loss. I also recommend that she keeps a diary of what she eats, to count her calories, and how she feels when she eats to get an idea of what is causing her lack of “will power. Counting her calories and adjusting the caloric deficit will help her reduce weight.

Dietary Plan:

• Eating healthy for 6 days and having 1 cheat meal a week.
• More fruits & vegetables, reduce red meat, and increase poultry intake
• Switch to healthy oils like olive oil

Exercise

CDC recommends adults should get 150 minutes per week of moderate exercise, and 75 minutes per week if the exercise is vigorous. Taking into consideration Jauna arthritis, and asthma I would recommend moderate exercise for her to start. She already enjoys walking her dogs three times a day for two blocks, I would encourage her to continue to walk her dogs three times a day, but walk 3 blocks instead of two, and each week add 1 more block until she hits twenty-one minutes making a round trip, and she will be able to reach the recommended CDC guidelines for 150 minutes per week. However, if her arthritis or asthma get exacerbated, we might need to make some modifications. These modifications include singing while she is cooking as it would be easy on her bones, and lungs. And if she is open to it may be taking up swimming as it will be easy on her arthritis.

Harm Reduction:

A harm reduction initiative for Juana would be to switch from cigarettes to smokeless nicotine alternative, as she was able to quit smoking for 6 months previously. However, went back to smoking. Quitting right away didn’t help but switching to smokeless nicotine would help her tremendously. Jauana, is a huge fan of Puerto Rican food, and Puerto Rican food can be carb heavy especially since a lot of dishes contain rice. Switching from white rice to brown rice would be a great choice since brown rice contains more fiber, vitamins and minerals, and the fiber would keep her filling fuller longer. Also, cutting back on red meat, and eating more fish, and increasing vegetables into her diet would be beneficial for her.

Brief Intervention:

Topic: Smoking cessation & Obesity:

Ask: I would ask Ms. Nergron, if she is comfortable speaking to me about her weight goals, and her plans to quit smoking this would open a dialogue to get more information.

Question I would ask her: “Ms Nergon, are you ready to try quit smoking again, and how do you feel about your current weight”?

Assess:  I would assess BMI, waist circumference, physiological functions such as anxiety, and depression, and how it is affecting her smoking habits, and her health.

Question I would ask her: “How is your smoking, and weight affecting your day-to-day life?”

Advise: I would ask permission from Ms. Negron to talk about the benefits of losing weight and remind her how when she quit smoking originally the benefits, she felt from it.

Question I would ask her: “Now that we have an understanding of your situation, is it okay if I recommend some action plans to help achieve your goal”

Agree:  This is the stage where I would work with Ms. Negron in achieving a realistic goal something where we both can meet in the middle, and if there is any concerns, she has with the plan we can rework it.

Questions I would ask her: “Ms. Nergon, how do you feel about this plan, is there anything you would like to add or change?”

Assist:  I would help address any barriers that are affecting Ms. Negron such as medical issues like her arthritis that might be preventing her from exercising, and her anxiety regarding her sons financial issues, and the thoughts of her losing her apartment.

Question I would ask her: “Is your arthritis making it difficult for you to exercise, and is your anxiety regarding your son’s financial health, and the worrisome of your losing your apartment affecting you in anyways?”

 

What should be addressed first?

 

I think the vaccination and screening should be addressed first. Getting the flu vaccine, and any other vacation the CDC recommends will help protect the patient against the flu, and other viruses. Given Ms. Negron history of smoking, family history of hypertension, colon cancer, and breast cancer she should be screened for those because if caught early it would be treatable. In general screening and vaccination should be addressed first for most patients as both vaccination, and screening are preventive measurements.