CNM N1 S2 Case Study (sample3)

Question 1

Case Study: Margaret
Sex: Female
Age: 73
Height: 153cms
Weight: 95kg
Prescription medication: Blood pressure tablets for about 20 years (ACE inhibitor –
may increase potassium levels in blood – potassium supplements are contraindicated. ACE inhibitor side effects include persistent dry cough). Recently had to
increase her dosage as blood pressure is getting higher (currently at 160/93).
Supplements: None
Presenting Symptoms: Margaret is finding it difficult to walk up and down the
backstairs of her house without getting out of breath and having palpitations. She
has had a fall a number of years ago and broke her ankle - she is very afraid of that
happening again. There is a history of osteoporosis in her family and although she
hasn’t been diagnosed with it, she wants to do something to prevent it if possible.
She’s aware that she is quite overweight and wants some suggestions to reduce her
weight, she is hoping it will help to bring down her blood pressure too.
Margaret also suffers constipation, having a bowel movement once every 2-3 days.
She occasionally has blood in her stool. She is retired, spending long periods of time
sitting down watching television. She has become less sociable than she used to be
and spends quite a lot of time alone as her husband is into fishing and is often at the
river for the day. She doesn’t mind cooking but doesn’t like complicated recipes.
Medical history: She had trouble with her weight since the birth of her two children,
gaining weight each pregnancy that she never really lost. She also gained weight
through menopause. Otherwise generally healthy, occasional headaches when she
was working (as a teacher) and got over-tired or was doing a lot of marking.
Diet:
Breakfast: 2 slices of wholegrain toast with margarine and jam
1 cup of coffee with milk and 2 teaspoons sugar
Morning snack: an apple or some raisins
Lunch: Wholegrain sandwich with salad, cheese and mayonnaise or egg salad
sandwich
Afternoon snack: A large slice of store-bought cake and a cup of tea with milk
Evening meal: Crumbed, shallow-fried fish (if husband has caught any, usually pike)
or steak with three vegetables boiled – usually potato, carrot and peas.
Dessert: Chocolate ice cream or a couple of chocolate coated biscuits
Cravings: Sweet foods, bread, mayonnaise
Water: 2 medium size glasses of tap water
Tea: 1-2 cups, each with milk
Coffee: 1 per day with milk and 2 sugars
Alcohol: None
Lifestyle: Doesn’t currently do any exercise but is willing to. In bed at 10pm and
wakes at 5:30am. Sleeps well.

Answer 1

trigger and mediators will be asked on next card

Question 2

What are the likely triggers in this case? Please explain
your rationale (5 marks)

Answer 2

– poor diet, low fibre intake, dehydration, pregnancy, menopause

Question 3

What are the likely mediators in this case? Please explain
your rationale

Answer 3

nutrient insufficiencies, medication, hormonal changes, high sugar
intake causing BS imbalance, poor diet. (0.5 each)

Question 4

State any red flags identified (1 mark)

Answer 4

Blood in stool (1/2 mark)
Shortness of breath and palpitations (1/2 mark)

Question 5

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

Answer 5

• Support the endocrine system to improve blood glucose levels, improve energy
  and reduce sugar cravings.
• Support the endocrine system to improve blood glucose levels and help with
  weight loss.
• Support the Digestive system to improve absorption of nutrients.
• Support the digestive system to improve constipation and support elimination of
  toxins.
• Support musculoskeletal health to reduce incidence of osteoporosis.
• 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 – support GIT.
• Fibre – support GIT and detoxification.
• Magnesium – improve bowel motility.
• Glutamine - support GIT.
• Zinc - Immunity
• Vitamin D – support osteoporosis
• Calcium - support osteoporosis
• K2 - support osteoporosis
• Omega 3 - support immunity and gut health
• B vitamins – energy support
• Vitamin C e

Question 7

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

Not an exhaustive list

Answer 7

• Vegetables for evening meal
• Protein with evening meal
• Wholegrains
• Protein with lunch
• Some fruit etc.

Question 8

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

Not an exhaustive list

Answer 8

• Excessive sugar intake - High refined carbs
• High GI
• High caffeine
• Low fibre intake
• Minimal water
• Binge drinking
• Refined snacks etc.

Question 9

What FOUR dietary changes could you suggest to Margaret? Please explain
your reason for these recommendations (4 marks)
- Not an exhaustive list

- Not an exhaustive list

Answer 9

• Incorporate protein with every meal and snack to balance blood sugar levels and
  reduce cravings.
• Increase leafy green vegetables, which are rich in magnesium to support gut
  health – rich in B vits and MG- 2 cups per day.
• Reduce snacks to balance blood sugar and aid weight loss.
• Choose protein rich snacks to balance blood sugar levels and reduce cravings.
• Include oily fish 3 times a week to support immunity and gut health.
• Incorporate probiotic rich foods to support gut microbiome and immune system.
• Remove refined snacks – inflammatory.
• Increase hydration to 2 L per day.
• Increase calcium rich foods to support bone health.
• Increase Vitamin D rich foods to support bone health.