Realage Health Promotion Paper - Jessica's Nursing Portfolio



RealAge Health Promotion PaperJessica HouseFerris State UniversityAbstractA RealAge test was completed online to discover a client’s true age given a series of health assessment questions. The results of the test were used to identify healthy behaviors, along with areas of opportunity. Based on the results of the test, a nursing care plan was created to address areas needing improvement. The clients weight and activity levels were tracked and adjustments were made as needed throughout the intervention. The client was able to effectively lose weight, feel more energized, with less aches and pains in the two months data was collected.RealAge Health Promotion PaperNathan House is a 32-year-old Caucasian male. He is a father of two small boys, ages 3 and 5. He is a Police officer who works night shift full time. He has gained 20 pounds since graduating from the police academy 6 years prior. His activity usually consists of light walking and light lifting at home, although he has done some building and hauling of materials within the home. At work, activity consists of “some running, but mostly sitting in my police car.” He wears a gun belt with heavy equipment and also heavy work boots. His diet consists of his favorite foods such as oatmeal or toast for breakfast if he remembers to eat breakfast at all. He did state he likes to eat pancakes, sausage/bacon with hash browns or his favorite chorizo (Mexican breakfast sausage). For lunch he mostly enjoys pizza or sandwiches, hamburgers, or nachos for dinner. He also enjoys a Jameson and Vernors, or beer at night approximately 3 nights a week. He states “I don’t have a whole lot of time or energy to go to the gym, being busy with my boys, and never feeling rested working night shift.”Nate House completed the Real Age Test on January 19th, 2016. The results estimated his real age to be 33.2, only 0.3 higher than his actual age at the time the test was completed. The test was divided into 4 sections; health, feelings, diet, and fitness. Some areas of opportunity were included at the end of the test and reviewed by the client and the nurse.AssessmentRealAge test resultsHealth. To start this assessment with the positives, there were many areas with which the client is doing well. His cholesterol was within normal range with a total cholesterol level of 181. His LDL (bad cholesterol) was 93 and his HDL (good cholesterol) was 50. These numbers contributed to a lower RealAge according to the test due to the fact his total cholesterol was low, regardless of his HDL being mediocre. The client in the past had been a smoker but has been smoke free for 9 years so reinforcement was provided to continue the good work with staying tobacco free and to remain an ex smoker. The client is also very good about avoiding sunburns given his family history of melanoma. Recommendations based on the RealAge test, advised the client to continue to apply sunscreen liberally and reapply every 2 hours with any exposure to sun, and to cover skin when possible. It was also encouraged to continue to do skin checks, as the client has had multiple moles removed and biopsied (What’s your actual age, 2015).Some areas of improvement in this health section of the test advised Nate to watch his weight. His current waist size is a 33 inches, a BMI of 27.61, and a weight of 215, which is slightly above ideal body weight for someone his height at 5’11”. With his history of lower back pain from carrying around a heavy gun belt at work, some stronger core strength and losing the extra weight could contribute to less pain and less injury ("The health effects of overweight and obesity," 2015, table 1). Other important reasons to keep off the weight-obesity can lead to high blood pressure, type 2 diabetes, unhealthy body image, aches and pains, sleep apnea and other sleep disorders, and mental disorders such as depression or anxiety ("The health effects of overweight and obesity," 2015, para. 1).Some suggestions were listed to help lose weight include drinking green tea. Green tea contains caffeine known to be beneficial as a stimulant and in the aid of losing weight. (Gunnars, 2016, para. 8). It also contains EGCG (Epigallocatechin) a substance that can boost metabolism (Gunnars, 2016, para. 8-10). Other suggestions for losing excess body weight include aerobic exercise. “Regular physical activity contributes both to physiological stability and high-level functioning and assists individuals in actualizing their physical performance potential” (Pender, Murdaugh, & Parsons, 2015, p. 122).Although the client stated he is getting enough sleep, he is not feeling rested during the day, partly due to the night shift schedule. The RealAge test results suggested developing a rest promoting sleep schedule to