Running head: HEALTH PROMOTION PROJECT

Senior Health Promotion Project

Cody Singleton
NUR 4113
Gerontological Concepts and Issues

On my honor, I have neither given nor received aid on this assignment or test, and I pledge that I am in compliance with the BSMCON
Honor System. Cody Singleton

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This client is a 74-year-old white male. He has been widowed for 10 years and lives alone. He requires glasses to see well, but
when he wears his glasses, his vision is quite good. However, his hearing presents difficulty. He wears hearing aids, but is still quite
hard of hearing in both ears. This was important to make note of early on in planning the education methods to be used for this client.
This client is in very good health overall. He is quite active, going on two walks a day. However, his diet leaves much to be desired.
His wife used to do all of the cooking and ever since she died, he usually eats some combination of packaged foods, fast foods and
microwaveable meals. This is a common adaptation to widowhood, especially in males (Touhy & Jett, 2012). This has resulted in
recent years in the development of hypertension. This is largely controlled with Dutoprol, a combination diuretic/beta-blocker.
However, if his diet continues unchanged, this hypertension will likely cease to be managed by this medication and could lead to
complications. Outside of this, the patient is in remarkably good health. With some modifications to his diet, this patient could benefit
from this high level of health and functioning for much longer than if he continues his current diet.
Two specific Healthy People 2020 goals are being focused on with this teaching plan. The first of these is OA-3. This goal
involves increasing the percentage of adults who report confidence in controlling a chronic condition (Centers for Disease Control and
Prevention, 2015). This is the most relevant Healthy People goal for this client. The chronic condition at work is hypertension. This
clients hypertension is currently well controlled, but in speaking with the client, he has expressed confusion at what exactly
hypertension is, how his medication affects it and how his diet affects it as well. Providing education in this area would likely reduce
this confusion and increase the clients confidence in his ability to control. If he knows what the problem is and knows that the actions

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he is taking are designed to control it and how, this confidence will increase. More tangentially, this teaching plan also involves goal
OA-5. This goal is focused on decreasing the number of adults with moderate to severe functional limitations (Centers for Disease
Control and Prevention, 2015). This is not yet a concern for this client. However, if his poor dietary choices continue unchanged, his
medication regime could become ineffective and he could suffer complications of his hypertension, such as a cerebrovascular accident
(CVA) or myocardial infarction (MI). These complications can have severe impacts on his level of function. Because of this, providing
education that hopefully changes his behaviors and limits his risk of a CVA or MI would be designed to preserve his function level.
The diagnosis chosen for this client is deficient knowledge regarding condition and self-care related to information
misinterpretation and denial of diagnosis as evidenced by statement of misconception and request for information (Doenges, 2010, p.
46). This diagnosis was chosen because the client clearly lacks important, basic information on hypertension and methods for self-care
of hypertension. This client demonstrated a misinterpretation of information by stating that, for example, just because I have high
blood pressure doesnt mean Im more likely to have a heart attack. This is problematic because obviously, there is a direct link
between hypertension and the likeliness of suffering an MI. The client also has downplayed the diagnosis and denied its importance,
stating that, my pressure isnt that bad. The client does have well controlled blood pressure, but it is controlled with the use of daily
medication. The client has also given statements of misconception. For instance, he has stated on numerous occasions, it doesnt
matter what I eat as long as I exercise. I walk a lot, so I can eat what I want. Exercise is a wonderful tool in combating hypertension,
so the client is correct in taking multiple walks each day and seeing this as a way of controlling his hypertension. However, exercise is

