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The Cookout: Case Study Question: Case Study Late afternoon on a Monday in June “The backyard is ready for tonight’s cookout,” Jim announced as he entered the kitchen and dropped into a chair. “The tables and chairs are set up, the grill is clean, and the drinks are on ice. Sure glad I cut the grass yesterday. I don’t think I would have had time to do that today too. What are you doing? Do you need any help?” “No, thanks,” said his wife Nancy. “I’m almost done with these snacks. Why don’t you fix us a drink so we can sit and relax a little before the neighbors arrive. Getting ready for these parties used to be a breeze, but right now I’m pooped. Can’t understand why I feel so tired all the time.” “OK, Hon. Put your feet up for a bit. I’ll be the waiter.” He gave her shoulders a good rub and then headed to the refrigerator, returning shortly with two cool drinks. As they sat on the porch swing and sipped their drinks, Jim and Nancy went over the list of things they had done and the things they had yet to do before their cruise to Alaska. Planning had been intense. It was the middle of June and the Towers had been working hard to get their garden beds planted and odd jobs finished around the house before they left on their two-week vacation. Jim retired last year after 40 years in sales. He had suffered a massive heart attack a few years earlier and now takes medication to control his blood pressure as well as an aspirin every night. He is 68 years old, overweight, and keeps promising to quit smoking. Nancy is 62 years old and just retired from teaching mathematics at the college level. She’s still trying to find a place at home for the books and papers she decided to keep. Although she swims a few laps and lifts weights several times a week at the local Health and Wellness Center, Nancy weighs more than she should. She has been taking hormone (estrogen) replacement therapy since she had a hysterectomy at age 45. Now she’s concerned about developing osteoporosis because her sister was recently diagnosed with it, and their mother died in early April from complications following a broken hip. Later that evening The neighborhood cookout was a success. “I’m stuffed,” sighed Nancy as she finished her last bite of pie. “Let’s just sit and talk some more before we start cleaning up. I don’t know if I can move! I’ve had a pain in my back all week, and now I have a burning sensation in the lower part of my chest. If I didn’t know better, I’d say that something happened to me last month when I retired. I suddenly seem to be falling apart!” “You probably just ate too much. Why don’t you take some antacid?” suggested her friend Harry. “It helps my indigestion every time.” Others agreed with Harry’s suggestion, and Nancy left to search the medicine cabinet. The pain in her chest eventually lessened, and Nancy enjoyed the rest of the evening with Jim and their friends. The next day, Tuesday After cleaning up the remains of their cookout Jim and Nancy began their final packing in earnest. A few neighbors stopped by to confirm house-sitting duties and to see if they could help with any last minute details. “Jim and I are really looking forward to getting away. It’s been years since we splurged on a vacation. But, getting ready to go is so much work! We thought we’d never get the garden ready in time. Sometimes I think it would be better just to stay home,” said Nancy. “I know what you mean,” said their next door neighbor Jill. “But I’m sure you’ll love the cruise and Alaska. Don’t worry, everything back here will be fine.” In the midst of the day’s hubbub, Nancy’s test results from an early morning screening at the local Health and Wellness Center arrived in the afternoon mail. She glanced at them briefly and stuck the paper into a book she was taking along on vacation. “Maybe later I can figure out what all of this means,” she said to herself. Nancy’s test results (at rest and fasting levels): Test Nancy’s Result Normal Range Heart rate 88 beats/min 60-100 beats/min Blood pressure 138/85 mm Hg 90/60 – 140/90 mm Hg Total cholesterol 238 mg/dL   HDL 46 mg/dL 45-60 mg/dL LDL 161 mg/dL   Triglycerides 220 mg/dL   Glucose 128 mg/dL 80-100 mg/dL Questions: 1. Assess the health of Jim and Nancy by listing the healthy and not-so-healthy things we know about each of them. Fill out a table similar to the one below to list your observations about their health status.   JIM NANCY Healthy Not-so- Healthy Not-so- Healthy Healthy     2.    What diseases are Jim and Nancy at risk for and why? 3. What other information might be helpful to know in assessing their health? How would this information help?   Answers: 1. Table For Health Details Of Jim And Nancy JIM NANCY Healthy Unhealthy Healthy Unhealthy Jim was in sales that indicates standard amount of physical activities Aspirin intake regularly at night Swimming Feeling tired all the time Helping Nancy with a hand indicating active status of Jim Overweight Lifting weights several times in a week Overweight Jim was identified to cut grasses which again indicates standard level of physical activity of Jim Unable to quit smoking   Pain in back       Burning sensation in lower chest portion       Feeling to stay at home indicating lack of energy       High Triglyceride (220 mg/dL)       High level of blood glucose (128 mg/dL)       High LDL (161 mg/dL) 2. Risk Of Diseases For Jim And Nancy Nancy depicts symptoms that identify high risk of incurring diabetes. The feeling of tired all the time indicates high blood glucose level diminishing the body’s capability to produce energy by the breakdown of the glucose into glycogen (Mathews & Liebenberg, 2011). The burning sensation in the chest of Nancy and indigestion at a frequent basis is an indication of the risk of acid reflux and GERD (Gastro Esophageal Reflux Disease). The temporary status of the pain experienced by Nancy indicates the chances for GERD presence.   Regular intake of Aspirin at night may expose Jim to the risk of intestinal bleeding and ulcers. As per the reports of FDA (Food and Drug Association), the efficiency of Aspirin in preventing heart diseases and attacks is controversial. Although it is believed to prevent cardiovascular diseases, yet some studies shows a higher probability of recurrent heart attacks and  internal bleeding in patients taking aspirin on a daily basis. It increases the risk of heart attack for Jim. The overweight tendency of Jim exposes him to the risk of recurrent heart attack as it increases the chances of storing fats and cholesterol in body that may lead to blocking of arteries causing heart attacks (thrombosis). As asserted by Okumura (2011), the smoking habit of Jim majorly exposes him to the risk of heart block. 3. Information Regarding Health Assessment Of Jim And Nancy The study identifies Nancy to be feeling tired all the time, which is an indication of the presence of a disease as diabetes that results in such experience. The information about Jim encountering of the massive heart attack and receiving medications to control his blood pressure (BP) along with aspirin daily at night is essential is assessing his health as it provides insight on his body’s health condition. The information about the age of Jim, his body weight and smoking status are assist highly in assessment of his health condition. It is applicable for Nancy too. Details about age, physical activities, medical history and her family’s medical history are significant (Dahabreh & Gatsonis, 2014). It enables identification of the risk of osteoporosis and complications arising from it all together thereby facilitating the assessment of the health of Nancy. However, the information about their lifestyle, current medications Nancy takes and their diet can prove useful to assess the risks they can be exposed to.   References Dahabreh, I., & Gatsonis, C. (2014). A Flexible, Multifaceted Approach Is Needed in Health Technology Assessment of PET. Journal Of Nuclear Medicine, 55(8), 1225-1227. doi:10.2967/jnumed.114.142331 Mathews, E., & Liebenberg, L. (2011). A Practical Quantification of Blood Glucose Production due to High-level Chronic Stress. Stress And Health, 28(4), 327-332. doi:10.1002/smi.2415 Okumura, Y. (2011). Smoking and the risk of the perpetuation of atrial fibrillation: under debate in large cohort studies. Heart Rhythm, 8(8), 1167-1168. doi:10.1016/j.hrthm.2011.03.054

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