Looks like plan

Mrs White• Interview• Scenario• Life Stage• Assessment of present health status• Physical Measures• Summary of factors and expected benefits of improvement• SMART Targets – long and short term• Justification of plan: how will this plan meet her needs?

Mrs White - InterviewA brief interview to assess Mrs White’s current health and well being. This interview was completed in an office where Mrs White was assured that her confidentiality would be maintained.

INTERVIEW Questions:• How would you evaluate your current overall health?• What is your current living arrangements? Do you live with a spouse, partner, family member? Do you have

any pets that reside with you?• What about the amount of social support you receive from your family, friends, neighbours? Do you feel

you have someone to talk to if you need to? How often do you visit family, friends or neighbours? How often do you get out and socialise?

• Do you belong to any organisation within your community?• How do you feel generally? Are you happy, content, sad?• Can you safely walk a short or long distance?• Are you able to perform everyday tasks to meet your daily needs without assistance?• Can you do your own housework? Shop for groceries? Can you prepare your own meals, do your laundry,

manage your money?• Can you manage your appearance? Dress and undress yourself? • How good is your memory? Do you sometimes feel lost and/or confused? How often?• Do you currently take any medication? What do you take, how often and why?• Do you experience chronic pain? How often, where, why?• Are you employed? Do you like your job?• Any history of surgeries, medical treatment? Any personal or family history of heart problems, cancer,

diabetes, headaches, glaucoma, epilepsy, Alzheimer's?• How well do you sleep at night? How many hours of sleep do you get? • What is your history of pregnancy? When did you first start your period? When was your last period? Has

there been any difficulties with your monthly cycle? • Do you smoke? How much and how often? Do you consume alcohol? How much, how often?• What concerns do you have about your current health? What would you like to change?

Scenario – Mrs WhiteAfter a brief visit and some personal questions asked in confidence, we learned the following: Current situation: Mrs White is 40 years old and is obese. She was widowed at the age of 36 and has sought comfort in food. She has no children of her own and other than her cat, has very little company. Mrs White doesn’t get out much and she feels her job keeps her busy. She has been working at the same primary school for the past 10 years and she enjoys being around children. How she sees herself: Mrs White has not had a holiday since her husband died and she now feels physically uncomfortable because of her weight gain. She would like to do something about it. What she would like: Mrs White would like feel more confident, perhaps go on a holiday and meet other people and for a change, maybe find a different place to work. She feels in a rut. She feels she is ready to make some changes in her life to feel better about herself.

Mrs White – Life stage

At 40 years old, Mrs White is currently in the Adulthood stage of life (19-64 years). With the stress of losing her husband at such a young age due to a long term illness, her body is going through some changes. Mrs White is beginning to go through menopause and the hormonal changes could be contributing to her weight gain. She is feeling more settled since her husband passed and now wants to move forward with her life. She is ready to deal with her loss of confidence (which she attributes to her weight gain), and wants now to “get control” of her life again. As Mrs White stated in her interview, she wants “to start living” again but needs to deal with her physical issues and is seeking some help in order to do so.

Mrs White’s assessments: BMIHeight: 5’6” Weight: 99.8 kg (15.8 stone)BMI is at 35This puts her in the Obese range and she will need to be assessed for diabetes, cholesterol levels, triglycerides checked, checked for heart disease and an overall evaluation for cancer risk.In addition, thyroid and hormone levels should be checked (menopause). Cholesterol Level: 5.5 Mrs White would benefit from taking a statin to reduce her cholesterol level. After a change in diet, this should be re-checked in three months time. Mrs White reported that she began to put weight on after her husband died. She should be assessed for depression. Low grade chronic depression could contribute to her increase in weight.

Assessment: Peak FlowPeak flow: 350 Recovery after exercise: 5 minutesAt her age (40 years) her peak flow should be anywhere between 475 and 500. She is well below a healthy level. This suggests she has a large amount of body fat that is pressing against her lungs and making it difficult for her lungs and vital organs to get the right level of oxygen it needs to be healthy. She must lose weight and begin a healthy exercise program.

Assessment: Blood Pressure & Heart RateCurrent blood pressure:150/95mm HgThis is high for her age and can certainly be an indication of heart disease, kidney damage and/or menopause.Mrs White’s high blood pressure is an indication of her lifestyle choice This can be treated with medication but getting her obesity under control is now very important.

Heart rate: with a resting heart rate of 92; there is concern for heart disease and diabetes. Mrs White needs to be put on a healthy diet and a moderate exercise program.

Summary of Factors & Recommendations

Based on the physiological assessments, Mrs White is a 40 year old woman who is in the process of going through menopause. She is 5’6” and weighs 15.8 stone. Her blood pressure is slightly elevated, her resting heart rate is high and her cholesterol level is slightly elevated at 5.5. She has been tested for diabetes, thyroid, kidney and liver problems, and has had a general assessment for physical health. Mrs White leads a fairly sedentary lifestyle with little exercise. After three years of taking care of her terminally ill husband, she was widowed at the young age of 36. Mrs White shows a small indication of depression, but that can improved with a healthy diet and exercise program. Short-term recommendations: Medication for the treatment of high blood pressure; medication for the elevated cholesterol. Long-term: Refer to a dietician for advice about a high fibre diet and mild to moderate exercise program. Mrs White would also benefit from a supported group such as Weight Watchers.