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most effective in conjunction with a proper diet, something this client struggles with. Finally, in spite of these statements to the
contrary, this client has expressed a desire for more information. He has made statements about doctors not taking the time to
thoroughly explain this issue. He has also pointed out that hes been quite healthy most of his life, lacking any real health issues to
educate himself on. He has stated that, I know I should probably make some changes. If I knew why I was making changes and
trying to eat better, I would probably stick to them better. Obviously, this client is in need of education in regard to his hypertension
and the role of his diet in managing his hypertension.
I had two short-term outcomes for this client. I planned to engage in four teaching sessions, and by the end of two of these
sessions, the client would be able to explain the basic mechanism of hypertension. By the end of the fourth session, he would also be
able to explain how his medication and diet affect his hypertension. I would measure this by his ability to confidently recall the
information I had provided. I would deem that these outcomes had not been met if it seemed like the client was struggling too much to
share the information or if he demonstrated that he misunderstood the teaching.
One long-term goal was pursued with this client. This will hopefully be followed up by more ambitious goals designed to
further improve this clients diet, but this long-term goal was deemed a good starting point. At the end of two months, the client will
demonstrate that he is consuming half the amount of bad foods (based on a list we composed together, consisting of fast food,
packaged meals, etc.) that he was previously consuming. This will be measured by the content of a food journal this client has

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promised to maintain. This will require a special effort from this client because he generally lacks a support system, so it may be
necessary to personally check in with this client to see if he is maintaining this food journal.
This teaching plan was mutually developed through the use of good communication techniques. I left behind all pre-conceived
ideas of what this client needed to know and how I would teach these topics. I listened intently to his concerns and tried to determine
where he required the most education. To clarify further, I asked the client if I was correct in determining that he wanted teaching on
hypertension, his hypertension medication and his diet. He affirmed that these were areas where he needed teaching. In addition to
this, I observed this patient and how he interacted with the environment. In conjunction with the survey of preferred learning methods
provided with this assignment, I determined that he was a kinesthetic and visual learner. As before, I offered this information to him to
verify whether or not this is how he learns best. He verified that he has always learned best by seeing and doing and that this is even
more applicable as his hearing progressively declines. In this manner, we determined the subjects to be covered and the method to be
used in doing so.
On October 5th, I utilized an infographic from the CDC to offer basic information on hypertension, its effects on the body, and
ways to control it (Centers for Disease Control and Prevention, 2014). I allowed the client to first read it by himself. I then walked him
through this material, pointing out sections particularly relevant to him, such as the increased risk of CVA and MI in those with
hypertension. I solicited any questions, answered them to the best of my ability and left the material with him to study over the next
week.

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On October 12th, I used two videos from a website named Khan Academy. This is a website I have used before as a supplement
to my studying and personally knew the information to be accurate and presented in an easily digestible fashion. I played the videos
Hypertension effects on the blood vessels and Hypertension effects on the heart (Khan Academy, 2012). These videos are short
and packed with information presented in a format that is easy to understand. These videos also offer subtitles at the bottom of the
screen, which is important for this patient in light of his hearing difficulties. These videos provided more in-depth information on how
exactly high blood pressure changes the shape and function of the blood vessels and heart in ways that increase the risk for CVA and
MI among other complications. As before, I solicited any questions before asking the client to explain the basics of hypertension and
how it affects the body.
On October 19th, I used two graphics obtained from www.cardiachealth.org to teach this client about how his medication,
Dutoprol, affects his hypertension. This drug is a combination diuretic/beta-blocker. These graphics clearly explain that diuretics lower
blood pressure by ridding the body of excess water through increased urination and that beta-blockers lower blood pressure by
slowing the heart rate (Cardiac Health, 2015). The client seemed to remember more about his medication then he previously thought,
stating that, I know it helps me get rid of water and slows my heart down. However, he now seemed to make the connection
between the mechanisms of hypertension and why the effects of Dutoprol would lower his blood pressure.
In our final session on October 26th, I first used an infographic from the American Heart Association that explains how sodium
increases blood pressure (American Heart Association, 2013). I then shared another resource from the same organization that listed

