Patient Hx:

35-year-old woman who had lost her wife to breast cancer about a year ago. Pt has a 5-year-old son and lives with him in an apartment. A few months ago, the pt presented with complaints of constant tiredness which appeared to stem from grieving the passing of her spouse as well as experiencing inadequate sleep. The pt claimed to have lost 15 pounds and experienced decreased appetite. The patient’s personal complaints also included weakness and worry about being unable to care for her son.

 

Plan from last visit:

Pt was prescribed an anti-depressant and a support group for recently bereaved single parents was recommended.

 

Present presentation:

Pt is still grieving but reports feeling much better. Pt’s sleep has also improved and is fairly regular. Pt complains of feeling out of shape and is seeking guidance on how to improve her diet and regain her strength.

 

Barriers to diet and physical activity changes:

-The deceased spouse was the primary cook for the household and the pt now worries she may be out of practice with cooking.

– Pt is Filipino and enjoys the traditional cuisine but does not know how to cook the foods. Pt wants to ensure that she is preparing healthy foods for her son.

-Pt complains that she is unable to find healthier cereal choices in her local store.

-Pt previously took up running but has been unable to return to it ever since the passing of her spouse.

 

Medical notes to consider:

-Pt’s BMI is 18 which is slightly below a normal body weight.

-Fhx of diabetes

-Pt has a slightly low blood pressure

 

My responses (Patient-centered care)

 -I would first commend the patient for her resilience and her perseverance to care herself and her child despite the passing of a loved one.

-I would also commend patient for her recognition for the need for a healthful diet and her efforts to avoid high sugar foods as well as her determination to ensure and give her child healthier food options.

 

Dietary changes I would suggest:

– I would first address the patient’s dietary barriers. I would suggest that if it is possible that Amy consider buying her groceries from a different (maybe bigger) grocery store that may have more food varieties so she can find cereals that contain less sugar. I would also suggest she consider buying some of her non-perishable food items in bulk and storing them in a pantry

 

-As Amy is Filipino and enjoys her traditional cuisine, I would recommend either purchasing a cookbook or reaching out to family members (like her mum) for recipes so she can prepare the foods herself. Cooking again may help Amy brush up her cooking skills and would allow her be able to modify her foods to healthier options by using healthy cooking methods (like baking or grilling as opposed to frying) and healthier food choices (like cooking more vegetable based meals and reducing red meat use when possible.)

 

-In regard to her current diet I would suggest that with her foods Amy consider using low fat milk, and dairy products with her cereals and breakfast foods. She is already doing a good job including a fruit with her cereals and I would recommend just alternating the fruits she and her son eat so she has more varied nutrient intake. (I would also recommend that Amy aim for eating about 5 servings of fruit and vegetables a day- and eating various types of fruits and veggies.) I would also recommend a glass of water with each of her meals and avoiding sugary drinks.

 

-For Lunch it appears Amy does not eat enough. I think she does well to eat a salad when she does, but I would recommend that she have a full meal to accompany her salads. Maybe a plate of vegetables and a protein food (e.g. can eat chicken, and vegetable stir-fry with rice.) I would also recommend avoiding eating pizza so often. Maybe if she can cut it down to no more than 1-2 slices a week a to begin with.

 

-For dinner I would recommend that the home cooked leftovers Amy’s mum prepares be used to create a meal plan for the week or however long it would last. I would also recommend that if eating out that Amy should opt for healthier food options i.e. salads, meals that come with a serving of vegetables, a serving of grains and proteins such as fish, other seafood, chicken etc. as opposed to greasy and very fatty foods like burgers etc. The rice, beans and soup sound like good options to continue but I would recommend cutting back on the bread with the meals. I also think Amy should continue her habit of giving her son fruits for deserts.

 

-For her low blood pressure, I would recommend that Amy slightly increase her daily salt intake for a week to see if that helps, but she should not consume above the level of 2300mg which is the limit for Americans based on the healthy eating plate recommendations.

 

-As a way to ensure a healthful eating pattern for Amy I would also recommend the Mediterranean diet to Amy. Since Amy is at a lower risk for diabetes (has a Fhx of diabetes but is overall healthy -with the exception of the low BP- and is not overweight.) The diet entails eating foods rich in omega 3 fatty acids, dietary fiber, seafoods, fish, nuts, fruits and vegetables, cooking with olive oil and consuming standard red wine intake (no more than 1 glass a day for women) and lastly limiting red and process meat consumption. A diet such as this may be beneficial for Amy.

 

 

Exercise Recommendations:

-It is clear that Amy cares very much for her son and I think a good way for her to increase her physical activity is too also engage in games and maybe sports activities with her son like swimming. She is fairly physically active since she does a lot of walking but maybe adding the activities with her child can help her be more active.

 

-Since running has been hard for her since the passing of her spouse, I would suggest that Amy can also engage in other sport activities which she enjoyed such as soccer.

 

-Overall since Amy is mostly sedentary at work it is important; she engage in more physical activity to help maintain her muscle tone and over all well-being. I would recommend that she begin at the recommendation for moderate aerobic physical activity of 30 minutes for 5 days a week or a total of 150 minutes a week. Since she had listed strengthening as one of her goals, she can do this in addition to any muscle strengthening exercise of her choice (e.g. resistance band exercises) for twice a week.

 

Final thoughts:

-I think Amy is on a good track to getting back to her old self.

-I think mental health and self-care is also very important for being one’s best self. I would recommend that Amy keep seeking support as necessary whether through counselling or the group.

-I would also recommend sleep hygiene practices to help Amy improve her sleep (e.g. avoiding bright lights and activity before bed etc.)

-I would also recommend the My Plate as a resource for her to keep track of what she is eating and to help guide her food choices and servings.

-In a real-life situation, this would be a lot of overwhelming information to throw at someone. So, although these would be my recommendations, realistically I would suggest them all to Amy and work with her to see which as of these are more realistic changes for her, and then set SMART goals for her to achieve those which she sees as attainable.

 

Please note: The patient is a fictional character used to practice clinical reasoning skills.

Sources:

http://www.cdc.gov/physicalactivity/everyone/guidelines/adults.html

https://www.cdc.gov/physicalactivity/downloads/pa_examples.pdf

https://www.dietaryguidelines.gov/sites/default/files/2019-05/2015-2020_Dietary_Guidelines.pdf