Patient: Alexi Burr
Alexi Burr is a 34 year old woman with ulcerative proctitis, currently being treated with suppositories. She is not hypertensive, with a blood pressure of 122/68 and she has a BMI of 17, which is considered underweight. Based on her current active problems, past medical history, family history, and social history, I have developed a care plan that can cater to Mrs. Burr’s needs.
Health Promotion and Disease Prevention Concerns
Diet
Based on her history, Mrs. Burr had lost a significant amount of weight due to ulcerative proctitis. Currently, due to her busy schedule, she is unable to make proper meals for herself. She mainly eats fruits and vegetables, and eats little red meat. Her breakfast is small, consisting of a piece of toast with almond butter and a cup of coffee. Her dinners are inconsistent, ranging from home-cooked meals to take-out from a “healthier” food chain. Not only has she lost 20 lbs due to ulcerative proctitis and her BMI is indicative of being underweight, she has a past medical history of anorexia. Her history indicates that Mrs. Burr requires an improved diet regimen, that can help her gain weight back and maintain a healthier lifestyle.
My recommendation for Mrs. Burr to maintain a healthy diet, considering her busy schedule and lifestyle, would be to implement meal-planning in her weekly routine. By setting aside some time one day a week, Mrs. Burr can have healthy, well-balanced meals ready for her to grab on-the-go. In addition to the meal recommendations, I would refer her to a dietitian and provide her with information on healthy ways to gain weight.
BREAKFAST
Currently, Mrs. Burr’s breakfast consists of a single piece of toast with almond butter and a cup of coffee. This breakfast is lacking in nutrients and is approximately 270 calories, which isn’t enough to maintain a healthy weight (Food Calculator: Carbs, Calories, Fat, Protein and More, n.d.).
Considering that the almond butter on her toast provides a source of healthy fat and protein, a simple modification to her breakfast would be to eat a bowl of oat-bran cereal with milk along with her toast and coffee. This way, she can increase her fiber and calcium intake, which is beneficial to attain a healthy BMI. Another substitution I would recommend is switching almond butter for eggs, for added protein.
Another easy breakfast option I would recommend is making over-night oats, with chia seeds, a plant-based milk, and fruits for added protein, carbohydrates, and healthy fats. This is a fast breakfast that can be made the night before, and will be ready to grab on the way to work on those busy mornings.
LUNCH
Currently, Mrs. Burr mostly eats salads bought from her university’s cafeteria for lunch. She also tends to eat more fruits and vegetables. Although salads are a great healthy option for lunch, depending on the type of salad she eats, she may not be receiving a sufficient amount of nutrients. For lunch, I recommend Mrs. Burr meal prep taco salads. These salads can include brown rice, grilled chicken, beans (of her choice), romaine lettuce, tomatoes, corn, cilantro, peppers, and homemade guacamole. This ready-made lunch ensures that Mrs. Burr receives an adequate amount of fiber, carbohydrates, protein, and healthy fats, which can help her gain and maintain a healthy BMI.
DINNER
According to her history, Mrs. Burr’s dinners are inconsistent and can be a mix of home-cooked meals and take-out due to her busy schedule. For the weeks where her husband is unavailable to make dinner for the family, I recommend marinating salmon with spices, ginger and low-sodium soy sauce ahead of time and keeping it in the freezer. She can also make brown rice and steamed vegetables earlier in the week and keep it in the fridge to use for dinners for herself and her family. The pre-marinated salmon is an easy dinner option, since salmon will take approximately 20 minutes to bake in the oven. A dinner of salmon, brown rice and steamed vegetables is nutritionally balanced, and promotes a healthier BMI.
Exercise
In addition to a diet plan, I would recommend an exercise regimen for Mrs. Burr, to promote a healthier lifestyle. Currently, she states that walking across campus and standing while giving lectures is her exercise. However, she can benefit from aerobic exercise to increase her heart rate. Due to her busy schedule, I would recommend simple exercises such as walking briskly around the block after dinner to increase her heart rate. I would also recommend lifting 5-10 lb weights for 20 minutes two days a week, to help build her strength. This exercise regimen is not for weight loss, but for increasing strength and leading a healthier lifestyle.
Screening
The next issue that I would like to tackle with Mrs. Burr is screening. Based on her history, Mrs. Burr has been diagnosed with ulcerative proctitis. According to the World Journal of Gastroenterology, “the risk of colorectal cancer for any patient with ulcerative colitis is known to be elevated, and is estimated to be 2% after 10 years, 8% after 20 years, and 18% after 30 years of disease” (Lakatos, 2008). Because of these statistics, I would discuss with Mrs. Burr, the importance of colon cancer screening, and may recommend that she start receiving colonoscopies at an earlier age than 50, which is what USPSTF would normally recommend. This is because, due to her current illness, Mrs. Burr may be at an increased risk for colorectal cancer and it is beneficial for her health to be screened sooner than later.
Additionally, Mrs. Burr has a family history of breast cancer. According to the USPSTF, under normal conditions, women can choose to receive a mammogram every two years between the age 40-49, and must receive a mammogram every two years from age 50-74 (Recommendation: Breast Cancer Screening: United States Preventative Services Taskforce, 2016). However, if the patient has a family history of breast cancer, then the patient should begin receiving mammograms 10 years prior to the earliest diagnosis in the family (Breast Cancer Screening Guidelines, n.d.). Based on the history provided, I do not know when Mrs. Burr’s aunt was diagnosed with breast cancer, but considering that she died at the age of 65, I would recommend that Mrs. Burr should start getting screened for breast cancer.
Injury Prevention
Based on her history, Mrs. Burr has up to four glasses of wine every week. Although I do not feel that this constitutes as alcoholism, I do commend her for having a designated driver to take her home when she is under the influence of alcohol. I would encourage her to continue doing so, as it is for her best interest and safety, as well as the safety of those on the road (Gardner, 2007).
Immunizations
Finally, because it is November, I would recommend her to get her influenza vaccine and would even offer to give her one in the office. Based on whether or not she received her Tdap booster within 10 years ago, I would offer her that as well (Immunization Schedules, 2020).
Works Cited
Breast Cancer Screening Guidelines. (n.d.). Retrieved November 05, 2020, from
guidelines-breast
Food Calculator: Carbs, Calories, Fat, Protein and More. (n.d.). Retrieved November 12, 2020,
from https://www.webmd.com/diet/healthtool-food-calorie-counter
Gardner, H. (2007, January 01). Office-Based Counseling for Unintentional Injury Prevention.
Retrieved November 12, 2020, from
Immunization Schedules. (2020, February 03). Retrieved November 12, 2020, from
Lakatos, P., & Lakatos, L. (2008, July 7). Risk for colorectal cancer in ulcerative colitis:
Changes, causes and management strategies. Retrieved November 05, 2020, from
Recommendation: Breast Cancer: Screening: United States Preventive Services Taskforce.
(2016, January 11). Retrieved November 05, 2020, from
screening
