(Test Bank) Health & Physical Assessment in Nursing, Canadian Edition

Amico, 1

Nursing

Test Bank

1st Edition

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Test Bank for Health & Physical Assessment in Nursing, Canadian Edition, The downloadable file consists of 160 pages, and the total size of the file is 402.71 KB. Purchase now only for highly discounted price.

Author(s): Amico

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Week 1 disscun Healthy People Initiative (graded) As the school nurse working in a college health clinic, you see many opportunities to promote health. Maria is a 40-year-old Hispanic woman 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 doing 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 is in class a total of 15 hours per week, plus 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 6 hours of sleep per night, but that is okay with her. She lives 1hour from campus and commutes each day. Using Healthy People 2020 as a guide: What additional information would you like to gather from Maria? What are Maria's real and potential health risks? Pick one of Maria's health risks. What would be one reasonable short-term goal for this risk? Respond This section lists options that can be used to view responses. Collapse All Print View Show Options Responses Responses are listed below in the following order: response, author and the date and time the response is posted. Sort by Read/Unread Sort by Response Sorted Ascending, click to sort descending Sort by AuthorSort by Date/Time* (an instructor response) Collapse Mark as Unread IMPORTANT - PLEASE READ Instructor Nurss Email this Author8/23/2014 12:31:59 PM For Discussions (graded), you are expected to log into the course and post (respond) to each topic in the threaded discussion area on a minimum of two separate days per week, beginning no later than Wednesday. Discussions will always close Sunday, 11:59 p.m. Mountain Time (MT) for the week. You can post to the next weeks discussion thread on Sunday but not before. Respond (an instructor response) Collapse Mark as ReadPlan for MariaInstructor Nurss Email this Author 8/23/2014 12:33:04 PM Maria's situation is likely similar to many of you. She is 'burning the candle at both ends so to speak. Your plan for her should recognize her family responsibilities, school pressures and cultural considerations. You can begin posting to this thread for credit on Sunday, August 31, 2014 Respond Collapse Mark as Unread RE: Plan for Maria Arthel Tamakloe Email this Author 9/1/2014 6:02:25 PM 1. I will like to collect Maria's current health statistics such as height, weight, Body Mass Index family history of heart, high blood pressure stroke, diabetes, obesity, alcoholism and mental illness. Does she exercise? How often and for how long? Does she often feel depressed or stressed? Nutrition log, and her hobbies. 2. Maria's real health risks are stress, obesity and heart attack. Maria's potential health risks are high blood pressure, diabetes and stroke. 3. The goal of Healthy People 2020 is to guide individuals toward making informed health decisions. It also measures the impact of prevention activities. With this in mind, I will encourage Maria to include vegetables, fruits, grains, fat-free dairy products, fish, lean meat, poultry, and foods low in sugar and saturated fat in her diet. Maria can cook most of her meals on her on Sundays and store them in storage containers for the weekdays. By bringing her own food to school, helps her to eat healthy and save money rather than buying fast foods which is costly but not healthy . Maria can also assign some of the house chores to her husband and school age children she does not have to do everything her self. This will give her some free time. Maria and her family can have a family time by going for a walk. Maria will need a time management schedule by writing down each day activities and also priorities her time with her school, study time, family friends and time for a hobby or do things that she likes to do to reduce some stress . References: D'Amico, Barbarito, Donita, Colleen (2010). Health & Physical Assessment in Nursing. 2nd Edition. Pearson Learning Solutions. Respond Edit (an instructor response) Collapse Mark as ReadRE: Plan for Maria Instructor Nurss Email this Author 9/2/2014 9:22:02 PM Arthel, you have made some valuable suggestions for Maria. I am wondering whether or not she will follow through with the suggestion to assign her husband some of the household chores given her cultural background. Although I have known many Hispanic families that do share the household chores, many who follow a more traditional road where the household is a woman's domain. What are your thoughts about this? Anyone? Respond Collapse Mark as Unread RE: Plan for Maria Arthel Tamakloe Email this Author 9/6/2014 5:38:30 PM I will advise Maria to have a family meeting and tell her family how Her life had change since starting nursing school and that she will need their help to survivor nursing school. She needs to communicate her needs with her husband and assure him that the change is going to be temporary. I understand her culture background but this is temporary until Maria completes her education. You never know her husband may even enjoy his new role.Respond Edit (an instructor response) Collapse Mark as ReadRE: Plan for Maria Instructor Nurss Email this Author 9/7/2014 10:41:03 PM Excellent suggestion Arthel. Communication is always a great starting point. Regardless of cultural traditions her family just may be willing to step up and help her. If they are unaware of her struggles things will likely continue as they are. Respond Collapse Mark as ReadHealthy People 2020 Lacy Lewandowski Email this Author 9/1/2014 1:14:03 PM 1. I would like to gather more information from Maria about: height, weight, BMI, family and health history, activity and diet log. I would also find out more information about what has changed in her diet and activity schedule since she started school and her perceived barriers to achieve weight loss to help to encourage healthy behaviors and better adjust her plan of care to suit her needs. 