WRITING SUB-TEST: DIETETICS - 7

 WRITING SUB-TEST: DIETETICS - 7

TIME ALLOWED: Reading Time: 5 Minutes

                                  Writing Time: 40 minutes

Read the case notes and complete the writing task which follows.

Assume that today's date is 15 June 2022. You are a dietician at Midland Hospital. Mrs Crawford has been referred to you by her doctor for dietary advice and management. 

PATIENT DETAILS

Name: Michelle Crawford

DOB: 13 October 1957 (age 63 yo)

Address: 300 Church Road, Willington St., Perth.  

Social background: Social worker -runs deaddiction centre. Consultant to the government. No physical labour. 

Medical history:   1965 Typhoid

                               1990 Appendix removed

                               2000  Angina

                               2021 Hypercholesterolaemia

Family history: Father died Myocardial infraction

                           Mother: Died Cervical cancer

                          Elder sister; survived 2 hear attack

                          Grand mother:: hypertension

Medication:      Metoprolol

Treatment record:

01 June 2022

Reason for presenting:             Worsening angina with activity and after meals.                                                                         Hypercholesteolaemia

Anthropometry:                      Wt:104, Ht: 182 cm, BMI: 31.6, waist: 116 cm

Dietary information:              High fat diet, high in GI carbs, fried foods

                                               Lunch: Junk food - busy life

                                              Snacks: chocolates, crisps, soft drinks.

                                               Dinner: Husband cooking mostly. takeaway 2 nights/wk

Full blood examination:                 

                                             Total cholesterol; 221 mg/dl. (Normal less than 200)

                                             LDL cholesterol:  116 ( normal 100mg/dL)

                                            HDL cholesterol: 36 (Normal 40mg/dL)

                                            CRP:  1.5 mg/L (average heart disease risk).

Evaluation:                         Multiple coronary risk factors - obesity, hyperlipidemia, family                                               history

                                          Diet: Excessive in total energy, high in fat (especially saturated                                                fat), high in unrefined carbohydrates with high GI, high in                                                        sodium, low fibre. 

Management goals:            * Lower energy intake

                                           * Improve fatty acid profile of diet (reduce saturated fats,                                                             increase monosaturated & polyunsaturated fats) 

                                          * Reduce total carbohydrate intake (reduce high GI carbs.                                                        * Increase low GI carbs)

Specific advice includes:  * Avoid fast food, prepare lunch at home. (e.g., healthy                                                              leftovers/ sandwich with lean chicken & salads)

                                           * Change type of fat used in cooking at home. (e.g.,                                                                     butter/margarine to  olive/canola oil)

                                          * reduce unrefined carbohydrate foods, choose healthier low GI                                                 options. ( e.g., brown rice, whole meal pasta, wholegrain bread,                                              high fibre cereal)

                                          * increase portions & variety of vegetables & salads, and use                                                      healthy dressings ( e.g., olive/canola oil & lemon                                                                     juice/balsamic vinegar)

                                          * Snacks between meals: fresh fruits/unsalted nuts

                                          * Increase legumes (e.g., baked beans, soyabeans, lentils, tofu) in                                                diet 

                                          * Oily fish at least 1 x /wk

                                           * Trim all visible fat from meat, remove poultry skin (eat only                                                     the meat)

                                          * Avoid added salt at the table & in cooking., avoid salty foods

                                          * Increase physical activities (e.g., walk for 20 minutes after                                                       dinner)

15 June 2022

Progress                            Wt: 103 kg (-1kg)   Waist 115 cm (-1cm) 

                                          * Eating home cooked lunches/snacks at work, no take away                                                       foods.

                                          * walked 2 x after after dinner

Plan:                                  * Go on with the current changes/diet &exercise program

                                          * Gradually decrease amount and frequency of high carbohydrate                                               foods. (given "Healthy Heart" recipe booklet)

WRITING TASK

Using the information in the case notes, write a letter  to the referring doctor, Dr Mustaffa, outlining your assessment of Mrs Crawford, her progress-to-date, and your management plan. Address the letter to Dr Amina Mustaffa, Midland Hospital, 112 South street, Newport.

In your letter: 

* Expand the relevant case notes into complete sentences

* Do not use note forms

* Use correct letter format

The body of the letter should be approximately 180-200 words.

__________ The End__________