Client/Health Improvement Plan

1. Client/Health Improvement Plan Clients Pseudonym: Michelle Physician: Raney Bloom

2. Client Overview • Gender: Female • Age: 60yrs old • Height: 5’5” ft. • Adult illnesses: • Family Health History: Congenital Hip Dysplasia, Depression, Client has been married for 30 years. Has 3 children, two of which are 17 and one 20 year old.

3. Chief Complaints • Hips: hips hurt when weather is wet or cold due to Osteoarthritis. • Patient has had congenital hip dysplasia since she was born. • Has had three hip surgery's in her life time. The doctor says she might require one more. • Rheumatoid Arthritis: Patient experiences swelling and aching when consuming certain foods (red meat, pork, simple carbs, alcohol, sugar.)

4. Health History Hips: • Patients first hip surgery was when she was five years old. • When patient was eighteen years of age hip started bothering her(started seeing anorthopedist regularly). • In 1998 patient had another surgery on her right hip • Last surgery was in 2008 on her left hip • Doctor says she has “great mobility”.

5. Health History (continued) Rheumatoid Arthritis: • Patient only experiences pain or swelling when consuming foods that irritate her. • Rheumatoid Arthritis is all over her body, when she does eat these foods her feet and hands are usually where she experiences pain. • Patient takes medicine for arthritis.

6. Research • “Ginger is an edible root often used in cooking as a seasoning. In the context of alternative medicine, ginger is sometimes recommended to settle an upset stomach”(Madsen, 2009 pg. 2). • “One hundred years ago, it was touted that ‘night-shade’ foods, such as tomatoes would aggravate rheumatoid arthritis” (Rheumatoid Arthritis, 2014 pg. 2) • “Proper regular exercise is important in maintaining joint mobility and in strengthening the muscles around the joints” (Rheumatoid Arthritis Diet, 2014 pg. 2) • “All people taking methotrexate require regular blood tests to monitor blood counts and liver function. Taking folic acid as a supplement can reduce the risk of methotrexate side effects” (Rheumatoid Arthritis, 2014 pg. 2)

7. Target Behavior Eating foods that don’t irritate Rheumatoid Arthritis and exercise to improve joint mobility

8. Personal/Professional Analysis • Social Cognitive Theory fit my patient better than I thought so following intervention plan made it easier. • Patient was well cooperative with goals and as far as I can see tried as hard as she could. • Making the graphs has been the hardest part of the project. • I have learned that following the intervention plan and having a good relationship with client makes it easier to reach end goals.

9. Social Cognitive Theory • Reduce social factors- self management skills, self-efficacy • Reduce environmental factors- family behavior, media influences, social norms • Address the whole “system” rather than just the individual • Create the “domino effect”

10. Intervention Plan • Tell family to support patient to reduce environmental factors • Help patient recognize she is part of the “system” • Show she has to address the system as a whole instead of her as an individual • Address personal factor: self-management skills

11. FOUR Week Goal • Eat only foods that don’t irritate Rheumatoid Arthritis • Get rid of all foods in the house that irritate patient • Keep Track of what food is eaten every day • Note any swelling or aching due to diet • Walk everyday for at least 15 minuets

12. Intervention Highlights • Increasing patients regular exercise • Reduce normal swelling due to diet • Change patients diet to healthier food

13. Graphs • Exercise chart (study not finished yet) • Food chart (study not finished yet)

14. Results • Patient was able to record foods that she ate everyday for 2 weeks. Patient was able to keep a steady diet of only foods that did not iritate her. She was able to reduce the amount of swelling she would normally get • Patient recorded all of the exercise that she got everyday. Patient was normally getting no exercise at all, she incresed it to walking at least 4 times a week • Patient was able to reduce enviromental factors by getting rid of all the unhealthy food in her house, as well as telling family so they new to support her behavior change.

15. References • Shiel Jr., MD, FACP, FACR, W. C. (n.d.). Rheumatoid Arthritis Symptoms, Causes, Treatment - "Second-line" or "slow-acting" rheumatoid arthritis drugs - MedicineNet. Retrieved May 11, 2014, from http://www.medicinenet.com/rheumatoid_arthritis/page7.htm • Shiel Jr., MD, FACP, FACR, W. C. (n.d.). Rheumatoid Arthritis Symptoms, Causes, Treatment - What about rheumatoid arthritis and pregnancy? - MedicineNet. Retrieved May 11, 2014, from http://www.medicinenet.com/rheumatoid_arthritis/page9.htm#what_about_rheumatoid_arthritis_and_pregnancy • Madsen, M., Ernst, E., & Altman, R. (2012). Prevention and Alternative Treatments | International Hip Dysplasia Institute. Retrieved May 11, 2014, from http://hipdysplasia.org/adult-hip-dysplasia/hip-dysplasia-and-every-day-life/prevention-and-alternative-treatments/ • Alternative Migraine and Headache Treatments. (n.d.). Retrieved May 11, 2014, from http://www.webmd.com/balance/nontraditional-headache-treatments