Running head: SENIOR HEALTH PROMOTION PROJECT

Senior Health Promotion Project

Samantha J. Hasenzahl
Bon Secours Memorial College of Nursing
Honor Pledge

SENIOR HEALTH PROMOTION PROJECT

Senior Health Promotion Project

Assessment
The client is a 67 year old, upper-middle class, Caucasian male. He recently married his
second wife. He has four children, including one step-son. His family is very close and involved
in his life. He and his wife lead a very active lifestyle. He is retired, but has no financial
concerns. He owns his own car, home, and has health insurance. Primary health concerns include
hypertension and high cholesterol. There is a history of myocardial infarctions and four stents
have been placed, however, there has been no issues in the past few years. He recently had hernia
surgery (January 2016), but is fully recovered with only mild pain every once and a while. His
BMI status is overweight (29). Exercise is part of his regular routine, but he does not eat well.
His diet is pretty much void of fresh fruit and vegetables and high in fat.
The U.S. Preventative Task Force (USPTF) (2016) recommends that adults who are
overweight and have known cardiovascular risk factors such has hypertension and
hyperlipidemia should be offered or referred to intensive behavioral counseling interventions to
promote a healthy diet and physical activity. The current client is overweight, has hypertension,
hyperlipidemia, and a history of cardiovascular events. Although he is physically active his diet
is counterproductive to those efforts and needs some improvement. Diet education, specifically
the DASH diet, will be reviewed with the patient and his spouse.
Nursing Diagnosis
The nursing diagnosis selected for this client is Readiness for Enhanced Nutrition
related to his hypertension, high cholesterol, and being overweight. This diagnosis was selected
for this client due to his high blood pressure even while taking several medications to help with
the problem. Outside of his cardiac history he is healthy. Nutrition is a modifiable risk factor that

SENIOR HEALTH PROMOTION PROJECT

can help improve his overall health. He has expressed willingness to enhance his nutrition. He is
aware of his poor nutritional habits and understand how that impacts his blood pressure,
cholesterol, and weight. He has identified the need to lose weight.
Three outcomes were decided upon; two short-term goals and one long term goal. The
short term goals are:
1. The client will verbalize the benefits of adopting a healthier eating pattern by the end
of the session, and
2. The client will demonstrate appropriate selection of meals or menu planning that
incorporates healthy eating recommendations by the end of a session (Gulanick &
Myers, 2014).
The long-term goal is that the patient will engage in desired behaviors to promote
healthier nutritional status as evidenced by a 10 pound weight loss in 6 weeks. Although 10
pounds a lot of weight to lose in that time frame, this is the patient stated goal.
Teaching Plan
When conducting the initial interview the client discussed his unhealthy eating habits.
The writer inquired if this would be an area he would be interested in working on and he agreed.
His wife was also interested in learning more as she is the primary cook in their household.
Research has demonstrated that teaching the DASH diet to client can help reduce weight and
lower blood pressure (Jarl, Tolentino, James, Clark, & Ryan, 2014). Reedy, Krubs-Smith, Miller,
Leise, Kahle, Park, and Subar (2014) found that following a DASH diet can decrease mortality
from CVD and cancer in older adults.
A teaching plan was created based on the clients preferred learning methods: kinesthetic
and auditory. The author decided to utilize film, brochures, and complete menu planning

SENIOR HEALTH PROMOTION PROJECT

exercises. The film is auditory learning and the menu planning and picking out recipes is
kinesthetic.
In order to reinforce the impact that diet can have on health, the author decided to watch
the documentary Forks Over Knives (2011) with the patient and his family. The film
demonstrates through documented evidence, that eating a plant based diet will have a positive
influence on ones overall health. The goal in watching this film was not to convert the patient to
a plant based diet. But instead, to demonstrate the effect that increasing the amount of fruits and
vegetables while decreasing the amount of meat and processed food could have on his
cardiovascular health. After watching the film the author facilitated a family discussion about
their opinions on the film. The wife and step-son expressed a lot of concern about the clients
health and the client stated he wanted to work on improving his diet. The patient was able to
identify the benefits of eating healthier which was one of the short-term goals.
During the third and final session, the author presented the client and his wife with
handouts about the DASH diet (National Heart, Lung, and Blood Institute, 2015; U.S.
Department of Health and Human Services et al, 2001). In these resources there were sample
recipes, menus, and a food diary. The handouts explained, in laymans terms, how the DASH diet
worked and what made it different than other diets. The handouts also provided space for the
client and his family to plan their own menu and follow the dietary guidelines. The wife really
enjoyed this handout and was excited to try the recipes. Getting the wife involved was very
important because she is the cook. Outside of breakfast the wife cooks every meal.
The client and his wife expressed that they like how the diet would increase their fruit
and vegetable intake, but not eliminate meat. They liked that there were recipe ideas for them to
try. After reviewing the recipes, the client shared which recipes he would like to try. This not

