NR 305 Discussion Assessment for Health Promotion

I would want to collect more subjective and objective data from Maria. As for subjective, I would want to hear her describe her emotional state. (i.e. happy, stressed, sad) I would want to collect data regarding her personal health history and her family health history. It would also be helpful to know her values and beliefs in addition to her family relationships and support system. Lastly, I would want her to describe her daily routine, bedtime routine, and a typical eating routine. Additional objective data I would want to collect would be her current weight, blood work, including cholesterol and blood glucose, skin turgor, and reflexes.

I would identify her sleep deficit and caffeine use as immediate health concerns. Her 14 lb weight gain is definitely a risk factor for heart and circulation issues. I would also consider the amount of work that she assumes responsibility for is a risk to her sense of well being.

In order to promote health and wellness for Maria, we will first have to identify ways her family can contribute to lightening her stress load. Maria could meet with her family members and find ways to distribute the household work. This could allow her time for relaxation, studying or light exercise. We could also discuss teaching her family the recipes that she likes to cook. This would also provide quality time with her family, thus relieving the stress of feeling she has to do it all. We could explore technology to help her relax, such as apps on her phone for 10 minute meditations, or using the reading feature on her electronic school books to listen to her reading assignments while taking a leisurely walk. Lastly, we could explore strategies to promote a more restful sleep. In my office setting, we often discuss sleep hygiene, which can help improve one’s psychological and physiologic well-being. (Jaffe & Engelke, 2018)

My nursing diagnosis for Maria would focus on her sleep deficit. Therefore, using the formula in our textbook, I would write an actual nursing diagnosis. (Janet R. Weber Rn Edd & Kelley, 2018, Tables 5-1) My nursing diagnosis for Maria would be, Sleep Deficit, related to demands of household and schoolwork, as manifested by average sleep time of 5 hours, and patient’s dependence on caffeine to, “keep her going”, and “stay awake” throughout the day.

References

Jaffe, S., & Engelke, Z. (2018). Patient Education: Teaching Adult Patients Good Sleep Hygiene (Sleep Habits) Techniques (D. Pravikoff, Ed.). CINAHL Nursing Guide.

Janet R. Weber Rn Edd & Kelley, J. H. (2018). Health assessment in nursing (6th ed.). Lww.

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I imagine many of you can relate to Maria’s scenario in one way or another! I know I can. For that reason, it would be important to me to carefully consider the questions I ask and not assume I understand what she is going through. I look forward to reading your thoughts on this week’s discussion!

Please remember that this is a nursing assessment class so while mentioning the labs or consults is okay, this is not in our scope of practice to “order”… unless there are protocols in your facilities you might discuss. I am looking for nursing assessments and nursing interventions when asked.

Remember that this week, you may start posting for credit on Sunday 7/12. You need a minimum of two posts due Sunday 7/19 by 11:59 pm MT.

Here are a few tips:

Per the rubric, you need to cite one class source and one outside source sometime within your posts.
1. Also, your response should add new information to further the discussion rather than repeating what your peer stated or saying: “I agree”.
1. Responses should be more than 60 words and should not contain a quotation that is more than 25% of your post. When you use too many quotations, this raises flags for plagiarism. You should have a maximum of one citation per every four sentences and a maximum of one direct quote per post.
1. You also need to make sure you cite your references in your writing and not simple list them at the end (I hope this makes sense). See example below:

As stated by Professor Wills, be sure that you don’t simply list your references but also include them in your writing.

Following the tips mentioned above will help you maximize points. I look forward to more stimulating discussions!

Reference:

Professor Wills, Chamberlain College of Nursing

Maria is stressed just like many nursing students who are also mothers. She is Hispanic, eats lots of foods, drinks a lot of caffeine including diet soda. I would like to know how many diet colas Maria drinks per day to start. I would also ask about family history of diabetes and hypertension. I would want to check Maria’s blood sugar randomly. I would also want to know more about sauces, spices, fat content, and amount of carbohydrates in the foods Maria is eating.

I have a concern for hypertension and diabetes based on lifestyle, heritage, and recent weight gain. Hispanic people are at risk for hypertension and comorbidities with that hypertension like diabetes (Patel, et al, 2012).

Maria would benefit from seeing a dietician who could pinpoint diet modifications needed. A food journal for maybe 3 days would help highlight what exactly is being consumed. Inventory of food intake is great accountability. Maria could download the lose it app to track food and break down food groups.

