PATIENT: DAMIEN JACKSON (33 YO MALE)

Immunizations

• flu
• Tdap
• MMR
• varicella

Screening

• alcohol abuse
• tobacco use
• depression
• HTN
• HIV
• CVD – Mr. Jackson is overweight with a BMI of 28.7, and also has other risk factors for CVD (namely tobacco use and HTN).

Health Promotion/Disease Prevention Concerns – please address all that are relevant for this patient:

• Injury Prevention That Should Be Discussed
  • Traffic Safety
  • Water Safety
  • Make sure he is lifting objects correctly at work.
• Diet Recommendations
  • Mr. Jackson drinks a gallon of full fat milk every day and falsely believes this is a healthy behavior.
    • advise switching to low-fat or fat free milk
    • advise Mr. Jackson to try limiting his milk consumption to a single 8 ounce glass per day
  • He claims to eat a lot of meat.
    • advise limiting red meat consumption
    • switch any red meats he would eat for chicken and other lean meats
    • avoid too much seafood, as that can aggravate gout – still, seafood is a better option than red meat and will have cardioprotective effects
  • Mr. Jackson acknowledges that he has a lot of sugary drinks, snacks, pastries, and cakes.
    • advise limiting sugary drinks to when he goes out or during special occasions – warn of its negative effects on gout
    • keep track of his desserts and limit them to once a day (maybe after dinner)
    • switch out his go-to snacks for healthier alternatives – like carrots and hummus
    • encourage ordering a side of salad at restaurants
    • make a shopping list with your wife before leaving the house – that will remind you to pick up fruits and vegetables
• Exercise Recommendations
  • patient is not getting the recommended weekly amount of exercise (150 mins/week of moderate-intensity activity)
  • take a walk after dinner every day
  • plan hiking trips and other outdoor activities for the family
  • ask around the church – maybe other community members will be interested in organizing basketball games
• Harm Reduction
  • warn against the dangers of cigar use – a large cigar can contain the same amount of tobacco as a pack of cigarettes
    • explore willingness to cut down/quit cigar usage
    • explore willingness to use nicotine alternatives

Brief Intervention – where relevant to your chosen patient, please explain how you would conduct a brief intervention for:

• Obesity
  • educate Mr. Jackson about the negative effects excess weight has on CVD, gout control, and exercise tolerance
  • talk about the nutritional and exercise recommendations mentioned above
  • talk about going on a diet with a long-term goal of losing 10-20 pounds
• Smoking Cessation
  • refer to counseling
  • talk about nicotine replacement therapy (gums, patches, etc.)
  • talk about medication (varenicline, bupropion)
• for both of the interventions above, we can use the 5 As intervention strategy. Example questions/statements are below.
  • Ask
    • Obesity: Can we talk about your weight?
    • Tobacco: Are you concerned about the effects of smoking on your health?
  • Assess
    • Obesity: Are there any activities that you can no longer participate in due to being overweight? 
    • Tobacco: How willing are you to quit at this time?
  • Advise
    • Obesity: What strategies can we implement to help you lose weight?
    • Tobacco: Tobacco use makes it harder to control your hypertension.
  • Agree
    • Obesity: Can you agree to go on a diet and limit caloric intake to 1800 calories per day?
    • Tobacco: Can you agree to limit cigar use to twice a week?
  • Assist
    • Obesity: Let’s meet again in 2 months and assess how you’re doing.
    • Tobacco: I’ll refer you to a counselor who works with people trying to quit smoking.