Angelika Dabu
Health Promotion and Disease Prevention
Professor Shami
Case Study— John Liou
Immunizations
John has not received any vaccinations since his last tetanus vaccination ten years ago. Therefore, a titer test should be ordered. John should receive the following vaccines:
- Influenza inactivated (IIV) or Influenza recombinant (RIV), 1 dose
- Td booster, 1 dose
- Zoster recombinant (RZV), 2 doses (preferred) or Zoster live (ZVL), 1 dose
- Pneumococcal polysaccharide (PPSV23), 1 dose or Pneumococcal conjugate (PCV13), 1 dose
Screening
John should be screened for the following:
- Tobacco use and cessation screening as he is a smoker
- Lung cancer screening with low-dose CT as he has an 80-pack-year history
- Abdominal aortic aneurysm screening via ultrasound as he is at increased risk being a smoker
- Blood pressure screening as he has a history of hypertension
- Cardiovascular disease screening as he is at risk being a smoker
- Diabetes screening as he is overweight and Asian and thus at risk
- Cholesterol screening with blood test/lipid panel as he is older, male and overweight thus at risk
- Obesity screening
- Alcohol use screening
- Depression screening
- Discuss colorectal cancer screening with colonoscopy if more than 10 years since last, taking into account his age (cut off age of 75), overall health and history
Injury Prevention
- Falls prevention — install ramps around the house if possible and use of a walker or cane as John is having trouble with his gait after recently being diagnosed with Parkinson’s disease.
- Traffic safety — use of seat belts.
Diet
Since John has a history of hypertension and GERD as well as a BMI indicating that he is overweight, the following diet plan detailing healthy eating patterns is recommended.
- Increase consumption of fruits, such as watermelon, berries and apples, and vegetables, such as broccoli, brussel sprouts, spinach, and carrots, to recommended 5 servings
- Decrease sodium consumption as sodium may increase John’s risk of heart disease
- Sodium is also linked to high blood pressure which he has a history of
- Try smaller portions of meals containing sodium
- Speak to John’s wife concerning the amount of sodium in his meals
- Decrease sugar consumption
- Natural sugar from fruits better than sugar consumed in sweets
- Have sweets as a treat rather than a routine after meals
- Limit red and processed meats
- Consume lean cut, low-fat or fat-free meats, chicken and turkey breast to limit undesirable fats
- Increase consumption of poultry such as chicken with the skin removed, fish such as grilled salmon, seafood, such as shrimp, and soy, such as tofu
- Increase fiber, vitamin A, vitamin C, calcium and potassium to help John feel stronger and healthier
- Low-fat diet as eating too much fat can contribute to and increase the risk of heart disease, high blood pressure, cancers, high cholesterol, obesity and type 2 diabetes
- Increase calcium consumption, eat tofu, salmon vegetables (dark leafy greens such as collards and turnip greens)
- Avoid high fat foods (saturated and trans fats), non-citrus fruits such as bananas, melon, apples and pear
- Consume complex carbohydrates such as whole grains
Exercise
John is not getting adequate exercise, as he as he is generally de-conditioned and sedentary having difficulty walking and tripping due to his diagnosis of Parkinson’s disease. The following exercise plan is recommended as increased physical activity, even light intensity activities, can help with hypertension and improve gait and balance.
- Walking slowly with a cane or a walker
- Stretching
- Stationary bicycle
- Dancing with his wife
- Physical therapy exercises
Harm Reduction
Since John has a significant 80-pack-year history and is considered overweight, the following harm reductions measures are recommended.
- Replacement of tobacco with smokeless nicotine alternatives
- Nicotine replacement therapy (NRT)
- Gum
- Patch
- Oral inhalers
- Nasal sprays
- Lozenges
- Encouragement of healthy food choices
Brief Intervention
Since John has significant history of smoking cigarettes and has had some success in being able to cut down, I would conduct brief intervention for smoking cessation.
- Motivational Interviewing through OARS
- Open-ended questions
- How do you think your continued smoking will affect your ability to interact with your grandchildren and your ability to continue to maintain your house and property?
- Tell me about what smoking does for you.
- How were you able to initially start cutting down?
- Affirmations
- I really admire your successful effort to cut down on smoking. It is great that you have been able to cut down to 1 pack a day.
- Reflections
- It seems really important for you to have the energy and strength to keep living in your home.
- Summaries
- It sounds like you are concerned about how your smoking may be affecting your ability to maintain your home and continue living there. That is a really important value to you, it seems, and I really admire that.
- Open-ended questions
- Brief Intervention through the 5 As
- Ask — How many cigarettes would you say you smoke daily?
- Advise — Is it all right if we discuss some options for nicotine replacement therapy?
- Assess — How ready are you to cut down again and maybe even attempt to quit smoking?
- Agree — As per our conversation, we will try lozenges as a nicotine replacement therapy starting next Monday.
- Arrange — I will call you in one week to check in and then see you for a follow-up appointment in two weeks.
Since John is also considered overweight, I would conduct brief intervention for healthful diet and physical activity for cardiovascular disease prevention. I also would assess if his ten pound weight loss was intentional or not.
- Brief Intervention through the 5 As
- Ask — Is it all right if we talk about weight and physical activity?
- Advise — Since having the energy and strength to continue living at home is an important value for you, some small changes to your diet and exercise will help to make that possible.
- Assess — Do you think you are ready to reduce the the amount of sweets you eat and start some muscle strengthening exercises?
- Agree — I like the alternative we agreed on to replace sweets with fruits to reduce your sugar consumption and the dance class you will take once a week with your wife.
- Arrange — I will see you in six weeks to follow up and see how you are doing.
Issues to be Addressed First
- Falls prevention
- Immunization and screening
- Smoking cessation
- Physical activity
- Diet/nutrition
References
HPDP Introduction PowerPoint, Professor Shami
Motivational Interviewing PowerPoint, Professor Shami
Helping Patients Make Healthy Eating Choices. City Health Information. The New York City Department of Health and Mental Hygiene. Volume 34 (2015). No. 7; 54-60.
Using the Nutrition Facts Label: A How-To Guide for Older Adults. FDA 1-13.
Nutrition PowerPoint, Professor Shami
Writing an Exercise Prescription PowerPoint, Professor Shami
Preventing Cardiovascular Diseases PowerPoint, Professor Shami
Helping Patients Quit Smoking PowerPoint, Professor Shami
Maxine A. Papadakis, Stephen J. McPhee, Michael W. Rabow. Current Medical Diagnosis and Treatment 2020 > Prevention of Cardiovascular Disease. Table 1–3.Expert recommendations for cardiovascular risk prevention methods: US Preventive Services Task Force (USPSTF).
Vallis, Michael, Piccinini-Vallis, Helena, Sharma, Arya M., Freedhoff, Yoni. Modified 5 As: Minimal intervention for obesity counseling in primary care. Canadian Family Physician. January 2013. Vol 59. 27-31.