2. Until further information is obtained her assumed risk would be that she is overweight which could lead to multiple other health risks. Potential Health risks for Maria include diabetes, stroke, arthritis, heart disease, and sleep disorders. 3. Marias age, race, lifestyle, and weight put her at a higher risk for heart disease. I would encourage Maria to walk for ten minutes three times day between classes or in the evening. With Marias hectic lifestyle I would also give her alternatives to walking for 15minutes twice daily or 30 minutes on Saturday and Sunday but striving for the goal of 30 minutes 5 days per week. Because Maria does the shopping and cooking, I would encourage her to try to adjust the menu to healthier substitutions. References: Healthy People 2020 Archive. Retrieved from: http://www.healthypeople.gov/2020/default.aspxD'Amico, Barbarito, Donita, Colleen (2010). Health & Physical Assessment in Nursing. 2nd Edition. Pearson Learning Solutions. Respond (an instructor response) Collapse Mark as ReadRE: Healthy People 2020 Instructor Nurss Email this Author 9/2/2014 9:28:32 PM Lacy, I appreciate your approach, especially involving Maria in the plan by asking about her 'perceptions' about what the barriers are to her health. Respond Collapse Mark as ReadRE: Healthy People 2020 Lacy Lewandowski Email this Author 9/5/2014 3:20:59 PM Professor Nurss, Perceived barriers of action are the perceptions of the barriers or difficulties involved in participating in the activity proposed by the patient (D’ Amico, 27). Maria is a very busy student, mother, and wife and being able to better understand what she perceives as her most difficult aspects of losing weight will help the nurse to better tailor a plan and together formulate a successful plan. To be successful in any health plan I believe it is important for the nurse to consider these barriers to help the patient overcome the obstacles. For a patient like Maria, she may feel like she does not have the time to walk for 30 minutes a day so working with her to develop a plan to make her more successful is key. Suggesting she break up the time between classes or walk 15 minutes a day 2 days a week and 45 minutes on the weekend will help her to see she can tailor a plan to successfully meet her goal. References: D'Amico, Barbarito, Donita, Colleen (2010). Health & Physical Assessment in Nursing. 2nd Edition. Pearson Learning Solutions. Respond Collapse Mark as ReadHealthy People Initiative Leslie Maier Email this Author 9/1/2014 3:13:20 PM The focus of Healthy People 2020 is for wellness, by preventing disease and improving health, I see that in the case of Maria, a 40 year old female, married, Hispanic nursing student, the struggle to juggle with home and school, has affected her health. Based on her own views, she verbalizes having gained 14 pounds since she started nursing school 2 years ago, she is afraid for her health, but doesn’t see a problem averaging 6 hours of sleep a night. My first concern knowing her Hispanic heritage, is with her weight. Her love for cooking delicious Spanish dishes, and if she is anything like my mom was, Maria probably doesn’t cut back on the saturated fats, starch, salt or sugar, ingredients many of these traditional dishes required ( that’s why they are so, so tasty!). She is not obese but she is susceptible if she doesn’t get her weight under control, “the prevalence of obesity in adults is 54% higher in blacks, and 21% higher in Hispanics when compared to Caucasians” (D’ Amico, p.34) To best serve Maria, an overall systemic health assessment is needed, but based on the data collected, my follow up questions to Maria regarding her weight will be; has she tried dieting? How active is she on the daily basis? Is the activity sedentary; in front of a computer, moderate; averaging a metabolic equivalent level (MET) between 3-6 METs? (D’ Amico, p.33), or brisk walking daily whenever possible for at least 15 minutes. Also, inquiring about her family history, is there history of diabetes, or heart disease? And most import the need to review Maria’s own experience of health, and illnesses. The potential risks for Maria if she continues to gain weight will predisposed her to obesity, and the risks to develop heart diseases, diabetes, lung diseases, psychosocial disorders, depression and possible sleep disorders (D’ Amico, p. 35). The potential problem of heart disease that I foresee for Maria if she doesn’t control her weight, is that of coronary artery disease (CAD), buildup of fatty deposits inside the coronary arteries which can lead to heart attacks or strokes. Based on Dunn wellness theory, gear towards maximizing the potential of