Read the following Case Study and Answer the questions that follow.

Mr. Munoz is a struggling young actor in Chicago who has battled alcoholism since approximately the age of 13 years.

“There was a lot of fighting in our house when I was growing up,” he says. “Entering my middle school years, it just got worse,” he says. Mr. Munoz’s parents had violent fights. Although they were both very supportive of him, he cannot remember when they ever really got along.

Still, Mr. Munoz was able to get through early adolescence as an honors student and starred on both the debate team and his school’s drama club. He even starred in an elaborate production of Shakespeare’s Richard III.

“In our school,” he says, “if you were a drama club kind of kid instead of an athlete, you really had to prove yourself to be a real man to avoid getting picked on. I did that by drinking. We had lots of ways to sneak booze into the places we met, and it was kind of exciting at first. You’re 15 years old, you’re outside on a starry night in a big city, you’re with your friends, and there’s plenty of alcohol. It makes you feel like a big man.”

Unfortunately, his parents never seemed to notice; therefore, Mr. Munoz never got help or encouragement to stop.

“After high school, my stress—and the reasons I gave myself for drinking—got worse. Those good grades got me partial scholarships to some local colleges—but mostly for drama awards, which suited me fine. But when my parents found out I wanted to be an actor, they freaked out.”

When Mr. Munoz refused to pursue prelaw, as his parents insisted, they withdrew all financial (and emotional) support, and they dissolved their marriage and household at the same time.

“It wasn’t all bad,” Mr. Munoz says. “I used the best partial scholarship, stayed local, living with friends, and we all went to school part time and worked part time—mostly in bars. The party just sort of—yeah—continued.”

Fourteen years later, Mr. Munoz is well known enough to “make a decent living” as an actor, teaching workshops on the side and waiting tables in the lean times. Half of his friends are now married and no longer trying to pursue acting.

“As the loneliness has increased, so has my drinking,” he says. “I mean, I have friends, but I never married, so those old days are just gone. I never made it to the New York stage as I’d dreamed, so all I have of those old party days is the alcohol. Only the alcohol has remained available. It tastes like nostalgia, you know?”

Because he started so young and because alcohol has played such a central role in his life, for the past 2 years, Mr. Munoz has already begun battling early stages of cirrhosis.

“I sort of didn’t expect this until old age,” he says with a sad smile. “Imagine my shock.”

He tells the nurse that he has not had a drink for 4 months.

1.      Mr. Munoz was initially treated with neomycin, followed by lactulose. “The lactulose has worked better for me,” he says, “but it has some side effects that aren’t any fun.” How should he be counseled nutritionally—taking into account both his condition and his drug therapy?

2.      Unfortunately, Mr. Munoz’s disorder progresses to end-stage liver disease, and he is awaiting a liver transplant. The good news is that he is an excellent candidate. What are likely his most crucial nutritional needs (a) at this time and (b) during the immediate posttransplant period?

Health Promotion: Prevention of Disease Case Study  Instructions: 

Read the following case study and answer the reflective questions. Please provide rationales for your answers. Make sure to provide citations/references for your answers in APA format.

CASE STUDY: 

Sandra, a 47-year-old divorced woman, received a diagnosis of stage 3 ovarian cancer 4 years ago, for which she had a total hysterectomy, bilateral salpingo- oophorectomy, omentectomy, lymphadenectomy, and tumor debulking followed by chemotherapy, consisting of cisplatin (Platinol), paclitaxel (Taxol), and doxorubicin (Adriamycin). She did well for 2 years and then moved back to her hometown near her family and underwent three more rounds of secondline chemotherapy. She accepted a less stressful job, bought a house, renewed old friendships, and became more involved with her two sisters and their families. Sandra developed several complications, including metastasis to the lungs. Then she could no longer work, drive, or care for herself. She had been told by her oncologist that there was nothing else that could be done and that she should consider entering a hospice. She met her attorney and prepared an advance directive and completed her will. She decided to have hospice care at home and, with the help of her family, set up her first floor as a living and sleeping area. She was cared for by family members around the clock for approximately 3 days. Sandra observed that she was tiring everyone out so much that they could not really enjoy each other’s company. At this time, she contacted the Visiting Nurse Association (VNA) to seek assistance. Her plan was to try to enjoy her family and friend’s visits. After assessment, the VNA nurse prioritized her problems to include fatigue and caregiver role strain. Other potential problem areas that may need to be incorporated into the care plan include anticipatory grieving and impaired comfort. 

Reflective Questions 

1. What are some of the stresses on Sandra’s middle-aged sisters and their families? 

2. What resources are available to manage these stresses and support the sisters while caring for their dying sister Sandra? 

3. Describe Sandra’s feelings about dependency and loss of autonomy because she is unable to do her own activities of daily living any longer