help feel more rested and that lack of sleep can make your RealAge older. His sleep switches from nights to days rather consistently possibly contributing to this overall sense of fatigue. Insufficient sleep also affects immunologic function and development of mood disorders and is associated with depression; deficits in cognition, memory and learning; and reduced quality of life (Perry, Patil, & Presley-Cantrell, 2013, para. 5). Further, as a police officer and a father, some additional things are important to consider. “One major consequence of insufficient sleep is daytime sleepiness, which reduces alertness and causes slow reaction time, leading to occupational and medical errors, workplace injuries, impaired driving, and motor vehicle accidents (Perry et al., 2013, para. 7). Feelings. As a working father, with a high stress job, marriage, and a lot of pressures some relaxation techniques were suggested to him from the real age test. One suggestion was to pull the plug on stress and to find ways to decompress after work and during times of increased stress. Suggestions to reducing stress include talking to others, sleep, exercise and taking a break from things that cause stress ("Coping with stress," 2015, para. 5).Diet. Due to the fact breakfast is often times skipped, a recommendation to eat breakfast every morning was suggested following the RealAge test, with a further recommendation to make sure the selections were healthy ones. More fruits and vegetables, more fiber and grains, with leaner protein choices were suggested for healthier food selections. Other suggestions for his diet included passing on the junk food, keeping red meat to a minimum, eating more fish, which include healthy Omega 3 fatty acids and suggestions to expand and diversify his diet with more doses of vitamin D. With a family history of heart disease, cardiac stents, diabetes, and hypertension, it is very important for the client to promote healthy behaviors now (What’s your actual age, 2015). Fitness. In order to promote a healthy lifestyle, more cardio was suggested in this section. According to Nate, not much time is spent on this since graduating the police academy. Goals included to be more physically fit include increasing his average of 1-2 hours of cardiovascular activities to 3.5 hours of cardio a week. One study investigated the effects of 6 and 12 months of moderate physical training on the levels of adipokines and cardiovascular markers in normal weight, overweight and obese volunteers. They concluded exercise demonstrated beneficial effects on the low-grade inflammatory state, decreasing leptin, resistin and IL-6 and cardiovascular clinical markers such as blood pressure and homocysteine in overweight and obese individuals (Gondim et al., 2015, p. 12).Transtheoretical ModelUsing the Transtheoretical Model, the client’s readiness for change was assessed. While interviewing the client, and reviewing the results of the RealAge test, the client expressed the desire to create a plan, and take action in making himself healthier immediately. I would assess the client to be in the Planning or Preparation phase of health behavior change. He is seriously thinking about engaging in the behavior change within the next month and making adjustments as needed along the way (Pender et al., 2015, p. 41). After reviewing the many recommendations made following the test, considering priorities by the client, and also personal recommendations by the nurse, a plan was put into place to address two areas of opportunity to start, and a goal to incorporate all the suggestions eventually into his long-term journey towards health and wellness. DiagnosisThere were two areas were of most importance to the client to first begin his positive change. The client was ready to get in shape and lose weight. The client verbalized “ I really want to be in better shape for my kids. I want to be healthy and be around for a long time for them. I want to be stronger at work so that I can come home again at night. I want to look better and feel better, I’m ready to finally lose some weight.” Further Given the client’s priorities two wellness diagnoses were selected (Taylor & Ralph, 2011).Imbalanced nutrition: More than body requirements, related to food intake in excess of energy expenditureSedentary Lifestyle: Related to physical deconditioning, as evidenced by daily routine lacking physical exercise, physical deconditioning, and preference for activities low in physical activities Expected outcomes (Taylor & Ralph, 2011).? Patient will seek professional consultation to develop an appropriate plan to increase physical activity.? Patient will increase physical activity and limit inactive forms of diversion, such as television and computer games.? Patient will increase lean muscle and bone strength and decrease