which Maria is capable (D’ Amico, p.24), the primary prevention I will recommend Maria will start with her cooking, she can cut back on the salt and sugar intake, use artificial sugar and salt, use lean meats, discard the fat from the meat, stay away from processed vegetable oils for cooking, instead use polyunsaturated oils, like olive oil. Another primary prevention for Maria will be to increase her daily activity, at her clinical practice if it is at a hospital, use the stairs whenever possible, avoid using the elevator, during family time with her 2 school aged children go for half hour brisk walks with them at least twice a week, it will benefit all them. Today a greater focus is placed on wellness, change is influenced by knowledge (D’ Amico, p. 2) as a second year student nurse Maria will recognize this and the changes she’ll implement in her daily life will not only benefit her but also the health of her children. References D'Amico, Barbarito, Donita, Colleen. Health & Physical Assessment in Nursing. 2nd Edition. Pearson Learning Solutions, 2010. VitalBook file. Bookshelf Respond (an instructor response) Collapse Mark as ReadRE: Healthy People Initiative Instructor Nurss Email this Author 9/3/2014 9:32:31 PM Excellent post Leslie. I appreciate your suggestions about how to modify her traditional cooking to make it healthier. Actually, if Maria adopts some healthy habits it may influence her children as well to make changes. Helping her to see herself as a role model for her family will help to motivate her to find those small changes that can make a significant difference in her health. Respond Collapse Mark as ReadHealthy People 2020 Marcie Smith-Corlette Email this Author 9/1/2014 6:47:47 PM After reviewing Healthy People 2020 the additional information that I would gather from Maria would be: does she have a primary care physician, when was the last time she has had a complete health exam along with blood work, and does she or anyone in her immediate family have a history of diabetes, hypertension, cardiovascular disease, and hypercholesterolemia. If Maria continues to gain weight that is putting her at risk for obesity, hypertension, cardiac disease, and hyperlipidemia. Maria is at risk for hypertension a short term goal would be to change eating habits. Since she likes to cook Hispanic meals she could still prepare them by incorporating the DASH (Dietary Approaches to Stop Hypertension) eating plan which consist of foods that are high in calcium, potassium, and magnesium. These nutrients can lower blood pressure. She and her children can prepare meals together for the entire week and also spend quality time together. Maria could also start an exercise program such as walking after dinner this would be a great way to reduce stress and include her family.References: Healthy People 2020. (2014, August 30). Retrieved from Healthy People 2020: www.healthypeople.gov/2020/default.aspx Marcie Respond Collapse Mark as ReadRE: Healthy People 2020 Megan Keith Email this Author 9/2/2014 7:28:38 PM Marcie, You make some excellent points about her cardiovascular health risk. I work for a cardiology office, and people like Maria are like many of the new patients we see! I would agree to have her see her PCP and get a full panel of labwork including, CBC, BMP , and fasting lipids. The fasting lipids will tell her cholesterol and triglyceride levels as well as her LDL and HDL, all which can indicate hyperlipidemia and in turn cause coronary artery disease. Gaining weight can cause many other health issues besides cardiac-related. She should also have a fasting glucose or hemoglobin A-1C to check her risk for diabetes mellitus. Regular exercise and a well-balanced healthy diet can help to combat weight gain and fend off the rest of the negative health effects. Great job Marcie! Respond (an instructor response) Collapse Mark as ReadRE: Healthy People 2020 Instructor Nurss Email this Author 9/3/2014 9:36:28 PMYou have some good ideas for Maria Marcie. Remember that your goal should be timed and measurable. How could you write the goal that you have stated meeting this criteria? Respond Collapse Mark as ReadRE: Healthy People 2020 Marcie Smith-Corlette Email this Author9/5/2014 10:05:30 PM Professor Nurss: It could be measured when she starts a walking plan for a week she could have a pre-weight and after a week weigh again and see if she has accomplished the goal. Marcie Respond Collapse Mark as ReadHealthy PeopleGloria George Email this Author 9/1/2014 9:15:41 PM 1. In order to know more about Maria, I need to gather information about her health history. I will include information about Maria’s past and present history of illness and injury, family history, and health patterns. I also need to obtain objective data which are laboratory testing, client record form and other health provider information, height, weight, and Body Mass Index data. Subjective data would be about her nutrition, psychological and emotional factors. 2. Maria’s health risks factors are obesity, high blood pressure, coronary artery disease, stroke, type 2 diabetes, high levels of triglycerides and LDL, sleep apnea, osteoarthritis which extra weigh puts more pressure on her joints. 