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some foods that may be unexpectedly high in sodium (American Heart Association, 2013). This seemed to make a big impression on
this client. He stated that he was not aware of just how central sodiums role is in hypertension. He also shared that it made intuitive
sense to him that salt holds on to fluid. The more fluid you have, the higher your pressure is. When your fluid gets too high, some of
these other bad things can happen.
This client was very easy to plan for in terms of choosing teaching aids. I knew that trying to lecture could lead to a lot of
misunderstandings and confusion. In going the visual route, I found a wide range of options at my disposal to teach about
hypertension, antihypertensive drugs and dietary factors in controlling hypertension. With hypertension being such a widespread
problem worldwide, there have already been countless attempts at educating (Makridakis & DiNicolantonio 2014). I stuck to visual
mediums both graphics and video in an effort to play to this clients strength as a visual learner. Some of these materials discuss
things in a way that may have been difficult for a person of lower intelligence or level of function to understand. However, this client
showed no signs of dementia or confusion and operated at a high level of intelligence. Because of this, he was able to digest all the
information I provided him.
Both short-term goals were met in the specified time frame. These were both quite easily accomplished. After two meetings,
when asked to explain the basics of hypertension, the client stated that, too much pressure on the blood vessels and heart can stress
them out and change the way they work. If blood vessels are damaged, they do not work as well. If they change too much, this can
mean the blood supply is cut off or it can even mean a blood clot. This showed a basic understanding of how hypertension can lead to

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a CVA or MI. After the fourth meeting, the client was able to explain that, my medicine works by making me pee out water if I have
too much in me. The other part of it makes my heart beat slower and takes some pressure off of my heart and vessels. This
demonstrated to me that he understood the effect of his diuretic/beta-blocker medication. Also, he stated, I need to cut back on readymade meals and junk food. That stuff has a lot of salt in it. That salt likes to hold on to water and this puts too much pressure on my
heart and vessels. This demonstrated to me that the fundamental idea of sodiums effect on blood pressure and the need for changes
to the diet were understood by my client.
In regard to the long-term goal, this patient has determined to fill out a food journal in the ongoing months. He has no family
around him most of the time and lives alone, so he may require motivation to keep up with the food journal. However, if he does this,
it should provide a reminder to eat a more heart-healthy diet.
Nursing outcomes were all tertiary in nature. This client already has hypertension and takes medication for it. These outcomes
were centered around fostering an understanding of this condition, an understanding of the medication he takes for it and dietary
changes he can make to halt the progression of this condition. These are all tertiary in nature.
This was quite an easy client to teach to. The only true limitation was his hearing difficulty, which was easily counteracted
with the use of visual instruction instead of verbal. Outside of that, he possessed more than enough intellect to grasp the material and
apply it to his situation. The teaching ended up being very effective and as seen by the quotes provided above, this client demonstrated
at least a basic understanding of the material and its relevance to his situation.

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I honestly cannot think of a better way to teach this client or ways in which strategies could have been altered. I do know that
this teaching strategy will not work for every patient. Not all people are visual learners and not all clients will be coherent or
intelligent enough to comprehend the material being presented. Verbal instruction may need to be utilized if the clients are not visual
learners. Material may need to be broken down into small segments or repeated more often in more frequent teaching sessions for
demented or confused patients or even those just lacking somewhat in intelligence. However, these materials and this method seemed
to work perfectly for this client.
I thought this was a wonderful project and a great opportunity. I was able to use a number of different resources to provide
teaching on an important topic that has major relevance for this patients wellbeing. This experience makes me more excited to engage
in patient teaching in the future and gives me more confidence in doing so. The most important thing I learned is that teaching must be
tailored to the one doing the learning, not the teaching. Nurses must meet clients where they are in terms of learning preferences and
intellectual ability, not the other way around.