body fat.? Patient will demonstrate weight control and, if appropriate, weight loss.For the purposes of the care plan, Sedentary Lifestyle was selected (Appendix A). The client felt focusing on activity and getting stronger would have the most positive results. Additionally, the client verbalized to better support this transition he would be eating more fruit’s and vegetables and limiting his dietary intake. The client was provided with the care plan and was agreeable.Planning/Intevention (Taylor & Ralph, 2011).Goals Lose 1 pound per weekWalk for 30-45 minutes a dayDrink one daily cup of green teaIdentify barriers to activityIdentify support systemsMeasuring Effectiveness (Taylor & Ralph, 2011).Weigh client once per week (Appendix B)Create an activity log or exercise record to track activity and duration of exercise (Appendix B)Create a questionnaire before and after to evaluate the overall feeling and energy level of the client (Appendix C)EvaluationThe nursing care plan, activity tracker and questionnaire were given to the client at the beginning of the intervention. The plan was reviewed and approved by the client and February 1st began the intervention. Week 3 the client purchased a fitbit to assist with even better activity tracking. One set back shared with the client occurred during the week of his birthday where he recorded gaining 2 pounds. Adjustments were made the following week and the client was able to get back on track. According to the client, having a nurse supervise and participate in this project, provided even more motivation to be successful by creating accountability with ensuring activities were completed on the calendar, and that his weight was trending in the right direction. April 1st was final weigh in. The client had many positive results from the care plan intervention. The client successfully lost 7 pounds in 2 months. He stated he felt better overall and more energized. He also enjoyed the additional time he spent with the family doing physical activities like playing in the yard, going for bike rides, and also taking his children swimming at the YMCA. He also enjoyed switching from Mountain Dew at work to iced green tea. The client provided feedback regarding the capturing of data. He stated having his activity recorded on his phone using his fitbit app was very helpful and motivating. Once the first 5 pounds was lost he started feeling better and it increased his motivation to keep going. All materials were shared with the client upon the final completion of the care plan. The client has goals to continue losing an additional 15 pounds and to start strength training and focus more on his dietary intake of healthy foods. A final questionnaire was completed by the client and submitted to the nurse with feedback.ReferencesChristakis, N. A., & Fowler, J. H. (2007, July 26). The spread of obesity in a large social network over 32 years. The New England Journal of Medicine, 357, 370-379. with stress. (2015). Retrieved March 30, 2016, from , O. S., Nunes de Camargo, V. T., Gutierrez, F. A., Fatima de Oliveira Martins, P., Pereira Passos, M. E., Momesso, C. M., ... Cury-Boaventura, M. F. (2015, October 16). Benefits of regular exercise on inflammatory and cardiovascular risk markers in normal weight, overweight and obese adults. Plos One, 1-14. , K. (2016). How green tea can help you lose weight natually. Retrieved from , N., Murdaugh, C., & Parsons, N. A. (2015). Health Promotion in Nursing Practice (7th ed.). New Jersey: Pearson Education Inc.Perry, G., Patil, S., & Presley-Cantrell, L. (2013). Raising awareness of sleep as a healthy behavior. Retrieved from , C., & Ralph, S. S. (2011). Sparks & Taylor’s nursing diagnosis reference manual (9th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.The health effects of overweight and obesity. (2015). Retrieved from your actual age [Database record]. (2015). Retrieved from Sharecare Inc. ASedentary Lifestyle(x)Actual (_)PotentialDefinition: Reports a habit of life that is characterized by a low physical activity levelAs evidenced by: (X) Daily routine lacking physical exercise (X) Physical deconditioning (X) Preference for activities low in physical activityDate & SignPlan and OutcomeTarget Date:Nursing InterventionsDate Achieved:2/1/16The patient will:(_) Identify barriers to increasing physical activity level(_) Identify health benefits to increasing physical activity level(_) Will develop a plan to increase physical activity(_) Will increase lean muscle and bone strength and decrease body fat(_) Will demonstrate enhanced psychological well-being and reduced risk of depression(_) Will demonstrate weight control and, if appropriate, weight loss(_) Will have reduced depression and anxiety and an improved mood 4/1/16? Discuss the need for activity that will improve psychosocial