3. Since Hispanic/Latino Americans are at risk of type 2 diabetes. Maria’s lifestyle change would benefit her to prevent or delay the onset of this illness. I would recommend to low her daily intake of carbohydrates and increase vegetables in her diet. Also, to reduce her meal portions and eat frequent small meals to let her body metabolize the food faster. Maria’s snacks between meals could be fruits or nuts. The recommended ADA diet would be explained to her in detail. I will give to her a hand out of the diet for reference. Her lifestyle is stressful, so she can walk for 30 minutes every other day in her neighborhood. She can take 10 a minute break for 50 minutes of studying. In order to have less work in her house chores, she can teach to her children how to help her out. References: D'Amico, Barbarito, Donita, Colleen. Health & Physical Assessment in Nursing. 2nd Edition. Pearson Learning Solutions, 2010. VitalBook file. Bookshelf. http://www.healthypeople.gov Respond Collapse Mark as ReadRE: Healthy People Melanie Bonanno Email this Author 9/3/2014 8:20:35 PM Hi Gloria, I like the idea of the frequent small meals. Especially for someone that seems to be constantly on the go. Melanie Respond Collapse Mark as ReadRE: Healthy People Gloria George Email this Author 9/7/2014 7:10:40 PM Melanie, Unfortunately, I had to respond to the discussion based on what our text book said. Many books are written by people from other cultures and they are not necessarily assertive. Respond (an instructor response) Collapse Mark as ReadRE: Healthy People Instructor Nurss Email this Author 9/7/2014 10:45:30 PM Gloria, I am not really understanding you post here. Respond Collapse Mark as ReadRE: Healthy People Gloria George Email this Author 9/8/2014 7:12:35 PM I am sorry, I made a mistake with the post about the student nurse Maria. Respond (an instructor response) Collapse Mark as ReadRE: Healthy People Instructor Nurss Email this Author 9/3/2014 9:43:42 PM Gloria, the elements of your assessment that you have described are central to the Health History that we will be gathering later in the course. Getting a full picture of her past history including her family history and her current health status will help you to formulate a plan that will have a better chance of working for her. Good job on this post. Respond Collapse Mark as ReadRE: Healthy people initiative Nicole McKenzie Email this Author 9/2/2014 3:38:17 AM Modified:9/6/2014 3:06 PM1. The additional information I would like to gather on Maria include her family history (heart disease, diabetes), height, weight, lab test (cholesterol, sugar level, urinalysis), exercise patterns. 2. To me Maria's real and potential health risk include the weight gain, sleep deprivation due to 6 hours of sleep per night, falling asleep behind the wheel related to the 1 hr daily commute, developing hypertension, and diabetes or even having a stroke. 3. The health risk that I choose is heart disease because of her weight gain, her lack of exercise, her diet and lack of sleep. A short term goal would include Maria will begin walking 30 minutes after dinner 4 times a week as evidence by 1 lb of weight loss per week in 4 weeks. D'Amico, Barbarito, Donita, Colleen. Health & Physical Assessment in Nursing. 2nd Edition. Pearson Learning Solutions, 2010. VitalBook file. Bookshelf. Respond (an instructor response) Collapse Mark as ReadRE: Healthy people initiative Instructor Nurss Email this Author 9/5/2014 6:07:49 PM Nicole, remembering that goals need to be timed and measurable, how could you re-write your goals to meet these two criteria? Respond Collapse Mark as ReadRE: Healthy people initiative Nicole McKenzie Email this Author 9/6/2014 3:05:08 PM Instructor Nurss, I would re-write my goal to state. Maria will begin walking 30 minutes after dinner 4 times a week as evidence by 1 lb of weight loss per week in 4 weeks. Respond Collapse Mark as ReadRE: Healthy People Initiative Gerardo Velez Email this Author 9/2/2014 9:41:33 AM Modified:9/2/2014 9:46 AM Hi Class, D'Amico, Barbarito, D. (2010) state that the collection of objective data and subjective data are important in the health assessment process. Objective information is based on physical examination while subjective data is obtained from the person. How they feel, signs and symptoms they are experiencing are examples of subjective data. Objective data would be more concrete symptoms that can be observed through physical examination, lab results, or other medical tests (D'Amico, Barbarito, D. 2010). Since Maria is Hispanic and has gained 14 pounds it is important to find out when Maria’s last physical examination was. Hispanics do have a high risk for developing diabetes and hypertension. Since she is a nursing student and is under a lot of stress, it would be prudent to ask her if she has considered that she may be developing diabetes or is at risk for developing diabetes. I would ask her if anyone in her family is diabetic, has hypertension, hyperlipidemia, and or heart disease. I would then ask her when her last physical examination was and if her MD found anything abnormal during her examination, or within her blood chemistry. Since stress is a factor in her life I would also like to know if Maria is feeling run down, anxious, has increased healing times, experiencing heart palpitations, has gotten sick frequently, has noticed a change in her menstrual cycle, and last what her eating patterns are. Since one of Healthy People 2020 initiatives is preventing and controlling diabetes, it is important to point out to Maria that stress increases blood glucose levels, and that her