Alexi Burr is a 34 year old female and mother of 2 children. Due to her complaints of work overload,anxiety and alcohol misuse for letting off steam, I would focus primarily on screening then do brief intervention. After those two I would do health promotion and disease prevention and immunizations. 

Immunizations 

Flu Vaccination

Screening

Perinatal Depression due to just having a child

Anxiety and Depression Screening because of family history and current overwhelming situation patient is in

Alcohol Misuse due to drinking more than 4 drinks a week

HIV Infection screening is recommended

Hypertension screening due to familial history

BRCA-related cancer risk because her maternal grandmother is an Ashkenazic Jew who had breast cancer.

Breast cancer screening because of family history from maternal grandmother and maternal aunt

Intimate Partner Violence

Cervical Cancer Screening

Colorectal Cancer Screening recommended because the patient has ulcerative proctitis  gene  

Anorexia Nervosa/ Eating disorder screening because of her eating habits and past history

Health Promotion/Disease Prevention Concerns 

Injury Prevention 

Traffic safety

Because Ms. Alexi has children: 

Fall prevention, Choking, Burn, Drowning, Safe sleep, Poison and Firearm Prevention

Diet 

•  Unhealthy meals for dinner→ Would recommend choosing healthier eating out options,  meal prepping or signing up for a meal program to make healthy balanced meals
  
•  Due to having Ulcerative Proctitis→ She should avoid alcohol, caffeine, foods high in fiber, raw fruits and vegetables and spicy foods and eat more Omega 3 fatty acids like fish oil. (​​https://www.webmd.com/ibd-crohns-disease/ulcerative-colitis/create-an-ulcerative-colitis-plan)
• Not eating enough→ Because of her past history of anorexia nervosa, her eating patterns and her stress, I am concerned about her not eating enough. So I would recommend she count her calories to make sure she is getting enough or ask her when she was in camp what helped her overcome anorexia and if she still uses those practices.

Exercise  

The patient is most likely not meeting current guidelines so I would encourage her to do more exercise at home. Since she used to have an exercise routine. I would discuss it with her and then see which parts she can go back to. I would also recommend going out for a walk after dinner or taking the older child to ride their bikes in the park or doing any family event the inquires movement.  I would encourage her to work out about 150 hours per week at moderate intensity.

Brief Intervention 

Substance Use- Ms. Burr currently drinks more than 4 drinks per week which is considered alcohol misuse. Before discussing with the patient her alcohol misuse I would Ask for her permission to talk about it. If she agrees I would then continue with the rest of the 5 A’s. Some questions I would as are:

• Assess: Do you think you are drinking too much? Do you feel like you are using alcohol to let go of your problems and stress?
  
• Advise : Do you know what risk factors are associated with alcohol use?   
• Agree:  We can discuss different treatment plans and together agree on a treatment plan. What do you think can be done instead of drinking to let off steam? Do you think having a therapist would help? Do you want to see a therapist
• Assist:  We can schedule a therapist together  that can fit your schedule and not take too much of your time.