well-being.? Educate patient about how sedentary lifestyle affects cardiovascular risk factors (such as hypertension, dyslipidemia, hyperinsulinemia, insulin resistance) to motivate patient to be more active.? Identify barriers and enhancers to increasing physical activity, including time management, access to facilities, and safe environments in which to be active. ? Instruct patient to keep a daily activity to help him achieve a more objective view of his behavior.GoalsLose 1 pound per weekWalk for 30-45 minutes a dayDrink one daily cup of green teaRide bike three times per weekIdentify barriers to activityIdentify support systems2/1/162/1/162/1/162/1/162/1/16Appendix BActivity Log/Weight TrackerRecord your activities in this Calendar. Weekly goal of 3 days of aerobic activity a week and walk 30-45 minutes everyday. Drink 1-2 glasses of green tea each day FebruarySundayMondayTuesdayWednesdayThursdayFridaySaturday IF DocVariable MonthStart \@ dddd Error! No document variable supplied. = "Sunday" 1 "" IF DocVariable MonthStart \@ dddd Error! No document variable supplied. = "Monday" 1 IF =A2 0 <> 0 =A2+1 2 "" IF DocVariable MonthStart \@ dddd Error! No document variable supplied. = "Tuesday" 1 IF =B2 0 <> 0 =B2+1 2 "" IF DocVariable MonthStart \@ dddd Error! No document variable supplied. = "Wednesday" 1 IF =C2 0 <> 0 =C2+1 3 "" IF DocVariable MonthStart \@ dddd Error! No document variable supplied.= "Thursday" 1 IF =D2 0 <> 0 =D2+1 4 "" IF DocVariable MonthStart \@ dddd Error! No document variable supplied. = "Friday" 1 IF =E2 0 <> 0 =E2+1 5 "" IF DocVariable MonthStart \@ dddd Error! No document variable supplied. = "Saturday" 1 IF =F2 0 <> 0 =F2+1 6 "" 123456First weigh in day215lb78910111213Weigh in day213 lb14151617181920Weigh in day211 lb21222324252627Weigh in day211.5lb2829Weigh in day210lbAppendix BActivity Log/Weight TrackerRecord your activities in this Calendar. Weekly goal of 3 days of aerobic activity a week and walk 30-45 minutes everyday.MarchSundayMondayTuesdayWednesdayThursdayFridaySaturday IF DocVariable MonthStart \@ dddd Error! No document variable supplied. = "Sunday" 1 "" IF DocVariable MonthStart \@ dddd Error! No document variable supplied. = "Monday" 1 IF =A2 0 <> 0 =A2+1 2 "" IF DocVariable MonthStart \@ dddd Error! No document variable supplied. = "Tuesday" 1 IF =B2 0 <> 0 =B2+1 2 "" IF DocVariable MonthStart \@ dddd Error! No document variable supplied. = "Wednesday" 1 IF =C2 0 <> 0 =C2+1 3 "" IF DocVariable MonthStart \@ dddd Error! No document variable supplied.= "Thursday" 1 IF =D2 0 <> 0 =D2+1 4 "" IF DocVariable MonthStart \@ dddd Error! No document variable supplied. = "Friday" 1 IF =E2 0 <> 0 =E2+1 5 "" IF DocVariable MonthStart \@ dddd Error! No document variable supplied. = "Saturday" 1 IF =F2 0 <> 0 =F2+1 6 "" 123456789101112Weigh in day210lbClients birthday13141516171819Weigh in day211lb20212223242526Weigh in day210lb2728293031Weigh in day2018lbFinal weigh in April 1st: 208 poundsAppendix CBefore StatementStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeDietI am satisfied with my current diet planxI routinely watch what I eatxI feel in control of my dietary intakexI try to limit the amount of sugars and preservatives in my diet to a minimum.xI eat a healthy amount of fruits xI eat a healthy amount of vegetables xI drink enough waterxActivityI am satisfied with my current activity levelxI make it a priority in my schedule to be active dailyxI am not limited in any activity that I want to do (ex: hiking, biking, playing with kids, running etc…)xWeightI am satisfied with my current weightxOverall, I am satisfied with the way I lookxObstaclesI have a lot of support from my family to exercisexI have a lot of support from my family to eat healthyxI can perform all my daily tasks without any painxAdditional Comments:Appendix CAfterStatementStrongly AgreeAgreeNeutralDisagreeStrongly DisagreeDietI am satisfied with my current diet planxI routinely watch what I eatxI feel in control of my dietary intakexI try to limit the amount of sugars and preservatives in my diet to a minimum.xI eat a healthy amount of fruits xI eat a healthy amount of vegetables xI drink enough waterxActivityI am satisfied with my current activity levelxI make it a priority in my schedule to be active dailyxI am not limited in any activity that I want to do (ex: hiking, biking, playing with kids, running etc…)xWeightI am satisfied with my current weightxOverall, I am satisfied with the way I lookxObstaclesI have a lot of support from my family to exercisexI have a lot of support from my family to eat healthyxI can perform all my daily tasks without any painxAdditional Comments:“My jeans are all too big, my mood is better, I’ve been grilling healthy things, and I bought bikes for the family.” ................
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