NR 305 Week 2 Discussion Assessment for Health Promotion
This week’s graded topics relate to the following Course Outcomes (COs).
CO 1 – Utilize prior knowledge of theories and principles of nursing and related disciplines to explain expected client behaviors, while differentiating between normal findings, variations, and abnormalities. (PO 1)
CO 2 – Recognize the influence that developmental stages have on physical, psychosocial, cultural, and spiritual functioning. (PO 1)
CO 4 – Identify teaching/learning needs from the health history of an individual. (PO 2)
As the school nurse working in a college health clinic, you see many opportunities to promote health. Maria is a 40-year-old Hispanic who is in her second year of nursing school. She complains of a 14-pound weight gain since starting school and is afraid of what this will do to both her appearance and health if the trend continues. After conducting her history, you learn that she is an excellent cook and she and her family love to eat foods that reflect their Hispanic heritage. She is married with two school-age children. She attends class a total of 15 hours per week, plus she must be present for 12 hours of labs and clinical. She maintains the household essentially by herself and does all the shopping, cooking, cleaning, and chauffeuring of the children. She states that she is lucky to get 5 hours of sleep per night, but that is okay with her. She drinks coffee all morning to “keep her going.” She lives 1 hour from campus and commutes each day, and often drinks diet cola to “stay awake.” When asked what she does to relax and de-stress, Maria states she “doesn’t even have time to think about that.”
Maria’s vitals today are as follows; T 98.6, R 20, HR 88, BP 148/90
Using the lesson and text as your guide, answer the following questions.
What additional assessment data (subjective and/or objective) would you like to gather from Maria?
What actual health concerns and risk factors have you identified?
What are some opportunities to promote health and wellness for Maria?
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!)
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.
Weber, J.R. & Kelley, J.H. (2018). Health Assessment in Nursing (6th ed.). Wolters Kluwer.
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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 (6th ed.). Wolters Kluwer.