Farhana Chowdhury

HPDP case study

Due: December 4, 2018

What should be addressed first:

Mr. Khoury’s chief complains of the shoulder and left-hand pain should be addressed first because it is impacting his daily life. Next, the diet should be seriously considered because he has uncontrolled glucose and blood pressure level. He also has a family history of diabetes, hypertension, and stroke; therefore, it is crucial to control the food portion and increase exercise to maintain a healthy weight. Immunization and screening are also important to identify how he is functioning currently so that should be the next priority in the list.

Immunizations:

Immunization	Reason
Influenza	Based on the CDC recommendation 1 annual dose should be administering during the flu season.
Td/Tdap	CDC recommend giving a Td booster in every 10 years and if the patient has received tdap 10 years ago then he will receive a booster
PPSV23	CDC recommends for diabetic patient to get 1-3 dose depending on indication
Hepatitis B	Diabetic patient is recommended to get 3 dose according to CDC recommendation

 

Assumed childhood immunizations:

HepB, dTAP, HiB, PCV13, polio (IPV), MMR, Varicella, HepA, Meningococcal {MenACWY}, HPV (about 13-26)

Screening

Colon cancer screening:

According to USPSTF, American Cancer Society and American Academy of Family practice, both male and female starting ago 50 should be screened for colon cancer. If Mr. Khoury did not complete his colon screening, then he has 5 different modalities to choose from. For example, Flex. Sig. , Dbl-contrast BE and  CT Colonography are done every 5 years while annual FOB or FIT OR Stool DNA test done in every 3 years. However, colonoscopy is sometimes referred to as the gold standard as it is good for 10yrs. Regardless, there is no one method better than other so the patient can decide to perform any form of the screening.

Depression Screening:

According to the USPSTF, all age group would moderately benefit from depression screening. The patient currently suffers from moderate to severe depression controlled by medication. The provider would want to screen to check for the level of depression to determine if the medication needs to be upgraded or should continue the current dose.

Alcohol misuse:

Based on USPSTF, both men and women would get moderate benefit from screening for alcohol use. Even though the patient has no previous history of alcohol use, but the provider should make sure nothing has changed in the past few months course. If alcohol misuse can be detected early, then alcohol dependency can be avoided.

Obesity Screening:

According to the USPSTF, all ppl both men and women would get moderate benefit from screening for obesity regardless of the age. This patient is currently diabetic and has a sedentary life style that’s why obesity screening should be conducted. Additionally, “Obesity increases patient risk for heart disease, hypertension, type 2 diabetes, arthritis, and some cancers.” Since, obesity can lead to other detrimental issues, if it is detected early it can help to control before it becomes a problem.

Tobacco Use and cessation:

USPSTF recommends screening all age of male and female for tobacco use because tobacco can lead to other diseases.

Dyslipidemia/cholesterol screening:

Based on USPSTF, men 35 and older are strongly recommended to screen for lipid disorders because if the problem is detected early then the preventative therapy is very effective. Dyslipidemia increases the risk for Coronary Heart diseases and if it detected early then the damage can be controlled and abated through medical therapy.

Abnormal glucose/diabetes:

The USPSTF recommends screening for abnormal glucose and diabetes in both men and women over the age of 35 if they are overweight or obese. Mr. Khoury has a BMI of 26.5 which is overweight BMI also he has a history of type 2 diabetes. This screening will determine his glucose level currently, which can help to decide whether he should be on insulin or not. Additionally, based on his glucose level, the different preventative method can be discussed if the patient really opposes insulin intake.

Hypertension Screening:

The USPSTF suggests of conducting an annual screening for adult male older than 40 especially those with high blood pressure. Mr. Khoury is constantly having under 140/90 mm Hg with medication and he is overweight therefore he should be screened. This can also help the provider to determine if the medication need to alter or the dose needs to be upgraded.  In addition, he has a family history of Hypertension as his mother had hypertension and died at the age of 68 because of stroke. This family history makes it essential to screen for hypertension.

Hepatitis C Screening:

Based on the USPSTF, people born between 1945-65 should be screened and the patient age falls between this birth year so he should get screened.

Injury Prevention

Traffic safety:

Subway:

Mr. Khoury uses the subway to commute to work on the weekdays and there are accidents that can happen due to being careless. To avoid injury Mr. Khoury would be reminded not to stand on the edge of the track when the train is approaching, do not lean on the door, do not walk between the carts and do not go on the track for any reason.

Car:

When using a car, Mr. Khoury would be reminded of the importance of seat belt during riding care to prevent injury. In addition, the impact of alcohol/drug driving will be reiterated.

Bicycle:

Even though Mr. Khoury is not a bicycle rider, but it can be used as a form of exercise. If the patient ever decided to use this method of exercise then it is very important to wear the helmet

Firearm:

Even though the patient has no known history of a firearm, but it important to inform about the prevention method to avoid unwanted injuries. The firearm should be locked and placed in a safe place to avoid injuries.

