Case Study Mr. T

The time is 1900 hours. You are working in a small, rural hospital. It has been snowing heavily all day, and the medical helicopters at the large regional medical center, 4 hours away by car (in good weather), have been grounded by the weather until morning. The roads are barely passable. WR., a 48 year old construction worker with a 36 pack year smoking history, is admitted to your floor with a diagnosis of rule out myocardial infarction (R/O MI). He has significant male pattern obesity (beer belly, large waist circumference) and a barrel chest, and he reports a dietary history of high fat food. His wife brought him to the ED after he complained of unrelieved indigestion. His

Over the past few decades, deficiencies of essential nutrients have drastically diminished, many infectious diseases have been reduced, and most of the U.S. population can now foresee a long and productive life. In the meantime, rates of chronic diseases hefty portion of which are identified with poor quality diet and physical activity has increased. About half of all American grown-up have one or more preventable, diet-related chronic diseases including cardiovascular disease or type 2 diabetes, and overweight and obesity.

As per Healthy People 2020 most Americans do not consume healthy diets and are not physically active at levels needed to maintain proper health. As a result of these behaviors the nation has experienced a dramatic increase in obesity in the U.S with 1 in 3 adults (34.0%) and 1 and 6 children and adolescents (16.2%) are obese. In addition to grave health consequences of being overweight and obese. It significantly raises medical cost and causes a great burden on the U.S medical care delivery system ("Healthy People 2020," 2014, p. 1).

Felicia Allen is a 32 year old woman, who was initially brought into therapy after an attempt to steal a bus. Due to her reported “emotionally disturbed” nature, this consult became a priority. The police report states that Ms. Allen pulled out a knife, and threatened the driver after the driver declined her dollar bills. She then took control of the bus, and crashed it across the street. Upon our meeting, Ms. Allen was fidgety, and swayed back and forth all the while mumbling to herself. If she were questioned, she would look up and say “Sorry, sorry.” As far as patient history goes, Ms. Allen started hearing voices when she was 5 years old. These auditory hallucinations were mostly composed of critical, disparaging voices that made comments on her actions and behaviors. Her severe symptoms led her to be hospitalized fairly consistently since she was 11. Ever since she was young, she has been driven to please, and has a strong desire to be independent. Felicia has been prescribed clozapine for 1 calendar year, which helped her auditory hallucinations a great deal. Given the above symptoms and information, I have diagnosed Felicia Allen with schizophrenia.

In order to identify a condition as a disease, it should fit certain criteria. One of the reasons that obesity is classified as a disease is because of its large comorbidity. Obesity is a risk factor for chronic diseases such as hypertension, dyslipidaemia, type 2 diabetes, cardiovascular disease, sleep apnoea, musculoskeletal disorders and some cancers (Rossner, 2002). According to Rossner (2002), the death rate from all causes, cardiovascular disease, cancer and other diseases increases among moderate and severe overweight men and women in all age groups. Therefore, obesity is

Today in the Western Hemisphere, many chronic health problems result from bad eating habits. There are a mix of people who are over-nourished, malnourished, or both. We eat chemically altered, high-fat toxic foods that do not provide a sufficient amount of essential vitamins and

After consultation with the client, a healthy diet will be the focus. The client is not overweight, exercises adequately and consistently, and is generally in very good health. The client reports eating ‘junk food’, not eating breakfast, and not getting the recommended daily servings of each food group as endorsed by the United States Department of Agriculture (USDA).

D.D. is a 50-year-old, African American male presenting with a number of anxiety and depressive symptoms. The client reports that he came to counseling for “extra support and someone to talk to.” D.D. has been struggling with mental health issues since he was young. Since the age of 15 he has been hospitalized on and off for “hearing voices.” In the early 1980’s he was diagnosed with schizophrenia and prescribed Risperdal to treat the symptoms. Since then, D.D. has been in a variety of mental health settings, including hospitals, day programs, and outpatient treatment. The client has an extensive alcohol and drug use history that he believes impacted his Schizophrenia. In the early 1980’s the client would use alcohol every day “to avoid the voices,” drinking “anything he could get his hands on.” He was also heavily involved with drugs at that time and regularly used marijuana, PCP, cocaine, and heroine. In 2000, the client was sentenced to eight years in jail for four bank robberies. While in jail, D.D. received mental health treatment and alcohol and drug treatment, which was greatly beneficial. When the client was released from jail in 2008, he was drug and alcohol free and was taken off of Risperdal.