MenopausalElevated cholesterol, heart rate, blood pressure and

low peak flow

Blood pressureHeart ratePeak Flow

Blood tests, see slides 6-8

Healthy diet and exercise, this will contribute to weight loss

and help her to come off medication

Lose 2-3 lbs per week

Lose 3 stone in 6 months

Meet with dietician; monitor weight every 2

weeks with GP Refer to community

exercise program, support group (Weight

Watchers)

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Regularly review diet, education regarding weight and health factors; use

of support group; review medication, review short-term goals – as Mrs White’s weight and health improve, she should

be removed from medication.

40 yr female, 5’6”, 15.8 stoneCurrently obese, wants to lose

weight and feel better about herself

Mrs White’s Plan

Mrs White to introduce small targets; such as rewarding herself with new clothing or hair cut; weekend away at a spa, training classes to improve her employment prospects, etc.

Mrs White’s PIESS

Current Status• Physical: Mrs White is obese and

needs to lose 3 stone• Intellectual: Mrs White feel stuck

in her current job and wants to develop further skills

• Emotional: Mrs White is feeling self-conscience about her weight and feels a bit down because of it

• Social: Because of her weight, Mrs White tends to stay at home and not visit or go out with others

• Spiritual: Mrs White currently is not involved in any organisation and does not get any other support

Benefits of health plan • Physical: Mrs White will feel better, less

stress on heart, bones and lungs• Intellectual: Attending a support group,

learning about a healthy diet, engaging in further education and training

• Emotional: Losing weight and getting further training and education will increase Mrs White’s self-esteem and self-confidence

• Social: Attending a support group for her diet and exercise will help her to get to her goal; this will also help her to meet new people and make new friends

• Spiritual: Getting involved in with the support groups and getting further training will help her to feel connected to others, less alone and supported. She should find comfort in making these contacts

Monitor and ReviewLong-term goal: lose 3 stone in 6 months• Short-term goal: lose 1 1/2-3 pounds per week

• Weigh every two weeks at GP; every week at diet support group (Weight Watchers)• Check in with Dietician every fortnight • Amend diet when necessary; review tracking of diet

• Teach Mrs White to monitor her own success by tracking her diet and weight loss• Plan meals; plan lunches; prepare foods ahead of time; create a shopping list and stick to it.

Never shop when hungry – these are ideas to help Mrs White stick to the plan• Mrs White might do well with some counselling to discuss how she responded to the loss of

her husband; talk through new emotions that emerge during the weight-loss journey Focus on the following points to help maintain long-term goal:• Improve employment skills towards a better or different job• Focus on becoming healthy by learning about a healthy diet and exercise, rather than

obsessing on numbers (weight)• Learn about healthy eating; keep a food diary to monitor daily food intake• Getting out more with exercise and social group (diet support)• Save money by eating healthy!• Spend money as a reward; new clothes, new hairstyle, holiday

• Come off the medication! As Mrs White’s health improves and she is physically assessed again, she should be able to come off all medications (blood pressure and cholesterol tablets)

Assessing the planThe health benefits to be gained for Mrs White sticking to the plan is significant. Weight reductions have been shown to improve back and joint pain, symptoms of breathlessness and sleep apnoea. Marked improvements in blood pressure , peak flow, heart rate and other risk factors for coronary heart disease, diabetes and cancer, have also been observed in individuals successful at losing weight. The personal satisfaction of improving health, fitting in clothes, looking and feeling better, having an improved sex life, and reaching a personal goal, greatly adds to confidence, self-esteem, and overall quality of life. The long-term goal of losing 3 stone in 6 months time, may seem difficult at first. 1 ½ -3 pounds weight loss per week may not seem much, but it is a healthy and safe amount to lose that is less stressful on the body and over the long term, less likely to come back.Losing weight can be exciting when first starting, but can be a long, slow process. It is very important that Mrs White remains enthusiastic. It would help to work on short-term goals that will get her to her long-term goal. As she improves her health, her attitude will naturally be more positive due to the increase in serotonin levels in her brain because of exercise. Empowering Mrs White by helping her take responsibility of her health will help her to feel in control of her health and wellbeing. Taking an interest in her success will reflect a more person-centred approach to her health care and her quality of life.

Celebrate the end result• Throughout the process, Mrs White needs to celebrate the short-

term goals. • For example: how much money is she saving by changing to a

healthier lifestyle? • Work towards specific rewards that Mrs White wants– this will

empower her towards success!• Long-term goal: The long term reward is the overall health

benefits; but with guidance, Mrs White can work towards a special reward. For example: Going on that long awaited holiday! She can save money throughout the process (money saved by changing to a healthier lifestyle), and put that towards her long-term holiday plan!

• This health care plan was put together with the help of Mrs White; involving her in her own health care plan will improve her success.

• Keeping a food diary will help Mrs White to monitor her success; will create an awareness of what she eats, will empower her to take control over her food intake; will enable her to see where she can improve

• When she reaches her goal, it is important to have follow up visits to see how she is doing to help her maintain her success!