 

Diet

It must be difficult to dedicate extra time to prepare breakfast, but it is a very important meal of the day. Mr. Khoury has a past medical history of type 2 diabetes, high blood pressure, and overweight issue; therefore, he must start healthy breakfast other than butter roll. Especially since the patient is resilient to start insulin, he must put the effort in changing his eating habit to control the sugar and blood pressure. For example, in the weekend he is mostly home which can be used to prepare breakfast for the weekdays. If he does not like preparing, then there are other easy healthy options such as:

• Cereal and milk, with fruits on the side. While buying cereal, he should consider ingredients like 100% whole grain, protein, high in fiber at least 3g per serving, less than 2g of saturated fat, l0g or less sugar, and less than 200mg of sodium.
• Yogurt and nuts: this can be combined with the cereal for other breakfast option.
• Scrambled eggs and toast- this can be bought from also outside even though the homemade one tends to be healthier
• Muffins- that are low in calories and sugar
• Bagel with thin spread nut butter
• Also, instead of the large coffee, maybe buy a medium coffee with no sugar.

For lunch, it will be best if he can eat homemade food but that’s not possible then there are options of choosing food with low salt and low calories. For soup, he can try some healthy options with ingredients high in protein and low in calories and carbohydrates. For example,

• Chicken and vegetable soup
• Lentil soup
• Bean soup
• Ginger carrot soup
• Broccoli- shedder soup
• Mushroom caraway soup, etc.

There is also healthy sandwich option that he should try out in an effort to control blood sugar. The patient can choose whole wheat bread for the sandwich and fill with meats that are healthy. For example:

• Lean beef
• Chicken and turkey breast without the skin
• Tuna
• Low-fat cheese
• Low-fat dressing, mayonnaise

If he really likes to have chips then he should choose chips that are low in calories, total fat, total carb. trans fats, sodium. Based on health and wealth website some of the healthy chips’ options are:

• Bare veggie chips – high in fiber and protein
• Saffron road baked lentil chips- high fiber, protein and little unsaturated fat
• Vegetable chips- high in vitamin A, C, D, E, B6

However, he must slowly cut down on the cookies from the office because they are filled with sugar, which might be impacting his glucometer reading. However, it must be difficult to give up all at once therefore maybe eat a cookie on alternate days.

For dinner, he can also choose to have low-fat calories meal. He can try rice and beans because healthy rice options are an excellent source of B vitamins, bone-building phosphorus, and magnesium. Some of the healthy rice options are: brown (jasmine or basmati), yellow, white. Wild, black, Wehani, sprouted rice. In addition, it contains extra proteins and fiber, which helps to control blood sugar level and lower cholesterol.

Exercise

Mr. Khoury does not perform the recommended exercise. CDC recommendation every adult to get at least 150 mins of moderate to intense exercise to stay healthy and maintain a healthy weight. Since the patient stays sedentary most of the day then he should take every opportunity to walk around in the office such as: walking to a colleague, going to the bathroom, drinking water and stretching the extremities. In addition, he only walks about two blocks in a typical day, so to increase activity, it would be recommended to get off the bus maybe a few stops earlier and walk home when weather permits. In addition, instead of taking the elevator or escalator, he should try to take stairs because climbing stairs is a form of exercise. However, if he feels shortness of breath, he should inform the provider. Additionally, he like to take his dogs on the walk, which could be done more often to increase the intensity of exercise. Mr. Khoury feels pain while walking the dog so maybe he can take his wife to hold the dog and experiment to see if he still experiences pain in the hand and shoulder. He can walk around the park with his wife during the summer time and even he can ride a bike if he desires. Furthermore, his involvement in the mosque can be influenced because this will make him active at the same time allow him to mingle with different group of people. Mr. Khoury thinks he is allergic to exercise, the idea that any exercise is better than none should be reinforced.

Harm Reduction

Here are some ways the patient can reduce current level of harming his health:

• Decaf coffee
• a medium coffee with little to no sugar
• Maybe try green tea
• Eat cookie on every other day

Brief Intervention:

Obesity

The patient is overweight, so he is at risk for obesity. To prevent obesity 5A’s of obesity management can be used to come up with a preventative method. The 5A’s are to ask permission to discuss weight. Asses health status and explore the reason for weight gain. Advise the patient about the health risk related to obesity and then agree on an appropriate weight loss plan. Finally, assist with the resources and identifying the barriers. The patient should lose weight in a steady pace as only 10% of body weight loss is recommended in a year because fast weight loss comes back within 5 years. It is important to emphasize the importance of slow and steady weight loss and diet& exercise can play a fundamental role in the maintenance and losing weight. Additionally, as a motivation factor, the patient should be informed about the benefits of 10-15% weight loss. These benefits are “decreased BP, blood glucose, blood LDL & triglycerides, sleep apnea, the risk of osteoarthritis of weight-bearing joints and risk of depression”. Furthermore, the low-glycemic diet has been most effective at preventing weight gain, but the patient should practice a diet plan that they can stick to.

 

Smoking Cessation/ Substance Use

The patient has no history of smoking cessation and substance use; therefore, the patient will be only asked about the uses in the past. However, there is no indication /need for intervention at this moment of time.

 

Sources:

https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/high-blood-pressure-in-adults-screening

https://www.everydayhealth.com/type-2-diabetes/diet/breakfast-ideas-for-diabetes/

https://www.tasteofhome.com/article/unhealthy-and-healthy-chips/

Recommended Adult Immunization – Unites States 2016

Adult preventive health care schedule: recommendations from USPSTF

Summary of Recommendations for Clinical Preventive Services

The HPDP class PowerPoints