health history of weight gain, food choices, and ethnicity may put her at risk for developing diabetes in the future. This week’s Chamberlain 2014 lesson mentions being culturally sensitive and identifying important cultural information that help people on their journey to health, one goal for Maria would be to help her find and prepare the more healthy foods that reflect her Hispanic Heritage. A second goal would be to help her alleviate stress through delegation. She can do this by delegating some of her responsibilities to her family. Her school age children can do some cleaning, maintain their play and sleep areas, and her husband can chauffeur the children, or do the shopping, Between Maria and her husband they can formulate a schedule to help Maria and the family. Getting Maria to realize that she is not an energizer bunny and helping her and her family identify potential risks of her current lifestyle can help prevent the onset of the diseases that may be down the road for her. Formulating a plan that involves her family will also decrease Maria’s stress by giving her more time to sleep and accomplish her dream of becoming a nurse. This plan will also strengthen her family by active participation and the sharing of Maria’s dream to become a nurse. Gerardo Chamberlain College of Nursing. (2014). Lesson one lecture. Retrieved from http://nursingonline.chamberlain.edu D'Amico, Barbarito, Donita, Colleen (2010). Health & Physical Assessment in Nursing. 2nd Edition. Pearson Learning Solutions. Respond Collapse Mark as ReadRE: Healthy People Initiative Leslie Maier Email this Author 9/2/2014 9:42:03 PM Hi Geraldo, The approach to have Maria delegate some of the home’s responsibilities to her family was a great suggestion. I know that I wouldn’t of contemplated returning to school while working full time, if it wasn’t for the support of my family, around here we share chores. My only concern knowing the Mexican cultural phenomena with family patterns, men are the patriarchs of the family, they are the head of the family for they are considered wise and strong, ‘machismo’ (D’ Amico, p.69), good luck getting her husband to make beds, or vacuum. I know this from personal experience, my father never helped around the house, neither did my brothers, it was consider a woman’s job, at home we all knew my dad brought home the bacon and my mom cooked it , and cleaned afterwards. My dad expected to be served because he worked outside the home, my mom was a homemaker and she took care of the home and children. In Maria’s case maybe it will work because they are second generation Mexican-Americans. Anyways I liked your suggestion. References D'Amico, Barbarito, Donita, Colleen. Health & Physical Assessment in Nursing. 2nd Edition. Pearson Learning Solutions, 2010. VitalBook file. Bookshelf Respond (an instructor response) Collapse Mark as ReadRE: Healthy People Initiative Instructor Nurss Email this Author 9/5/2014 6:16:16 PM Leslie, thank you for sharing your personal experience. This adds credibility to the information that we read in our text. I agree that as cultural groups assimilate into mainstream American culture families tend to leave some of the gender stereotypes behind. Good points. Respond Collapse Mark as ReadRE: Healthy People Initiative Shapline Senestant Email this Author9/5/2014 8:32:21 PM Great point Leslie. I would like to add that although some men might not be willing to get involve in housework, they might agree to help the kids with their homework and making sure they go to be on time. At least it will be one less thing that Maria has to worry about. Shapline Respond (an instructor response) Collapse Mark as ReadRE: Healthy People Initiative Instructor Nurss Email this Author 9/5/2014 6:13:46 PM Gerado, your post is well done. Your rationale for the goals that you have set may help to convince Maria to challenge the traditional division of labor in the Hispanic family. However, convincing her family to take over chores will not likely be easily accomplished. Can you think of something that may give her a more immediate result in reducing her stress level. Changing other peoples behavior is sometimes a very difficult endeavor. Respond Collapse Mark as ReadHealthy peopleRonchetta Jackson Email this Author 9/2/2014 8:45:37 PM Additional information I would like from Marie is her physical activity level, tobacco, drug, or alcohol use, reproduction health and mental health. The real health risk for Marie is obesity. Marie’s potential health risks are hypertension, diabetes and mental breakdown. A reasonable short-term goal for Marie is to increase daily activity. By walking 30 minutes a day it will help with her unwanted weight gain and improve her sleep. Respond Collapse Mark as ReadRE: Healthy people Sharon Beatty Email this Author 9/3/2014 8:42:52 PM Ronchetta, I also believe that Maria can obtain the goal of increasing her daily activity. It would be easy for Maria to increase her daily activities by parking her car at the end of the parking lot at school, clinical site, or the grocery store. Maria could take the stairs at school or the hospital she has clinical at to increase her daily activity. Another option for Maria to increase her daily activity would be to include some of her cultural traditions of dancing while cooking and cleaning. By including dancing into her simple household chores she could possibly have better luck to encourage