CNM N1 S2 Case Study (sample2)

Question 1

SECTION C – Case Study (20 marks)
Name: Samuel
Sex: Male
Age: 39 years
Occupation: Delivery driver
Height: 159cms
Weight: 88kg
Prescription/ OTC medication: Ibuprofen (NSAID) and Proton Pump Inhibitors
(PPIs) for heartburn
Supplements: None
Presenting Symptoms: Samuel works as a delivery driver and works from 6am until
5pm every weekday. Samuel has suffered from digestive issues for the past two
years and has explosive diarrhoea that sometimes stops him from going to work.
Once a month finds blood or mucus in his stool. He often has heartburn which
started two years ago, and takes PPI’s for this daily, but still experiences heartburn
more than 3 times per week.
Other:
Samuel suffers frequently with migraines: average 2 -3 per month- takes maximum
ibuprofen (400mg 3X day). They started 4 years ago with the stress of losing his
father in an accident.
Medical history:
As a child he had recurrent infections (chest, ear and tonsillitis) in which he was
prescribed multiple rounds of antibiotics every year.
Migraines- after losing his father in an accident.
Diet:
Breakfast: Often skips breakfast and will have a strong coffee instead.
Morning snack: A cup of coffee and a sausage and bacon roll at 11am at the café he
passes on his delivery run.
Lunch: Will usually skip lunch as he isn’t hungry after his sausage and bacon roll.
Afternoon snack: Bar of chocolate with a cup of tea.
Evening meal: Has a home cooked meal made by his wife which always has 2-3
portions of vegetables and often include steak or lamb.
Dessert: Some fruit with ice cream or Greek yoghurt
Other: At the weekend he will often try to be healthier and have salads/vegetables
with salmon or chicken.
Cravings: Sweet foods
Water: Doesn’t drink water during the day as he is on the road and doesn’t have
access to a toilet easily. Will drink 1 litre when he gets home
Lifestyle: As he is active all week, he likes to spend his free time playing video
games with his daughter. In bed at 11.30pm and wakes at 4:30am. Sleep quality
varies. He is quite stressed about keeping up with his delivery schedule, and this
makes him quite tired which means he reaches for sweets to keep him going.

Answer 1

triggers and mediators questions in next card

Question 2

What are the likely triggers in this case? (5 marks)

Answer 2

Triggers – work environment – grief, stress, ibuprofen, PPI’s, antibiotics

Question 3

What are the likely mediators in this case? (5 marks)

Answer 3

Drivers – Alcohol intake, toxic load, nutrient insufficiencies, low fibre, poor circadian
rhythm, caffeine, dehydration.

Question 4

State any red flags identified (1 mark)

Answer 4

Blood in stool (1/2 mark)- must mention.
Mucus in stool (1/2 mark)

Question 5

Formulate THREE therapeutic aims based on your naturopathic summary (3
marks)

Answer 5

• Support the digestive system to improve motility and integrity and reduce
  heartburn symptoms.
• Support nervous system to reduce the effects of stress on the system/incidence
  of migraines, and improve energy
• Support the endocrine system to improve blood glucose levels, improve energy
  and reduce sugar cravings etc.

Question 6

List THREE nutrients you would initially recommend. Provide a rationale for your answer (3 marks)

Any sensible nutrient (½ mark) with sound rationale (½ mark) maximum tot

Answer 6

• Probiotics – SB – Gut support
• Fibre – Bulk out stool, balance BS levels.
• Magnesium – Migraine/NS energy support
• Liquorice - Gut support
• Glutamine - Gut support
• Slippery Elm- Gut support
• Zinc
• Milk Thistle
• Any adaptogenic herb etc

Question 7

List TWO positive things about the client’s diet (2 marks)

Not an exhaustive list

Answer 7

• Vegetables for evening meal
• Salad for lunch at weekends
• Chicken/salad
• Some fruit
• 1 litre of water etc.

Question 8

List TWO negative things about the client’s diet (2 marks)
Not an exhaustive list

Not an exhaustive list

Answer 8

• Excessive alcohol (particularly weekends)
• High GI
• Moderate caffeine
• Low fibre intake
• No whole grains
• Skips meals etc.

Question 9

What FOUR dietary changes could you suggest to Samuel? Please explain
your reason for these recommendations (4 marks)

- Not an exhaustive list

Answer 9

• Incorporate protein with every meal and snack to balance blood sugar levels and
  reduce cravings.
• Avoid skipping meals and having protein to balance blood sugar.
• Increase leafy green vegetables, which are rich in magnesium to support the NS2 cups per day
• Include bitter foods such rocket, chicory, endive before meals, ACV to stimulate
  digestion.
• Reduce caffeine – too stimulating for NS and increases cortisol levels. Will help
  with sleep
• Choose protein rich snacks to balance blood sugar levels and reduce cravings.
• Include oily fish 3 times a week.
• Incorporate probiotic rich foods to support gut microbiome.
• Remove gluten and dairy for a month to see if this assists with diarrhoea.
• Increase hydration to 2 L per day. Etc.