Question

A 48-year-old woman presents with a chief complaint of knee pain, with aching and stiffness on arising but easing up during the day. She does not engage in any type of exercise or activity. She is a grava 4, para 4 with a 10-year history of hypertension and a diagnosis of diabetes in the past 2 years. She calls it “sugar” and states that this condition is controlled with diet. She recently began working at a local Wal-Mart and has had to assist with shelving and loading of boxes.

CC: “My knee really hurts.”

Physical :

• Blood pressure, 154/94
• pulse rate, 88 beats/min
• RR 20/min.
• Afebrile
• Height, 5΄3΄΄; weight, 215 lbs. Her BMI 29.

The physical is remarkable for obesity and an erythematous rash under both breasts and in the groin. Her knee is tender and swollen. This patient is not new to your practice, but it is the first time that you have seen her. She lives with her husband, who is also overweight.

Questions:

1. Make a list of this patient’s problems. How would you prioritize these? Do you see her knee pain, hypertension, diabetes, and rash as all related to her weight?

2. What health promotion strategies are especially important for this patient at this time and why?

3. How will you manage this complex patient?

4. What Healthy People 2020 objectives are relevant?

5. What follow-up is needed for this patient? What patient education is important and how would you approach it?

6. Does voluntary weight loss, not associated with chronic disease or smoking, significantly lower morbidity and mortality in adults? What does the literature say?

7. What factors are important according to the current literature in helping individuals achieve a long-term commitment to fitness and exercise?

8.   What community-based approaches might help with obesity?

Answer 1

Answer: Patient is suffering from various health issues. Some of the health issues are:

• Knew pain
• Hypertension
• Diabetes
• Obesity.

The hypertension requires instant treatment whereas the diabetes is under control. Yes, these conditions is due to increased weight of the patient. The patient BMI reveals that patient is obese.

Some of the herh promotion strategies that are important for this patient are:

• Behavioural change
• Education
• Imparting knowledge to the patient.
• Indulging in physical exercise
• Healthy eating.

The objective of Healthy people 2020 includes :

• Eliminate the risk of the disease and infection.
• Make people healthy
• Have longer lives
• Attain health equity
• Improve health in the all group of population.

The patient need to reduce her weight. It is important to indulge in the exercise which could reduce the weight of the patient as well as manage the diabetes. The blood pressure can also be managed. The patient should eat healthy foods such as vegetables, fruits etc.