Question

Teresa Cordova, a 41-year-old Mexican American female, was evaluated in the emergency department after experiencing a myocardial infarction in the grocery store. She reports feelings of shortness of breath, chest pain, and pins and needles in her legs for the last few months. She has a history of type 2 diabetes. She is currently taking Metformin. She says that she is mostly compliant with her medication, but sometimes she forgets. Mrs. Cordova is 5 feet 3 inches tall and weighs 165 pounds. She states that she wants to lose weight because she is concerned about the long-term effects of diabetes. She recently joined a gym but has not gone to work out. She is also concerned about her husband and children because they are overweight and not very active. She has been referred to you for nutrition counseling. She comes to visit with her husband and two children ages 6 and 8.

1. Write two appropriate and correctly worded PES statements for Mrs. Cordova? Refer to class handout for wording.
1) PES: Excessive carbohydrate intake related to food and nutrition-related knowledge deficit and evidenced by self-reported patient food logs.
2) PES:
2. What are potential barriers to communication during this visit?
Interpersonal Communication
3. List three specific questions that you would ask Mrs. Cordova to obtain more information about her food and nutrition history?
4. What cultural considerations would be important in visiting with this client?
5. What is her stage of change?
6. Give two reflective listening statements that you could make based on what you are told in this case study.
7. Describe "change talk" that you would hope to evoke from Mrs. Cordova.
8. In preparation for you counseling session, compile a list of at least three specific behavior modification ideas and strategies to discuss with Mrs. Cordova.
9. What self-management or self-evaluating techniques might be helpful for this client?
10. When visiting with Mrs. Cordova, she makes the following statements: "I have always been heavy. I don’t think that I can ever lose weight" and "My husband likes me the way I am. He does not complain about my weight." List at least two reflective summaries or paraphrases of the thought or feeling Mrs. Cordova is expressing. Your reflective summaries or paraphrases should serve the purpose of seeking further information from the client.
11. Considering that all members of the family have different nutritional needs, discuss potential challenges that you will face in working with Mrs. Cordova and her family.
12. Describe the learning style that you think would be most effective for your session with Mrs. Cordova. How will you plan your session accordingly?
13. When would you recommend that Mrs. Cordova have a follow-up counseling session with you?
14.You arrange for Mrs. Cordova to attend a workshop for patients with type 2 diabetes. List three learning objectives that would be appropriate for a diabetes workshop. The objectives should be both specific and measurable.
15.During your follow-up visit, how can you evaluate the effectiveness of the workshop?

Answer 1

The case study involves providing nutrition counseling to a 41-year-old Mexican American female with type 2 diabetes. The PES statements, potential communication barriers, specific questions about food and nutrition history, cultural considerations, stage of change, change talk, behavior modification ideas, and self-management techniques are discussed. Reflective listening statements and reflective summaries are provided, along with challenges in working with the client's family, preferred learning style, timing for follow-up sessions, learning objectives for a diabetes workshop, and evaluation of workshop effectiveness.

Step-by-step explanation:

1. PES: Excessive carbohydrate intake related to food and nutrition-related knowledge deficit and evidenced by self-reported patient food logs.

2. PES: Inadequate physical activity related to sedentary lifestyle and evidenced by lack of gym attendance.

3. Potential barriers to communication during this visit include language barriers, cultural differences, and the presence of the husband and children, which may affect the client's openness to discussing personal health issues.

4. Three specific questions that could be asked to obtain more information about Mrs. Cordova's food and nutrition history are:

• What types of foods do you typically eat on a daily basis?
• Do you have any specific dietary preferences or restrictions?
• Can you describe your typical mealtime routines and eating habits?

5. Cultural considerations that would be important in visiting with this client include understanding the Mexican American culture, language preferences, traditional food choices, and cultural beliefs surrounding health and body image.

6. Mrs. Cordova's stage of change could be assessed by asking her about her motivation and readiness to make changes in her diet and exercise habits.

7. Reflective listening statements could include:

• It sounds like you're concerned about your long-term health and want to make changes.
• It must be challenging to balance your own health goals with the needs of your family.

8. The change talk that would be hoped to evoke from Mrs. Cordova includes statements or expressions of readiness, willingness, or desire to make positive changes in her diet, exercise, and overall health habits.

9. Behavior modification ideas and strategies that could be discussed with Mrs. Cordova include setting SMART goals, meal planning, portion control, incorporating physical activity into daily routines, and stress management techniques.

10. Self-management or self-evaluation techniques that might be helpful for Mrs. Cordova include keeping a food and activity journal, monitoring blood glucose levels, and regularly assessing progress towards personal health goals.

11. Reflective summaries or paraphrases of Mrs. Cordova's statements:

• It sounds like you have struggled with your weight for a long time.
• It seems like your husband's acceptance of your weight has influenced your own perception of your body.

12. Potential challenges in working with Mrs. Cordova and her family include addressing individual nutritional needs, coordinating meal planning and preparation for the entire family, and overcoming resistance or lack of motivation from family members.

13. The learning style that would be most effective for the session with Mrs. Cordova could be determined based on her preferred learning style (e.g., visual, auditory, kinesthetic) and adapting the session materials and activities accordingly.

14. A follow-up counseling session with Mrs. Cordova could be recommended within a few weeks to assess progress, provide additional support and reinforcement, and adjust the nutrition plan if necessary.

15. Three learning objectives for a diabetes workshop could be:

1. Understand the basics of diabetes, including its causes, symptoms, and management strategies.
2. Learn about the importance of proper nutrition in managing diabetes and develop practical meal planning skills for blood sugar control.
3. Explore the role of physical activity in diabetes management and develop strategies for incorporating regular exercise into daily routines.

16. The effectiveness of the workshop could be evaluated during the follow-up visit by assessing Mrs. Cordova's knowledge and understanding of diabetes management, reviewing her progress in implementing the nutrition and lifestyle changes discussed in the workshop, and evaluating any improvements in her overall health and well-being.