Case 2 - 35 minutes
Mr Wiremu Gordon is a 54 year old Māori male rural bank manager. He was diagnosed a year ago with type II diabetes.
Mr Gordon’s GP used Te Whare Tapa Wha as a framework to assess Wiremu and he shares with the GP that he is from Manaia in Taranaki but now lives in Southland. He doesn’t get back to Taranaki to visit his mum and brother very often as his job as a bank manager is very time consuming and has a high level of stress associated with it.
He is married to Jenny and they have four children together. The oldest two have left for University but his youngest son and daughter are in high school and live at home. Jenny and his tamariki have been encouraging him to see his GP as he has been complaining of pain in his right foot. He wonders whether it has anything to do with the cramp he experiences in the same leg when walking down the block to the shops.
His tamariki have been encouraging him to be more physically active and to learn more about how he can manage his diabetes, but he is still coming to terms with his diagnosis. His mother has suggested that he should come home to Taranaki to meet with his Aunty who is a rongoa Māori expert.
His father had “heart problems” and high cholesterol and died when he was 62 years old. Wiremu is worried that he will die early like his father and not be there to take care of his whānau. He is also anxious about the changes that he might have to make to his lifestyle to avoid this from happening.
Wiremu tells his GP that he is “not a religious man” but lately he has started to use karakia to open and close his day, in the same way that he was raised to do by his parents.
Part A - 15 minutes
- Identify two (2) issues (either positive or negative) impacting on Mr Gordon’s hauora for each of the following dimensions of Te Whare Tapa Wha. • Taha Tinana • Taha Hinengaro • Taha Wairua • Taha Whānau
Taha Tinana 1: low activity 2: diabetic foot ulcer Taha Hinengaro 1: stress from job 2: anxiety Taha Wairua 1: reciting karakia 2: coming home to taranaki to visit aunty Taha Whānau 1: strong family 2: strong focus to provide for family
Case 3 - 20 minutes
Case 4 - 10 minutes Parameter 3-years ago Now Adult female Reference Ranges Red Cell Count (RBC) 4.6 4.3 4.3-6.0x1012 /L Haemoglobin (Hb.) 131 92 115-155 g/L Haematocrit (Hct) 0.41 0.31 0.35-0.46 Mean Cell Volume (MCV) 88 72 80-99 fL Mean Cell Haemoglobin (MCH) 28 21 27-33 pg Platelet Count 290 405 150-400 x 109 /L Total Leucocyte Count (WBC) 6.3 7.6 4.0-11.0 x 109 /L Neutrophils 3.5 4.2 1.9-7.5 x 109 /L Lymphocytes 2.2 2.9 1.0-4.0 x 109 /L Monocytes 0.3 0.4 0.2-1.2 x 109 /L Eosinophils 0.2 0.1 0.0-0.5 x 109 /L Basophils 0.1 0.02 0.0-0.2 x 109 /L Parameter 3-years ago Now Adult female Reference Ranges CRP 4.6 4.3 4.3-6.0x1012 /L Liver funcRon test 131 92 115-155 g/L CreaRnine and Electrolytes 0.41 0.31 0.35-0.46 FerriRn 88 72 80-99 fL Maia is a 24 year old Māori female who started a new job as a primary school teacher six weeks ago. She has been feeling very tired for the past six months and now has difficulty focussing on lesson plans and providing a good learning environment. Her social life has become almost non-existent. She had been cycling to work but now finds she needs to walk up the last hill on her way to work as she is exhausted. She visits her GP because she has had unusually heavy periods for the past few months. The periods last longer with more bleeding than previously, and she also mentions how she is struggling with her new job and with cycling to work. The GP discusses Maia’s health and symptoms and finds nothing obvious. She has been eaDng well with a mostly vegetarian diet for the past 18 months, has a good appeDte, and has not lost weight. She has had no viral or other infecDons recently. She appears pale. Maia’s blood screen and clinical chemistry screen are shown above. 11. Summarise the blood screen findings. 12. Using the clinical chemistry informaDon, what is the most likely cause for Maia’s anaemia? 13. List reasons for a mildly raised platelet count. Identify which reason is likely to be the cause of Maia’s raised platelet count. 14. What would the GP tell Maia when she returns for the test results tomorrow? Include a recommendation on treatment and/or lifestyle management. 15. What, if any, follow-up is needed? Explain.