Aging comes with a host of health issues. Thus, it is imperative for the elderly not only to engage in activities that support healthy growth and development but also to be on the lookout for signs that may indicate ill health. Investing in health is critical for longevity and a joyous life, and should thus be a priority for every individual despite age. The following paper thus discusses various aspects of health of an aging adult drawing from the information present in the case study.
What is the client’s BMI?
BMI = weight (pounds) / [height (feet)]²
= 210 / [5’6]²
The client’s basal metabolic rate (BMI) is 33.9
Identify what screening tools you would use to assess nutritional and exercise knowledge, and why?
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The screening tools I would use for this purpose are WAVE and REAP. Experts have come up with the tools to aid with the improvement of nutrition. WAVE is an acronym that stands for weight, activity, variety, and excess. This particular tool is designed to enable faster assessment and counseling as the nutritional expert interviews the client ( Gans, 2013) . Notably, it comes with a pocket card with general questions about the nutritional and feeding habits of the patient. Furthermore, the patient is required to complete a self-administered eating pattern questionnaire to reveal the unhealthy patterns and thus make intervention possible. The other screening tool I could use is REAP which stands for Rapid eating Assessment for patients, and is useful in the provision of dietary assessment during history taking in for patients. The tool comes with 27 screening questions answered with usually/often, sometimes, rarely/never, or does not apply to me ( Segal-Isaacson, Wylie-Rosett & Gans, 2014) . Fundamentally, the questions gear towards unearthing the pattern of consumption in relation to the 2000 US dietary guidelines and the food guide pyramid. Aside from the 27 frequency questions, there are other three yes/no items which assess habits indicative of risks such as taking a special diet or skipping a meal. Unlike WAVE, REAP is more comprehensive and it covers topics ranging from soft drinks, sweets, fats and oil, snacks, fries, meat, dairy, fruits and vegetables, grains, meals, change readiness, special circumstances, and activity. One good thing about this tool is that it takes a relatively short time to administer in comparison to other tools. Therefore, it is ideal because the patient would provide answers before boredom hits.
Identify two client outcomes that are reasonable, measurable and realistic
The client outcomes that are reasonable, measurable, and realistic for this particular case include adopting a healthier eating program by eating 1,200 calories each day, and walking at least thirty minutes every day for more exercise. The client outcomes are not only realistic but are also measurable and reasonable. Eating a healthily will involve the client committing as well as being focused and not allowing any distractions whatsoever. It is true that setting goals is one thing and committing to them is another, and is the reason the client may need to target a weight loss of about 1 to 2 pounds weekly. Before even imagining losing weight, the client needs to appreciate the fact that she has to stop gaining more weight by eating healthy before attempting to lose weight through physical activity ( Wing & Hill, 2011) . This will include reducing the calorie intake by significant levels. In this case, it is reasonable and manageable to stick to 1200 calories each day. Looking at it from a long term point of view, the client will not be gain weight as much as they would have gained if they stack to their usual dieting program.
Even so, losing a considerable amount of weight will need more than just sticking to a diet plan. Five percent of the client’s total weight is a healthy one to lose, and cannot just happen by eating a specific amount of calories daily. This implies that the client needs to supplement their calorie intake with some form of physical activity. By walking 30 minutes every day, the client will lose about 1 to 2 pounds each day until she attains a weight that is healthy. This amount of weight loss is also critical at preventing some chronic diseases. Committing to achieve a substantial cut in weight needs a critical consideration of both process and outcome goals. In this case, walking for thirty minutes daily is a process goal while losing 1 to 2 pounds daily is an outcome goal.