For Maria, it is important to focus on diet planning about “lowering sodium” in foods and getting involved in an exercise program (Patel, et al, 2012). Her blood pressure is high, maybe due to added stress she is cooking more comfort foods or eating more. Maria can involve the family or get involved in community events for weight loss and health promotion (Patel, et al, 2012). Maria could benefit from stopping her diet soda intake altogether and benefiting from snack with energy and more water intake. Taking inventory can help in “prevention and wellness” for the entire family (Patel, et al, 2012).

Nursing diagnosis:

“Readiness for enhanced health management” r/t weight gain of 14 lbs. as manifested by concern for risks to health. (Weber and Kelly, 2018).

References

Patel, N. K., Wood, R. C. Espino, D. V. (2012). Cultural considerations: Pharmacological and nonpharmacological means for improving blood pressures control among Hispanic patients. International Journal of Hypertension. Pp 1-6. http://dx.doi.org.chamberlainuniversity.idm.oclc.org/10.1155/2012/831016

Weber, J.R. & Kelley, J.H. (2018). Health assessment in nursing (6th ed.). Philadelphia, PA: Wolters Kluwer.

1: Further objective data I would want to obtain would be body weight, height, BMI, and potentially labs such as cholesterols and triglycerides. Subjective data that I would want to get from the patient would be family health history. When obtaining the family health history, the patient should “include as many genetic relatives as possible” (Weber & Kelley, 2018). Weber and Kelley also stated that “such thoroughness usually identifies those diseases that may skip a generation (2018). For example, is there a history of heart attack or diabetes, what about obesity, or hypertension? Further, I would ask about smoking status, ways patient copes with stress, and what her typical meals include. Past medical history from the patient is also an important piece of information, does she take any medications, has she had any major surgeries, or does she have any chronic illnesses?

2: Jane Delgado stated “Hispanics have specific predispositions and risk factors concerning heart disease” (2014) in her article discussing Hispanic health. She went on to explain that Hispanics are also at an increased risk for diabetes as well (Delgado, 2014). Aside from her race, risk factors Maria has for heart disease would be her level of stress and potentially her weight. Depending on what Maria’s diet consists of, she could also be at risk for high cholesterol. Her recent weight gain, lack of sleep, and consumption of caffeine are all concerning.

3: Some points of health promotion that could be utilized are educating Maria on the importance of self care. It should be explained that despite having a busy life, not taking time for relaxation and yourself can lead to long term health problems. I would also want to provide education on the importance of a healthy diet. It is possible that Maria may need a referral to a dietician or to go see her primary care physician. Aside from her diet and stress, her lack of sleep would be something to discuss. Sleep hygiene should be explained. Maria may also need referral to a counselor to help her manage her stress and busy lifestyle, maybe the college has one on staff?

4: Imbalanced nutrition (more than body requirements) r/t increased caloric intake, sedentary lifestyle.

Stress overload r/t increased work, educational, and family responsibilities.

References:

Weber, J., Kelley, J., (2018). Health Assessment in Nursing 6th ed., pg 23.

Delgado, J., (2011) Hispanic Health, National Alliance for Hispanic Health, 136(94).

I totally agree. Lack of sleep is a big issue for most moms. We try to cram 30 hours of work into a 24-hour a day. Lack of sleep creates so many problems with the body such as brain fog, which can hinder school progress, reaction time in a car, and the ability to stay away from sickness. It is amazing that with the right amount of good quality sleep how well the body takes care of us as a whole. I think I would approach her last with adding exercise because she already exhibits problems with what she has to do daily, but maybe introducing a 3-5 minute meditation to start to help her take a time out to reassess her day would be helpful.

Also, Caffeine is a stimulant and works on the central nervous center. Caffeine increases heart rate, blood pressure, nervousness and agitation leading to increased anxiety levels. Caffeine can also cause insomnia, not having sleep can increase anxiety. “Consuming too much caffeine when you are already stressed is like adding fuel to the fire: you are simply revving up your body’s stress response” (Janes, H. 2013). Limiting Maria’s caffeine intake would be a great start at reducing her anxiety level.

Janes, H. 2013 Retrieved from www.stressbusting.co.uk/caffeine-and-anxiety

What additional assessment data (subjective and/or objective) would you like to gather from Maria?

