Question

Obesity and Chronic Disease

Background: You are a community health nurse staffing a free public health clinic in the South Bronx. Your role is to triage each patient, prioritizing his/her health needs and designing a health education program to meet these needs. Because the clinic’s resources are limited, assume that the bulk of your health education will be based on discussion and demonstration, rather than the provision of medications or materials.

For each of the following patients, please (1) Identify the top three priority health interventions you believe need to be addressed; (2) Design a health education program for the highest priority intervention; and (3) Describe a public health or legislative action you would advocate for to improve this patient’s highest priority health problem.

Patient A: Shelby Norman

Age: 38

Height: 5’6”

Weight: 224

B/P: 158/102

Presenting complaint: Numbness & tingling in extremities

Shelby is a divorced African-American female with full custody of her two sons, ages 7 and 9. She is employed by an office janitorial service, where she works 3 nights per week, and by a temp agency, for whom she works 2-3 days per week. It is the policy of both companies not to employ individuals full-time in order to avoid providing benefits. Shelby and her sons live in a 3^rd-floor apartment. The elevator often does not work; the stairwells are poorly lit and often filled with noisy groups. The nearest subway stop is 5 blocks away; the bus stop is 2 blocks away. There is a supermarket 12 blocks away. There is a McDonald’s, a KFC, a Wendy’s, and a deli within 1 block. There is also a corner convenience store. The boys walk to and from school. On the days that Shelly works, they are home by themselves after school. Shelby tells you that she is “exhausted all the time and barely feels like moving;” she is hopeless that things will improve, and worried for her sons’ safety.

Patient B: Nick Blessing

Age: 27

Height: 6’1”

Weight: 317

B/P: 142/96

Presenting complaint: Depression and anxiety

Nick is a single Latino male who is a non-custodial parent of a 1-year old daughter. He has been unemployed for 20 months since losing his job at a construction site that shut down. He is worried that his unemployment benefits will run out before he can find a new job, but there don’t seem to be many opportunities available for him and he doesn’t want to leave his daughter. Although he is the non-custodial parent, he often cares for his daughter due to the mother’s struggle with substance abuse. He is not named on the Birth Certificate and worries that his daughter will be placed in foster care. His mother lives nearby and, although she is in poor health, is a good emotional support for Nick. Nick eats almost exclusively at one of the many fast food restaurants on his block, as the nearest grocery store is 10 blocks away and he has no desire or energy to prepare meals. He states that he “feels like sleeping all day, but can’t fall asleep at night.” He feels like he has no purpose in life.

Answer 1

Patient a: shelby Norman

1, when there is high blood pressure if you have numbness and tingling sensation you must meet the doctor.

- patient must reduce the weight

- patient stress should be concerned

2, -Advice the patient about hypertension and its symptoms.

- Advice her about fast food and it's high risk..

- advice about diet followup

- advice about weight loss management.

- advice her contact management people about her job..

3, policy makers should concern about job security.

- poor housing condition associated with poor health condition..so public health practitioners should address an important social determinant of health

- facilities should be concerned and regulate by human resources management for safety, nutrition, multi facilities, security etc..

Patient b, Nick blessing

1, - job security should be concerned..

- wife should be treated in drug addiction center..

- health concern on avoiding fast food, and regular exercise can reduce his weight..

2, - though his mother is supportive in his daily life, there may be supportive intervention to deal with anxiety and depression

- explain about his fast food practice and it's high risk

- advice to meet psychologist in drug addiction center for his wife

- advice him to try for another job that may be supportive and avoid his laziness in the day time..

- educate him regular exercise and it's benefit

- advice him to go for counseling to avoid his loneliness and depression

3, - policy makers have responsible for reforms and meet the needs to improve labour markets and bring unemployment back..

- facility management professional and stakeholders must help in involved multi unit residential facilities in location..