Health Project

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Josephine
is a 20 year old female who is present for an eating disorder not otherwise
specified. She currently teaches salsa lessons at the community college and is
in her last semester of college. She reports she is living at home and the food
her mom prepares is not the healthiest because her mom is from Honduras and her
father is from Guatemala, so the food is prepared differently. She indicates
she has been thin all her life, but as soon as puberty hit, she has struggled
to maintain her weight and since she is a salsa instructor, she has to remain
fit. She reports she feels very guilty if she has consumed fried foods during
the day, but since that is the way her mom primarily cooks, she feels awful to
tell her mom to stop cooking that way. She reports if she does consume too much
fried foods or junk food, she will run at least 2-3 miles that day or else
force herself to vomit, but all the food does not come out. She reports
sometimes if she has a later class, she will not eat dinner or only eat 1 meal
per day. She has tried counting calories, but then she gets so mad at herself
for having more than 1200 calories it causes her to exercise more, which then
leads her to feeling exhausted. She indicates she is on no medication, but does
take a multivitamin when she remembers. She indicates she has gone from 110
pounds to 125 pounds over 5 years and wants to be back down to 110 or even
less. She also had gone to the doctor and he was quite concerned with her lab
values. She has provided you a 24 hour meal record:

Breakfast:

1-6”
corn tortilla

½
cup fried beans cooked with peppers, onions and oil

½
cup rice

1
cup no sugar added orange juice

Lunch:

1
slice of whole wheat bread

2
slices turkey

1
small apple

Dinner:

2-
6” tortillas

Beef
with onions, peppers cooked in oil

Tomato,
onion, pepper salad (made with oil and lime juice)

2
cups of rice

Height: 5’2” Weight: 117 pounds (based on
your scale in the office)

Labs:

Test

Result

Reference Units

Albumin
(visceral protein stores)

3.3 g/dL

3.5-4.8 g/dL

Sodium

133 mEq/L

136-145 mEq/L

Potassium

3.8 mEq/L

3.5-5.2 mEq/L

Iron

0.4 mg/dL

0.6-1.1 mg/dL

Vitamin
B12

185 pg/mL

200-835 pg/mL

Questions
for Unit 3:

1. 
What
stage of change do you believe Josephine is in? In the above paragraph, what
makes you determine she is in that stage of change?

2. 
For
this situation, how would you establish a rapport with the client?

3. 
What
personal boundaries would you establish for this seminar session?

4. 
What
cultural considerations do you have to keep in mind?

What other
physical or psychosocial questions would you ask this client?

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