-Additionally, to the above information, I would ask Maria for any past family health history to see what she was at risk for. Also, it would be important to know subjectively of her daily routine. This can be done by having her use a journal for a week and noting her everyday lifestyle. At that point we could possibly work together to find time that she can use for herself to do stress relieving activities. Some objective data would include breath sounds, heart sounds, and checking for any edema.

What actual health concerns and risk factors have you identified?

-Having a lifestyle routine full of non-stop activity places anyone at risk for many things. For example, Maria’s BP is high at 148/90 which places her at risk for heart disease. With the increase in weight also increases many other risks. According to Hopskins medicine, inactivity may increase your chances of developing type 2 diabetes, depression, and/or anxiety.

What are some opportunities to promote health and wellness for Maria?

– Some ways that Maria can promote health and wellness is to find even thirty minutes out of each day for her own self-care. This can include doing something relaxing like reading, yoga, walking, or even just taking a bath. It is also very important to at least exercise at the minimum of three days a week for thirty minutes or more. With the use of the daily journal, it will give Maria a chance to really be able to schedule time for herself.

Write one nursing diagnosis for Maria (actual, wellness or risk), based on one of the health concerns or opportunities you have identified. (Please use one of the formulas outlined in the text and lesson!)

– Risk for decreased cardiac output r/t hypertension

https://www.hopkinsmedicine.org/health/conditions-and-diseases/risks-of-physical-inactivityLinks to an external site. Retrieved July 13, 2020.

Weber, J., Kelley, J., (2018). Health Assessment in Nursing 6th ed., 2-3.

After reading about Maria, I would like to obtain some more subjective data from her including both her personal and family medical history including any history of high blood pressure. What medications she takes both prescribed and OTC and if she smokes, consumes any alcohol or takes any illicit or recreational drugs. I’d like to ask her if she experiences any headaches, visual changes, or nausea due to consumption or decrease in consumption of caffeine. I would like to know if and how much water she drinks. Due to her excessive caffeine intake, I’d ask her if she has experienced any increased irritability, nervousness, or anxiety. I would ask what time of day she stops consuming caffeine. I’d ask if she has noticed any changes to her bowel or bladder habits such as urinary frequency, bladder weakness, loose stools and when her last bowel movement was. I would ask her to tell me more about what she typically eats in a day including snacks. I would ask her to describe her nightly routine regarding sleep, if she has trouble falling and/or staying asleep and if she is aware of any factors that may be interfering with her sleep. I would also like to ask her about her caregiver role, her spouse’s role, cultural/spiritual beliefs, and support systems. I would ask what her coping mechanisms are when dealing with stress. For objective data obtain her current height and weight to calculate her BMI using the standard adult body mass index (BMI) chart (Weber & Kelley, 2018). I would perform a head-to-toe assessment focusing on her overall appearance, eyes, mouth/mucous membranes, signs of fatigue, skin integrity/turgor and auscultate her heart, lungs, and bowel sounds.

Identifiable health concerns and risk factors are Maria’s sleep deprivation, increased resting heart rate and elevated blood pressure. I’m concerned about her excessive consumption of caffeine. I’m also concerned about her risk for caregiver stress and lack of sleep and inattentiveness to self-care. Opportunities for health promotion are many. I would encourage Maria to keep a separate food and sleep journal so she can physically see what she is eating and drinking in a typical day and last time she eats/drinks and can keep track of when she falls asleep, wakes up, and how rested she feels. I would also suggest using a phone app to record these things to offer a more convenient option. I would then educate Maria on the effects of caffeine on health, mood, weight and sleep. Sleep deprivation is a known side effect of caffeine consumption (O’Callaghan, 2018). Maria reports she uses caffeine to help her “stay awake” and although caffeine may increase performance, it is usually consumed by those who are fatigued and in turn disrupts their sleep pattern (O’Callaghan, 2018). I would encourage Maria to avoid or significantly limit her consumption of caffeine and if she is unwilling to stop drinking caffeine altogether, I would encourage her to stop drinking it at least 4-6 hours before bed to help ensure better sleep. I would also encourage her to stop eating at least 2-3 before bed to assist with weight loss and better digestion prior to sleep. I would encourage her to increase her consumption of water and stress the importance of proper hydration. I would encourage her to discuss her caregiver responsibilities and stress with her family and suggest involving them in sharing in some of tasks. Since her children are school-aged, they can assist her around the house by dividing chores and may enjoy helping her prepare meals also as a way of both how to destress and lightening her load by putting a spin on the task as quality family time. Educate the client about the importance of self-care and provide techniques for relaxation. I would encourage her to incorporate at least 20-30 minutes a day to exercise by walking, possibly after dinner with family and/or stretching prior to bed help her body wind down from the day before sleeping. The nursing diagnosis I would apply to Maria’s situation would be: Fatigue related to caregiver/student responsibilities and over consumption of caffeine as evidenced by patient appearance and verbal reports of dissatisfaction of health status and poor sleep pattern

