Immunizations:

 

-Influenza

-Verify MMR & Varicella in childhood

 

Screening:

 

-Breast Cancer: Alexi’s maternal grandmother and maternal aunt had breast cancer, however, there is insufficient information provided related to whether or not they had the BRCA gene specificallyà hold off on screening because of age

 

-Alcohol misuse

 

-Depression

 

-Hypertension

 

-Obesity

 

-Tobacco use & cessation

 

-HIV infection

 

-Intimate Partner Violence

 

-Cervical Cancer: if she has not received a pap smear in the past 3 years, or in the past 5 years a “combo” option of pap smear + HPV screening

 

-Colorectal Screening: colonoscopy method is recommended because she is at an increased risk due to ulcerative proctitis

 

Injury Prevention:

 

1) Traffic Safety

 

1. a) Infants: currently approved child safety restraints, infant care safety seat should be rear-facing in the back seat (never in the front seat if there is a passenger-side air bag), infants should never be left unattended in an automobile, important for parents to use their own seat belts as well.

 

1. b) Preschool Aged Children: toddlers should be placed in a forward-facing car safety seat once they reach 1 year & 20 pounds, best to remain rear-facing until they reach the highest weight/height allowed in that position by the car safety seat, should always ride in the back seat, important for parents to use their own seat belts as well, never leave young children unsupervised in/around cars, be mindful of driveways and streets as they are particularly dangerous places for children to play, begin supervised pedestrian safety at this age: preschool children are not ready to cross the street alone, children must be watched closely when near driveways/streets, use of an appropriate bicycle helmet when riding tricycle of bike with training wheels.

 

2) Burn Prevention

 

1. a) Infants: smoke alarms in the home should be installed and maintained, hot water temperature should be set at a maximum of 120 degrees F to avoid scald burns, advise parents not to carry the infant and hot liquids/foods at the same time, milk and formula should not be heated in the microwave (can heat unevenly, causing pockets of liquid hot enough to scald the infant’s mouth), electrical outlets should be covered with devices that will not pose a choking hazard.

 

1. b) Preschool Aged Children: smoke alarm batteries should be checked regularly, children should be kept away from hot oven doors, irons, wall heaters, and grills, advise parents to keep hot food and coffee out of the reach of young children, cover electrical outlets.

 

3) Fall Prevention

 

1. a) Infants: window and stairway guards/gates are necessary to prevent falls from heights, infant walkers should not be used, infants should never be left alone on any furniture (changing tables, beds, sofas, etc.)

 

1. b) Preschool Aged Children: toddlers learning to walk/climb need to be protected from stairways, open windows, and heavy furniture that could topple over.

 

4) Choking Prevention

 

1. a) Infants: small parts/objects can pose a choking hazard to young children, round/cylindrical and compressible objects and foods can pose life-threatening risks of airway obstruction, balloons pose a similar risk for young children, to avoid the risk of strangulation parents should be advised to avoid clothes/toys with long strings and cords and cut looped blind/drapery cords, suffocation may occur from entrapment in unsafe crib environments and access to waterbeds or plastic bags, parents should be aware of hazards in any home where an infant spends time.

 

5) Drowning Prevention

 

1. a) Infants: very young infants drown most commonly in bathtubs and buckets while unsupervised, advise parents never to leave infants or young children in the bathtub or around other bodies of water without constant adult supervision, advise them to empty and properly store buckets immediately after use, parents should be reminded that the infant bath seats or supporting rings are not a substitute for adult supervision.

 

1. b) Preschool Aged Children: backyard swimming pools or spas need to be completely fenced on 4 sides to separate them from the house and yard, the fence should have a self-closing self-latching gate, the gate should open away from the pool and should be checked often to ensure that it is in good working order, children younger than 5 years should swim only with close adult “touch” supervision.

 

6) Safe Sleep Environment

 

1. a) Infants: infants should be placed for sleep in a supine position in a crib that conforms to current safety standards, infants should not be put to sleep on soft surfaces such as waterbeds or sofas, avoid soft materials in the infant’s sleep environment, if bumper pads are used, they should be removed when the infant begins to stand, never leave the crib sides down when the infant is in the crib.

 

7) Cardiopulmonary Resuscitation

 

1. a) Infants: important that parents become trained in infant and child cardiopulmonary resuscitation and learn how to access their local emergency medical service (i.e. 911).

 

8) Poison Prevention

 

1. b) Preschool Aged Children: medicines and household products should be kept out of the sight and reach of children and locked up whenever possible, these items should be purchased and kept in original childproof containers or blister packs, discard Ipecac if it is still present in the home, keep the poison control telephone number handy (1-800-222-1222).