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References
American Heart Association. The Effects of Excessive Sodium on Your Health and Appearance. (2013). Retrieved from
http://www.acediabetes.org/wp-content/uploads/2013/09/salty-health.jpg
American Heart Association. The Salty Six. (2013). Retrieved from http://www.acediabetes.org/wp-content/uploads/2013/09/saltysix.jpg
Cardiac Health. Beta Blockers. (2015). Retrieved from http://www.cardiachealth.org/heart-disease-treatment/heart-diseasemedications/blood-pressure-medications/beta-blockers
Centers for Disease Control and Prevention. Older Adults. (2015). Retrieved from http://www.healthypeople.gov/2020/topicsobjectives/topic/older-adults/objectives
Centers for Disease Control and Prevention. A Snapshot: Blood Pressure in the U.S. (2014). Retrieved from
http://www.cdc.gov/bloodpressure/infographic.htm
Doenges, M.E., Moorhouse, M.F., & Murr, A.C. (2010). Nursing care plans: Guidelines for individualizing client care across the life
span (8th ed.). Philadelphia, PA: F.A. Davis Company.
Khan Academy. Hypertension Effects on the Blood Vessels. (2012). Retrieved from https://www.khanacademy.org/science/health-andmedicine/circulatory-system-diseases/hypertension/v/hypertension-effects-on-the-blood-vessels

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Khan Academy. Hypertension Effects on the Heart. (2012). Retrieved from https://www.khanacademy.org/science/health-andmedicine/circulatory-system-diseases/hypertension/v/hypertension-effects-on-the-heart
Makridakis, S., & DiNicolantonion, J.J. (2014). Hypertension: Empirical evidence and implications in 2014. Open Heart, 1(1). doi:
10.1136/openhrt-2014-000048
Touhy, T. A. & Jett, K. (2012). Ebersole and Hess toward healthy aging: Human needs and nursing response (8th ed.). St. Louis,
MO: Elsevier.

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Appendix

PART I of Senior Health Promotion Project

Transcultural Assessment Tool
Data Analysis Sheet with Nursing Diagnosis/Outcomes
Assessment Data Collection Tools
Survey of Learning Methods

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Transcultural Assessment Tool

CLIENT INFORMATION
Initials: T.G. Age: 74 yo Gender: Male Race: White

OTHER INFORMATION
Students Name: Cody Singleton

Ethnicity: Caucasian

Dates of Client Visits: October 5th, October 12th, October

19th, October 26th

Length of time in country (if applicable): Since birth

Past or current jobs: Truck driver

Location of clients home:

Apartment

Urban

Rural

House

Does the client have any transportation issues? Yes

No
Unsure

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COMMUNICATION
How does client like to be addressed?
Formal Name
English Skills:
Understand

Speak

Read

First Name

Write

SPACE
What is the clients degree of comfort with personal
space? Does client move away if space is invaded?
Client prefers personal space, but due to hearing
difficulties, tolerates closeness from others. Will not
move if others move close.

Other Languages spoken: N/A

Will a Translator be needed?
Uncertain

Yes

No

Speech Impairments: None

Hearing Impairments: Difficulty hearing bilaterally

Does the client have preferences for gender of his/her

healthcare workers? If a gender preference is present, it
was not stated.
Does the client have preferences for ethnicity of his/her
healthcare workers? Caucasian

Vision Impairments: Wears glasses

Any communication styles/techniques that seem to make
client feel
uncomfortable? [e.g. eye contact, touch, silence,
hand gestures]
Dislikes being touched outside of a handshake. No
other techniques that make this client uncomfortable.
Is it necessary to vary the technique and style of
communication with the client to accommodate his/her
cultural background? No

Other comments related to Communication or Space:

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SOCIAL ORGANIZATIONHealth Beliefs

Clients Perception of his/her normal state of health:
Poor
Fair
Good
Excellent
How does the client define good health? Client stated
I know other people my age are in the hospital or falling
a lot, and that hasnt happened to me. So Id say Im in
pretty good health. I feel good every morning when I
wake up.
How does the client define bad health? Bad health is
being sick or in the hospital. I guess if someone isnt able
to do what they want or need to do you know, take care
of themselves theyre in pretty bad health, too.
What home remedies does the client use? Client did not
report the use of any home remedies
Any special practices that hasten healing and recovery?
Client is very religious and believes that his belief and
faith hasten his recovery and healing when he is ill
What does the client do to promote personal good
health? The client reports that he walks frequently,
including walking his dog once a day and walking to a
nearby store once a day. He appears to be physically
active

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SOCIAL ORGANIZATIONFamily
Current Living Situation: Single
Other