At the present time, the patient has two of the risk factors for heart disease, genetic predisposition, and obesity. The first risk factor, genetic disposition, is non-modifiable, however, the second, obesity, is a modifiable risk factor. The nursing diagnosis that can be applied in this situation is imbalanced nutrition: more that body requirements, evidenced by weight is more than 20% over ideal for height and frame, triceps skinfold >25mm in women and, sedentary lifestyle. The desired outcome for this individual is to demonstrate a change in eating patterns to attain desirable body weight with optimal maintenance of health, as well as to initiate and maintain an individually appropriate exercise program. Nursing interventions for this client should be (1) determine client’s desire to lose weight, (2) review usual daily caloric intake and dietary choices, (3) establish a realistic weight-reduction plan with the client, (4) encourage client to maintain a food diary that includes when and where eating takes place and the circumstances and feelings around which the food was eaten, and (5) refer to dietitian or weight management program (Doenges, Moorhouse, & Murr,

N.G. was a 43-year-old Russian female who was admitted to Palomar’s Downtown Behavioral Unit (BHU) on Monday 10/10/16. The patient’s reason for admission was that she was brought in by the San Diego Police Department on a 5150. She was being held on a 72-hour psychiatric hold for being a danger to others where she was making threats to hurt her mom. She has had a long history of treatment for her Schizophrenia that she was diagnosed with as a child. When she arrived to the BHU she had symptoms of a mood disturbances, including decreased sleep, increased energy, agitation, anxiety, and aggression.

Obesity, the condition of being severely overweight, is a serious issue in the United States that is gradually beginning to affect more and more citizens. In recent years, the number of Americans suffering from this chronic disease has significantly increased. Researchers have found that nearly one third of the U.S. population is considered overweight and, on average, three hundred thousand individuals die yearly as a result of obesity (Hollands et al. 2). When one participates in little to no physical activity and their diet consists mostly of high fat foods, chances are they will gain weight. If someone becomes obese, they may develop serious health related issues that, in some cases,

Approximately 22% of the American population suffers from some kind of mental disorder at any given time. (Passer and Smith, 2004) Schizophrenia is one of the most serious of these mental disorders, and there are many different kinds of treatment. While all mental disorders offer diagnosis and treatment challenges, few are more challenging than schizophrenia. It is both bizarre and puzzling, and has been described as “one of the most challenging disorders to treat effectively.” (Passer and Smith, 2004, 534)

I was born to a father with the history of Diabetic mellitus and on my mother’s side; there is a history of High Blood Pressure. Although my father is not diabetic, my mother has been diagnosed with blood pressure. Blood pressure has been a steady disease in my household which has affected four out my five uncles. In 2010, after a seven year long battle with infertility, I was diagnosed with High Blood Pressure which I was given medication for and shortly thereafter, I had a son after my aggressive treatment. Ever since, I have always link most diseases with food intake and I strongly believe that my nutrition and my health work hand in hand. According to Grodner, Roth &Walkingshaw (2012),

It is imperative that community nutritionists and health-care providers recognize risk factors so that they can

Mr. Trosacks new diagnosis of Diabetes and Hypertension need to be addressed. There are many psychosocial issues with his new disabilities and diagnosis. These are important because he needs to be able to accept his disabilities and take care of his health, in order to avoid serious complications, heal and cope. It is clear that Mr. Trosack is having a difficult time accepting his new medical diagnosis as well as not being able to be independent. His comments about being able to handle it all himself at home but yet communicating his frustrations by having to take medications and not being able to get up and down the stairs speak volumes. Continued diabetic teaching may help him understand the importance of food choices and listening to his body’s signals of low or high blood sugar levels. Even after discharge from the rehab center Mr. Trosack should continue having a home health nurse in for periodic visits since it may be difficult to