 

9) Firearm Safety

 

1. a) Preschool Aged Children: because of dangers of in-home firearms (i.e. handguns) parents should be advised to keep handguns out of places where children live and play, if parents choose to keep a firearm in the home, the unloaded gun/ammunition must be kept in a separate locked cabinet.

 

Diet:

 

1. Dietary Issues
   1. Anorexia Nervosa
      1. In terms of the anorexia, currently Alexi’s diet is mostly well balanced. The main concern here is to make sure that she makes enough time to continue to eat as she has been. As noted in the prompt, she chooses healthy food to eat including fruits, vegetables, little red meat, and no fried foods. As long as she continues to eat well-balanced meals 3x a day and does not skip any meals, there is less concern for her to return to her anorexic state. Currently her BMI is normal, but since there is a significant PMH of anorexia, it might be advised that Alexi add snacks throughout the day to her diet. Alexi can even add things that are small like granola bars, crackers, or other smaller items that can fit into her bag. In this way, it will be easier for her to snack throughout the day, whether it is on her way to work or possible in between teaching lectures.
   2. Ulcerative Proctitis
      1. It is important to highlight the foods that are problematic for those with ulcerative proctitis. Alcohol, caffeine, dried fruits, meat, and raw fruits/vegetables are not the best for consumption. On the other hand, foods that are high calorie, low fat, low fiber, and low salt are beneficial for those with ulcerative proctitis. Therefore, when choosing which snacks to add to her diet or even foods that are part of the 3 meals, Alexi should keep this in mind as it relates to her current medical history. Having the knowledge of what foods are best for her to eat/not to eat will ensure that Alexi does not consume anything that will be harmful to her because of the PMH of the proctitis.

Exercise

 

According to CDC, current guidelines suggest that adults should be performing 150 min/week of moderate intensity exercise or 75 min/week of vigorous intensity exercise. Adults should also be performing muscle strengthening exercises 2x a week. Based on this information, the current plan for Alexi is to improve her exercise regimen. Despite her busy schedule, it is important for Alexi to try and incorporate something even as small as walks, especially since she is sitting for a prolonged period of time. Alexi can also try to make time for muscle strengthening throughout the week by doing push-ups or sit-ups. Although it might seem difficult and that she does not have enough time, it is important for Alexi to try and incorporate even a little bit of exercise into her daily schedule. Walking from one end of campus to the other is definitely a start, but she should seek out other opportunities to build up her exercise regimen. Even a little every day can certainly help her blow off steam from the stress that is present in her life, but it can also ultimately inspire Alexi to return to her previous formal exercise program. Once she remembers how much she enjoys the exercise she will hopefully find the time to incorporate it into her schedule.

 

Harm Reduction

 

Since anorexia is a past medical problem of Alexi’s, it is in her best interest to make sure she stays in the normal weight range for her height, as she is located in right now. Losing more than 5 pounds would put her under the normal range of BMI. Alexi has made it clear that it is difficult to keep up with her diet as she feels she does not have time to focus on her own meals. However, it is highly important that she maintains her own health first and foremost. Only in doing so can she ensure that her children’s health is taken care of as well. This requires a conscious effort on Alexi’s part to remember to eat, with the knowledge that if she takes care of her own health she will be able to better take care of her loved ones.

 

Brief Intervention

 

Although Alexi doesn’t display signs of substance abuse, I would still offer her a brief intervention regarding alcohol consumption. Alexi admitted to drinking enough to the point where it is unsafe for her to drive which presents as concerning. Using the AUDIT interview, I would assess whether or not Alexi’s drinking is actually problematic. I would first ask how often she has a drink containing alcohol, how many drinks containing alcohol she has on a typical day when drinking, and how often she has six or more drinks on one occasion. If the score on these first 3 questions equals a “3” or more, then I would continue to ask the remaining questions in order to assess the degree of intensity we are dealing with (i.e. if Alexi only needs alcohol education, simple advice, simple advice + brief counseling and monitoring, or a referral to a specialist for diagnostic evaluation/treatment)

 

Diet should be definitely be addressed first with Alexi as it directly relates to her past medical history of both anorexia and proctitis. The main concern as mentioned earlier is keeping Alexi’s weight in check. Alexi must be able to accurately monitor her diet and ensure that she does not fall under 95 lbs, as that will leave her with an underweight BMI.

 

References

 

• Pediatrics on Office Counseling on Prevention of Injuries (AAPA)
• Preventing Sexually Transmitted Infections (CHI)
• Adult Screening 2016 (USPSTF)
• Adult Immunization Schedule 2016 (CDC)
• https://www.medicinenet.com/ulcerative_colitis_diet/article.htm
• https://www.anred.com/hltheat.html
• https://www.cdc.gov/cancer/dcpc/prevention/policies_practices/physical_activity/guidelines.htm
• https://www.everydayhealth.com/hs/ulcerative-colitis-treatment-management/colorectal-cancer-screening/