Partnered

Married

Number of Children: Two by birth, two by

marriage________
Parents/Siblings Living? One living brother; both parents
are deceased
What is the clients role in his/her family? Client lives
alone and only sees family on holidays twice each year
How would the client classify the decision making in the
family: patriarchal (male-led), matriarchal (female-led),
or egalitarian (equal between genders)? Patriarchal, as
he is the only member of his immediate family. When his
wife was alive, he was responsible for supporting the
family and made decisions then as well.
Does the client make his/her own personal decisions
about health care or should the family be consulted?
Yes, the client exhibits no signs of dementia and makes
all his own personal decisions regarding health care.
Does the client want to have any family members
present during the teaching project? No

Does the client believe in prayer or supernatural forces

or a Supreme Being? If so, how important are these in
the maintenance of good health? Yes, this client is a very
strong believer in the power of prayer and the positive
effects his faith has on his personal health. These beliefs

Does the client have any illnesses that he/she does not
want the family to know about? No

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ENVIRONMENTAL CONTROL
Locus of Control (check all that apply):
Client feels in control of his/her environment
(internal)
Client believes his/her decisions are important
for determining health (internal)
X
Client has a strong belief in fate, luck, or chance
(external)
X
Client believes that illness is Gods will
(external)
Locus of control is:

Internal

External

TIME
Orientation to time (check all that apply)
Client relies on traditions and rituals to pass
cultural heritage to successive generations
(past)
X
Client lives for the here and now (present)
Client plans extensively for the future
(future)
X
Client does not tend to make appointments
(past)
Client finds it acceptable to be late for
X
appointments (present)
Client finds it unacceptable to be late for
appointments (future)
Time Orientation is:
Future
Sleeps:

Poorly

Past
Fair

Present
Very Well

BIOLOGICAL VARIATIONS
Pertinent Physical Assessment/Review of Systems Data
Height 62
Weight 220 lbs (100 kg)
BMI 28.2
Body Type: well-developed well-nourished
cachectic
obese
BP: 116/76
Skin
Color: Appropriate for race
Gait: Steady
Skin problems: None observed Incontinence problems:
None reported
Use of Assistive Devices for Mobility: N/A
Get Up and Go Test:
Pass
Fail
Recent Falls: Never
Any confusion: None observed Forgetfulness: Normal
level
Client uses:
Hearing aids
Glasses
Dentures
Food or Medication Allergies: NKA
Family Medical History: Father and mother both died of
heart disease. Brother has hypertension.
Current Medical Conditions: Hypertension (controlled)
Past Medical History: No surgeries or past medical issues
outside of current diagnosis of hypertension.
Past Surgical History: None
_________________________________________________________
Current Medications: (Put a * by any meds that are on
BEERS List)
Medication
Dosa
Action
ge
Dutoprol (combination 25
Diuretic and betametoprolol/hydrochlor
mg/1
blocker for control of

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Assessment Data Collection Tools

The following assessment tools are to be completed on your client:
Mini-mental (MMSE) or Mini-Cog (If is frustrated easily or has dementia): 26/Normal
Geriatric Depression Scale (GDS): 4
Katz ADL: 6/Independent
SPICES (If a client has any of the six geriatric syndromes, choose an appropriate assessment tool for
further evaluation of the client problem.): No evidence of any six of these geriatric syndromes
In addition, the student will choose an additional assessment tool to complete, related to a client
problem that has been identified in the assessment data. You may not use any of the above assessment
tools, including SPICES, as your additional assessment tool. You MUST identify a different client problem
than above and choose a different assessment tool, ie: hearing screen, alcohol screen.
Alcohol screen: 3/ Possible alcohol problem

DATA ANALYSIS SHEET

HEALTH PROMOTION AND TEACHING NEEDS: based upon your discussions with the client and the
information found above, identify
Topic(s) that the client would like to/ needs to learn about:
Proper diet, especially in regard to controlling blood pressure
The effect drinking can have on his blood pressure

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How do these topics relate to Healthy People 2020 and/or USPSTF:

Healthy People objective OA-3 has to do with increasing the proportion of adults who report confidence in controlling
a chronic condition. This applies specifically to this patient and his history of hypertension. OA-5 has to do with
reducing the number of adults with moderate to severe functional limitations. This is not remotely a problem for this
client, but thats why it is still important to engage in prevention. Taking actions now to prevent functional limitations
down the road improves health outcomes.
Variables which may impact the clients learning and how this can affect your teaching plan (SYNTHESIZE &
remember to discuss these in your paper):
Economic: The client is comfortably retired and presents no economic challenges to teaching.
Cognitive: The client scored high on the MMSE and has shown no signs of dementia or confusion, leading me
to believe there are no cognitive hurdles to teaching.
Hearing/sight impairments: The client does wear glasses, but when he wears these, he sees very well. He is,
however, very hard of hearing in both ears, presenting difficulty in verbal instruction.
Sensory-motor capabilities or deficits: No sensory-motor deficits noted.
Education Level: Client has a high school education, but there would be reason to think there would be a lack
of intellectual ability to understand this
topic.
Family System/Support: The client lives by himself and does not see family often. However, he appears to
suffer no dementia or confusion and could be
expected to reliably track his own progress for long-term goals.

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Significant variables identified above (communication, space, social organization, environmental control,
biological): As stated above, the only real
challenge this client presents is that he is quite hard of hearing,
necessitating the use of non-verbal education methods.

NURSING DIAGNOSIS:

Nursing diagnosis for the client that addresses their health promotion learning needs, including related to
and as evidenced by. You also may use at risk for nursing diagnosis.
Deficient knowledge regarding condition and self-care related to information misinterpretation and denial of
diagnosis as evidenced by statement of misconception and request for information.
Desired Measurable Short-term Outcome(s) with time frame and detailed methods for evaluating outcomes:
Verbalize understanding of disease process and treatment regimen. Time frame: after two meetings. Method for
evaluating outcomes: ask the client to demonstrate a basic understanding of hypertension.
Describe reasons for therapeutic actions and treatment regimen. Time frame: after four meetings. Method for
evaluating outcomes: ask client to explain the effect of his medication and his diet on his hypertension.
Desired Measurable Long-term Outcome(s) with time frame and detailed methods for client to evaluate outcomes:
Reduce the consumption of high-sodium foods by half. Time frame: Two months. Method for evaluation: Keeping a
food journal and comparing it to previous behaviors.

Survey of Preferred Learning Method(s) *

DIRECTIONS: Read the following statements. If the statement is mostly true for you, then circle the letter
that follows the statement.

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1. Once Ive done something, then Ive got it.K

2. I must look directly at the speaker to understand him or her..V
3. My handwriting is quite good.K
4. I can spell words out loud better than when I have to write them downA
5. If someone asks me to spell a word, I have to write it down to answer..V
6. I would rather listen to tapes then view slidesA
7. I remember a lecture better than what I read..A
8. I understand material better if I read out loud.....A
9. I am often the last person to notice that something has been added to a room...A
10.
I learn better if I see and hear the material at the same time.V&A
11.
I often need to ask people to repeat what has just been said...V
12.
Sometimes in a lecture I tune out even when I am really trying to pay attention...V
13.
I use my hands a great deal when I speak...K
14.
I can tell if Im doing a new physical skill right by the way it feels...K
15.
I would rather demonstrate how to do something than explain it...K
16.
I have trouble remembering unless I write things down...V&K
17.
A page full of print is too much for me to read...A
18.
The easiest way(s) for me to learn something is to:
a. Read itV
b. Hear it.A
c. Try itK
d. Write it in my own words...K
e. Explain it to someone..A
f. Draw a picture or diagram of it...K
TOTAL EACH OF THE LETTERS YOU CIRCLED: Vs: 6 As: 1 Ks: 6
Vs indicate visual method; As indicate auditory method; Ks indicate kinesthetic method. Add
up the number of As, Ks, and Vs. The highest total indicates your preferred learning method.

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*Adaptation of the Swassing-Barbe Modality Index

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