her husband and children to join in on the fun of dancing which will also increase everyone’s activity amount. Realistically I think that by making some substitutes in her cooking style and increasing the nutritional value in the food selection she could also stand to aid in weight loss along with the increase of daily activity. SharonRespond Collapse Mark as ReadHealthy People Initiative Sharon Beatty Email this Author 9/2/2014 9:30:04 PM Nursing school was incredibly stressful and I completely understand her weight gain. In some sense I see myself in my own past in this story with a few exceptions. By utilizing the necessary tabs available on the Health People 2020, a nurse may directly make changes in their own lives as well as family members, patients, and the public. (Healthy People, 2014) There are also available resources to utilize evidence based practice research to support the information a nurse presents. 1. I think it is very important to get a full past health history and head-to-toe assessment on Maria. It is also important to find out if Maria has a primary care physician (PCP) and provide information on how to obtain one if she does not already have one. Next find out if she is currently on any medications or if she recently finished any medications that she is no longer going to be taking. It is also important to take a full set of vital signs including weight. Determining a patient’s psychological history of stress, depression, and any other mental disease can also help at determining factors that may be leading to some of the symptoms Maria may be presenting with. If no known recent lab values are available, it is necessary to take blood work to determine if outside factors aren’t the cause but rather genetics. Also, it is necessary to learn family medical history to compare all of the other information with one another. 2. Some of the real health risks Maria include, stress, anxiety, sleep insufficiency, and body dysmorphia. The potential health risks are hypertension, obesity, hypercholesterolemia, diabetes type II, and stroke. 3. A reasonable goal for the obesity risk could include physical exercise and consistent adequate sleep 5-6 days a week. The physical exercise could include both aerobic and anaerobic exercise for at least 30 minutes a day of those 5-6 days during the week. It is important to not continue the same workout for a long time as the workout may no longer be effective. It is more beneficial to change the routine also so that it Maria does not become bored or uninterested in the activity. Not only do our bodies need exercise and physical challenge, it also needs plenty of rest. After a long stressful day at school, clinical, or taking care of our family duties we must recharge our bodies by resting to prepare ourselves for the next day. Once a person begins to go days without enough sleep and rest our bodies begin to break down and lack the necessary regenerating cells to repair itself. ReferencesD'Amico, D., & Barbarito, C. (2012). Health & Physical Assessment in Nursing (2 ed.). Boston: Pearson. Spotlight on Health Webinar. (n.d.). Healthy People 2020. Retrieved August 31, 2014, from http://www.healthypeople.gov Respond Collapse Mark as ReadRE: Healthy People Initiative Gerardo Velez Email this Author 9/3/2014 7:48:14 AM Hi Sharon, I like our suggestion for Maria to exercise. A good exercise routine will help with weight loss and stress management. It may also decrease her risk for developing diabetes by using the reserves of glucose in her circulatory system and liver. I also agree with a proper sleep routine. Proper sleep helps the body regenerate and helps one's endurance in dealing with stress. Proper sleep and exercise increases immunity which helps prevent illnesses like the common cold. If Maria starts a healthy exercise routine that results in weight loss and feeling better, she will be more inclined to prepare the healthier Hispanic meals that reflect her Hispanic heritage. I myself am Mexican and love the the meals that reflect my Hispanic heritage, however, they can be on the more comforting side and not so healthy, but oh so good. Gerardo Respond Collapse Mark as ReadRE: Healthy People Initiative Sharon Beatty Email this Author 9/4/2014 4:17:08 PM Gerardo, I can understand your point about encouraging Maria to prepare healthier meals along with starting an exercise routine. I am partially Italian and love many of the Italian dishes my family makes. Some of the recipes my family makes can be rather full of unnecessary calories, but they are oh so delicious! My sister has worked to adjust some of our old family recipes to make them healthier for us while maintaining some of the great flavors. I’m sure if my grandmother was still around she would be incredibly upset to find out about changing the old family recipes. However, heart disease runs in our family and by simply changing some of the ingredients as well as the cooking methods we are able to enjoy our beloved Italian dishes without the some of the worry of dying from a heart issue. Sharon Respond (an instructor response) Collapse Mark as ReadRE: Healthy People Initiative Instructor Nurss Email this Author 9/7/2014 10:38:38 PM Excellent post Sharon. You have identified important potential problems for Maria and some reasonable goals. Good job. Respond Collapse Mark as ReadHealthy PeopleTam Dang Email this Author 9/2/2014 11:10:21 PM I would gather