Identify 3 nursing interventions for each client outcome and give rationales
For eating 1200 calories a day, the three fundamental nursing interventions include obtaining a thorough history, assessing dietary intake through questions hinging on the usual dietary habits or a 24 hour recall, and finding out the knowledge of the client about nutritious diets and the need for supplements. In obtaining a thorough history, it is appropriate to refer to a dietician in cases where the client has a medical condition. The rationale behind this intervention is that adults with no major health problems are the most appropriate clients for weight management ( Levine, 2016) . In situations where the client has a medical condition, the responsibility is tossed to a dietician. In this case, the client does not have any major illness and is thus fit for this intervention. Further, the rationale behind assessing dietary intake is the need to have accurate information and permit evaluation of the knowledge the client has about dieting. Finally, the rationale behind finding out the client’s knowledge about nutritious diet and supplements is to come up with an individualized teaching plan for the patient.
For walking 30 minutes a day to lose 1 to 2 pounds, the nursing intervention would entail evaluating physiological status of the client in relation to weight control, calculate body mass index, and determine the fundamental motivation for weight loss. The rationale behind evaluating the physiological status of the client is because interventions that are not diet-related focus on making the client at peace with their physical image and accept themselves for who they are before embarking on a weight loss program ( Levine, 2016) . Similarly, the rationale behind calculating body mass index is to determine if the client is overweight or obese and the amount of weight they need to lose. Finally, the rationale behind determining the fundamental motivation is because the fat deposits present on the peripherals of females, otherwise known as gynecoid, are not indicative health impairment.
Identify what weakness in the client’s life and supports may be impacting the client’s activity and diet?
The weakness in the client’s life that may be impacting on the activity and diet is loneliness. Even though the client gets social support, they live alone which sometimes makes individuals to be complacent. Notably, it is not easy for them to go far when they are alone despite sometimes being willing to commit. Studies aver that a strong support from family and friends can go a long way in helping sustain fitness goals ( Keller, 2018) . Worth critical to mention is that the client enjoys sufficient social support but does not get enough emotional support. Studies reveal that emotional support is one of the key components to beginning and maintaining exercise and dieting programs. Emotional support is critical for the elderly because they need someone to cheer them whenever they are going for a morning run or to complain to whenever they are not feeling like doing physical activities ( Keller, 2018) . Furthermore, the mere fact that someone is present and cares about the achievements is enough motivation for the elderly. So, for this particular client, it is authoritative to mention that she lacks the emotional support since her family is away and she lives alone. She is therefore likely to experience challenges in maintaining diet programs or physical activity.
What referrals would you make and why?
I would refer the client to a weight loss club to ensure consistency in her endeavors. Being part of a team comes with the benefit of emotional support that the client really needs to make her weight loss journey worthwhile. Besides, it will give them a sense of belonging and required strength to have to move the journey with their peers undergoing the same challenge. In the end, the results will be much more satisfying than if the client walked the journey alone. Another referral I would give the client is to visit a GP in their community to have more professional discussions about their weight and general health. Not only is it acceptable but also effective to have GP referrals as many studies have revealed. The good thing about GP referrals is that it does not last long and thus does not bore the patient. In some cases, the initial conversation alone is therapeutic.
Summarily, the client is obese and needs interventions to reduce weight significantly. While the nursing interventions are in order, it is important to reiterate that the client needs emotional support even though she has enough social support around her.
References
Gans, K. M., Ross, E., Barner, C. W., Wylie-Rosett, J., McMurray, J., & Eaton, C. (2013). REAP and WAVE: new tools to rapidly assess/discuss nutrition with patients. The Journal of nutrition , 133 (2), 556S-562S.
Keller, C., Records, K., Ainsworth, B., Permana, P., & Coonrod, D. V. (2018). Interventions for weight management in postpartum women. Journal of Obstetric, Gynecologic & Neonatal Nursing , 37 (1), 71-79.
Levine, M. E. (2016). Adaptation and assessment: A rationale for nursing intervention. The American journal of nursing , 2450-2453.
Segal-Isaacson, C. J., Wylie-Rosett, J., & Gans, K. M. (2014). Validation of a short dietary assessment questionnaire: the Rapid Eating and Activity Assessment for Participants short version (REAP-S). The Diabetes Educator , 30 (5), 774-781.
Wing, R. R., & Hill, J. O. (2011). Successful weight loss maintenance. Annual review of nutrition , 21 (1), 323-341.