O’Callaghan, F., (2018). Effects of caffeine on sleep quality and daytime functioning. Risk Management and Health Care Policy 11, 263-271.

Weber, J.R., & Kelley, J.H. (2018). Health assessment in nursing (6^th ed.). Wolters Kluwer.

With regard to additional assessment data, first, I would repeat Maria’s blood pressure to confirm that this number is accurate; then I would ask Maria about her previous weight and measure her current height and weight. If she was underweight in the past, a 14-pound weight gain, over the course of one year, may not be a problem. However, if this recent weight gain puts Maria near or in the overweight category, then her health may be at risk. I would ask Maria about family medical history, her own past and current medical history, surgical history, allergies, immunizations, current medications, and any current symptoms. I would then perform a head-to-toe assessment with a focus on any areas where Maria is experiencing symptoms. I would also ask about Maria’s current psychological state: How does she feel about her current schedule? Is she overwhelmed or anxious? In addition, I would gather information about Maria’s current support system: Is her spouse supportive, and would it be possible for her spouse to help with some of Maria’s responsibilities at home? I would also gather more detailed information about Maria’s eating habits: when she eats (times of day), what she eats (home-cooked meals or fast food), how often she eats, etc.

If Maria’s blood pressure is indeed accurate, then Maria is clearly hypertensive at this time. Her increased blood pressure could be related to increased stress and/or increased consumption of caffeine. A family history of hypertension could also put Maria at risk. If Maria’s weight gain continues, she could be at risk for developing a nutrition imbalance; this can put her at risk for heart disease, diabetes, and impaired physical mobility. In addition, if Maria does not find a way to manage her stress and get more sleep, this will contribute to the aforementioned health concerns and could lead to other health concerns and burn out.

Maria’s increased systolic blood pressure, consumption of multiple caffeinated beverages per day, recent weight gain, hectic schedule, insufficient amount of sleep, and lack of stress relief all provide opportunities to promote health and wellness. After establishing Maria’s preferred learning style and drawing on any knowledge she may currently have on these subjects, I would provide Maria with information that she can understand and apply to her life. Keeping in mind the importance of proper verbal and non-verbal communication, I would present this information in a non-judgmental manner with a focus on helping Maria achieve optimum health (Weber & Kelley, 2018). I would teach Maria about the risks and complications associated with hypertension and how it can be managed or prevented. I would council Maria about the importance of adequate water intake and a balanced diet; I would also educate Maria about the dangers of increased caffeine and sugary drink consumption and how these can worsen hypertension and put her at risk for other health issues. If possible, I would refer Maria to a registered dietitian or nutritionist. I would try to help Maria understand the importance of stress management by showing her how stress has impacted her health so far and how it can continue to affect her future health if it is not addressed. I would also provide Maria with suggestions for time management, and perhaps a weekly schedule template, so that Maria can plainly see how her time is spent and where it may be possible to include more time for self-care and sleep. I would also encourage Maria to talk with her spouse and other family members, if possible, so that she can share what she is going through and perhaps get some help from them.

Quite a few nursing diagnoses can be applied to Maria’s case. I have decided to focus on stress management, as I have found this to be an area that is frequently overlooked or under-addressed. By no means am I prioritizing this area of diagnosis over any other, this is merely the one I chose to use. The diagnosis I chose is as follows: Stress Overload r/t increase in educational responsibilities compounded with household responsibilities AMB decreased hours of sleep and stated inability to find time to relax and de-stress.

References:

Weber, J.R. & Kelley, J.H. (2018). Health Assessment in Nursing (6th ed.). Wolters Kluwer.

NR 305 Discussion Assessment for Health Promotion