SENIOR HEALTH PROMOTION PROJECT

only provided information for his wife on what to prepare, but it also got him involved in making
healthier food choices. The second short term goal was for the client to make appropriate meal
selections which the client was able to demonstrate by picking recipes he was interested in
trying.
The long-term goal, of engaging in desired behaviors to promote healthier nutritional
status as evidenced by a 10 pound weight loss in 6 weeks can be measured by the client at home
on a scale. The author suggested that the client should take a daily weight first thing in the
morning after urinating. This would give him a baseline to track his progress. The patient will
also be able to determine the effectiveness of this program by monitoring his blood pressure. At
his next physical he will be able to see if his blood pressure and cholesterol level has improved.
Evaluation
Given that the patient already has hypertension, the teaching plan is not primary
prevention. Instead, the author would argue that it is secondary/tertiary as the aim is to reduce the
impact of hypertension and hyperlipidemia on the patients life. Through dietary management the
patient can directly impact the advancement of his disease, if not reverse it. Monitoring weight,
blood pressure, and cholesterol levels are various screenings used by healthcare professionals;
screening is a form of secondary prevention. Adapting ones lifestyle to better manage the long
term effects of chronic conditions is tertiary prevention. The current patient has had four stents
placed as a result of his poor cardiac health. Learning about and adopting a healthier diet reduces
the effects of all the years of chronic hypertension on his body.
Overall the teaching was effective in that the patient was able to identify the benefits of
having a healthier diet. However, the wife seemed to be more engaged and interested in learning
about the topic than the patient. The video stimulated a good discussion about what it means to

SENIOR HEALTH PROMOTION PROJECT

be healthy and allowed the patient to understand how his health is impacted by diet. The recipes
helped the patient see that eating healthy did not mean that he could only eat salads. I think that
was an eye opening experience for him as he is a very picky eater.
The food diary did not seem like something the patient would be interested in doing, but
the author thought it would be a good thing to teach just in case. The sample menus were helpful
in that it allowed the family to get an idea about how their diet would change. In hindsight,
reviewing labels then going shopping with the patient might have helped him better understand
how to better select foods. In addition, actually preparing a healthy meal with the family might
have helped the patient explore different healthy options.
In summary, this was an interesting experience. This patient was pretty healthy and as a
result he did not feel that he needed to change much. He did not feel bad so change may not have
been high on the priority list. The patient knows that he needs to change his diet, but the wife
seemed more interested in making the change than he did. Trying to figure out how to teach the
client was a lot of fun and a learning experience for the author. However, trying to figure out
what information was most important and what could be left out was more challenging.
Education is an important part of nursing, it is how people can prevent/manage their diseases.

SENIOR HEALTH PROMOTION PROJECT

References
Fulkerson, L. (Director). (2011). Forks over knives. Santa Monica Beach, CA: Monica Beach
Media.
Gulanick, M., & Myers, J.L. (2014). Nursing care plans: Diagnoses, interventions, and
outcomes (8th ed). Philadelphia, PA: Elsevier.
Jarl, J., Tolentino, J.C., James, K., Clark, M.J.,& Ryan, M. (2014). Supporting cardiovascular
risk reduction in overweight and obese hypertensive patients through DASH diet and
lifestyle education by primary care nurse practitioners. Journal of the American
Association of Nurse Practitioners, 26, 498-503. doi: 10.1002/2327-6924.12124
Naegle, M.A. (2012). Alcohol use screening and assessment for older adults. Try This: Best
Practices in Nursing Care to Older Adults, 17. Retrieved from
https://consultgeri.org/try-this/general-assessment/issue-17.pdf
National Heart, Lung, and Blood Institute. (2015). In brief: Your guide to lowering your blood
pressure with DASH (NIH Publication No. 06-5834). Retrieved from
https://www.nhlbi.nih.gov/files/docs/public/heart/dash_brief.pdf
Reedy, J., Krebs-Smith, S.M, Miller, P.E., Liese, A.D., Kahle, L.L., Park, Y., & Subar, A.F.
(2014). Higher diet quality is associated with decreased risk of all-cause, cardiovascular
disease, and cancer mortality among older adults. The Journal of Nutrition, 144(6),
881-889. doi: 10.3945/jn.113.189407
U.S. Department of Health and Human Services, Public Health Service, National Institutes of
Health, National Heart, Lung, and Blood Institute. (2001). Facts about: The DASH diet
(NIH Publication No. 01-4082). Retrieved from
http://www.healthyinfo.com/consumers/ho/nut.dash.diet.pdf

SENIOR HEALTH PROMOTION PROJECT

U.S. Preventative Task Force. (2016). Clinical summary: Healthful diet and physical activity for
cardiovascular prevention in adults with cardiovascular risk factors: Behavioral
counseling. Retrieved from
http://www.uspreventiveservicestaskforce.org/Page/Document/ClinicalSummaryFinal/h
ealthy-diet-and-physical-activity-counseling-adults-with-high-risk-of-cvd