information about her health history such as “past and present history of illness and injury, family history, a review of systems, and health patterns and practices” (D’ Amico & Barbarito, 2012). I would also like to gather her vitals, height, weight, if she exercises, and what type of diet she has. I would also assess for signs and symptoms of menopause. Her real health risks include obesity, ineffective sleeping patterns, and a large amount of stress. According to Healthy People (2014), Hispanics are at highest risk for diabetes. Her potential risks may include coronary artery disease, myocardial infarction, hypertension, stroke, and hyperlipidemia. A reasonable short-term goal for Maria may include finding healthy alternative recipes to her favorite dishes. Being that she loves to cook, she may enjoy trying out new ways to cook her dishes. This can include buying lean meat, low-fat creams, and low sodium ingredients. Even doing that three times out of the week would be helpful.D'Amico, D., & Barbarito, C. (2012). Health & Physical Assessment in Nursing. 2nd edition. Boston: Pearson. Healthy People. (2014). Retrieved from http://www.healthypeople.gov/2020/topicsobjectives2020/nationaldata.aspx?topicId=8 Respond Collapse Mark as ReadRE: Healthy People Kristen Clearwater Email this Author 9/7/2014 4:16:55 PM Hello Tam, I think by adjusting her cooking habits in minor ways would be a great start to improving Maria's health. Being that she loves to cook, she can still continue doing so just by learning new and healthier dishes. She could still continue to make her traditional dinners from her Spanish heritage, if she did so in moderation. Respond Collapse Mark as ReadRE: Healthy People Sharon Beatty Email this Author 9/7/2014 4:38:18 PM Tam, Great point! By encouraging Maria to change some of the ingredients to healthier options, she will be able to make great healthy meals not only for herself but also her family. Sometimes we sneak ground turkey into our ground beef and my dad doesn’t know the difference if we ide all of the evidence. In this scenario it says Maria is an excellent cook and likes to make meals that reflect her Hispanic culture. It is often easy and cost effective to choose the high calorie, high fat, high sodium count easy-to-prepare meals than make homemade dishes. Not to say she makes easy-to-prepare meals, but an interesting point about cooking homemade meals is that the person cooking the meal knows what all goes in the dish and can normally pronounce every ingredient. Plus she can control how much of the butter, oil, or creams are added. Sharon Respond Collapse Mark as ReadRE: Healthy People Michelle Pecoraro Email this Author 9/7/2014 7:52:35 PM I agree totally. Hispanics are at a higher risk for many different diseases. When you include all the other factors that are going on in Maria's life, the rate increases drastically. Diabetes, stroke, heart disease are just a few. If Maria made little changes, her risk would decrease and she may even have an elevated energy level. Respond Collapse Mark as ReadHealth PeopleCrystal Toffton Email this Author 9/3/2014 11:35:13 AM I would get a full set of vital signs including a baseline for HR and BP , current weight, calculate her BMI and what her goal weight is. This will provide a baseline for future visits to be compared to. I would ask her about her medical and surgical history, as well as questions related to her stress levels and identification of any barriers she is faced with, such as financial. I am sure many people are going to focus on the weight gain and encourage healthy eating, I would give Maria resources for health cooking tips. In addition to this I would also take note of the mention that she is lucky to get 6 hours of sleep a night. I think sleep health may be playing a large role in her weight gain and impacting her overall health. Healthy People 2020 has several topics and objectives that they are currently focusing on. One of the objectives that I would like for Maria to work on would be Sleep Health. Healthy People states their goal is “Increase public knowledge of how adequate sleep and treatment of sleep disorders improve health, productivity, wellness, quality of life, and safety on roads and in the workplace”. The Overview tab of the site tells us that adequate sleep is necessary to fight off infection, support metabolic and neurologic functions, it also helps us to perform better at school and work. Not getting adequate sleep has been linked to an increase in heart disease, high blood pressure, obesity, and diabetes. The CDC defines adequate sleep for adults as 7 or more hours of sleep a night. With this choosing obesity as a possible risk factor, I would help her to set a goal to return to her base line weight in 3 months. The interventions to implement to achieve this short term goal will include, adequate rest of at least 7 hours each night along with healthy eating and regular exercise. References: Center for Disease Control and Prevention (2014, Sept 2) Retrieved from http.//www.cdc.gov Health People 2020 (2014, Sept 2) Sleep Health Retrieved from http.//www.cdc.gov/2020topicsobjectives2020/default.aspx Respond Collapse Mark as ReadRE: Health People Farrah Floyd Email this Author 9/4/2014 9:51:46 AM Crystal, I agree that healthy cooking tips for Maria would be very beneficial for her and her family. Not only is Maria at risk for health problems but her family is also. Great post. Respond Collapse Mark as ReadPlan for MariaShapline Senestant Email this Author 9/3/2014 12:14:27 PM Plan for Maria 1. In order to help Maria, we should first collect data such as past and present health history, family history and a head to toe assessment. The purpose of a health history is to obtain information about the client’s health in his or her own words and based on the client’s own perceptions (D’amico & Barbarito, 2012, p.5). Initial height and weight will be collected as well in order to develop a plan of care.2. Maria is at high risk for hypertension, type 2 diabetes, obesity, hyperlipidemia and heart disease. 3. Since the 14-pound weight gain is already effecting her body image and will affect her overall health in the long run, obesity is one of the most important health risk for Maria. We could start by helping her with a weekly planner to keep a balance between family, school, work and personal time. As a good cook, we can work with her on a food journal to see the areas of her diet that need improvement in other to help her make healthier choices while acknowledging her Hispanic heritage. Maria could go for a 30-minute walk with the kids or bicycling, especially during the weekend. This will not only allow her to spend time with the kids and encourage them to stay active, but she will benefit for the exercise herself. References D’ Amico, D., & Barbarito, C. (2012). Health & physical assessment in nursing (2nd ed.). Upper Saddler River, NJ: Pearson Respond Collapse Mark as ReadRE: Plan for Maria Marjorie Abbenseth Email this Author 9/4/2014 8:04:55 PM Shapline I agree with your post; We could also assist and motivate Maria to lose the 14 pound weight gain by, encouraging her to record her weight weekly; this will help her to monitor the effectiveness of her weight loss plan. Marjorie Respond Collapse Mark as ReadRE: Plan for Maria Melanie Bonanno Email this Author 9/6/2014 7:31:56 AM Hi Shapline, Great idea on finding out how the patient views their own health so we can understand and find solutions that will help them succeed. Respond Collapse Mark as ReadRE: Plan for Maria Lacy Lewandowski Email this Author 9/7/2014 8:13:19 PM I agree, I think a planner would help lays things out for her due to her busy schedule. A planner can be a great tool for her to track not only her schedule but goals and progress to keep her motivated. I know I am lost without mine. Lacy Respond Collapse Mark as ReadRE: Healthy People Michelle Pecoraro Email this Author 9/3/2014 5:26:07 PM Modified:9/3/2014 5:31 PM According to the Phase I Report of the Secretary's Advisory Committee regarding Healthy People 2020 (USDHHS 2010), the goals of Healthy People 2020 advocate for improvement of health and address environmental factors that contribute to health and and illness. The goals of Healthy People 2020 direct attention from health care to health determinants. Health determinants include personal. social, economic, and environmental factors that influence individuals and population health. Social determinants include but are not limited to family, community, income, education, sex, race/ethnicity, place of residence and access to health care. Physical determinants include natural environments and those such as transportation, water and sanitation, housing and others known as built environments. (D'Amico & Barbarito, 2012) When looking at a situation like Maria's, many things come to mind. There are many determinants that come into play. Maria is a Hispanic female who has gained 14 pounds in the last year, sleeps about 6 hours a night, and has a very hectic lifestyle and schedule. As a Hispanic, she eats a very high fat, high diet. When assessing Maria, I would find out first and foremost if anyone in her family has a history of heart disease or stroke. I would also ask what her normal weight is. Was she underweight, average, or overweight before gaining the extra weight. What is her normal BP and Heart Rate. Does she experience any symptoms? According to Health People 2020, Coronary Artery Disease leads to 86.5 deaths per 100,000 Hispanics. As a short term goal for Maria, I would have her start simply by changing her diet and incorporating exercise into her lifestyle. Although she had a very busy hectic lifestyle, seeing a Nutritionist or following a diet plan, can help drastically. The foods you eat can affect your weight, your hormones, and the health of your organs, including your heart/ Eating a healthy diet can help reduce the risk of heart disease and stroke. (www.familydoctor.org) References: D'Amico, D., & Barbarito, C. (2012). Health & Physical Assessment in Nursing. 2nd edition. Boston: Pearson. www.familydoctor.org http://www.healthypeople.gov/2020/default.aspx Respond Collapse Mark as ReadHealthy PeopleKailynn Rednour Email this Author 9/3/2014 8:15:42 PM According to the lesson, Healthy People 2020's goals include the following: eradication of preventable disease; reducing health disparities through a determinants of health approach by improving the holistic health of all groups of people; creation of environments to promote good health for all; and promotion of health development across all ages (Healthy People 2020, 2010). When performing a health assessment, it is important to keep these goals in mind. I would ask Maria about her past medical history, family history, annual physical exams, diet, stress management, and