Health Promotion Plan
Linda Nowlin
Western Kentucky University
Teaching Health Promotions
N340
Dr. Deborah Williams
March 14, 2012

NURS 340: Health Promotion Plan
Health Promotion Plan: Diet, Nurtrition (The Purpose of this Plan is to assist an individual to improve diet and nutrition through better food choices)
Assessment
Name: Linda Nowlin

Describe a typical day, including eating times and places, activities, etc. Since I work nights, my typical eating times and places are not on a schedule like most people. When I’m at work, I eat around 10 pm to 1 am. Sometimes it is just grab something while standing or sometimes sitting. Sometimes, it is in front of a computer while charting. On my days off, I try to have a scheduled time to eat, such as breakfast around 8 am, lunch around 12 pm and dinner around 5-6 pm. My activity level has really dropped this winter. I did exercise at the YMCA 3-4 times per week, lately, I haven’t been at all, but I do want to get back to it.

What vitamins or other supplements do you take? Include dosages. I currently don’t take any vitamins or supplements.

What kind of dietary restrictions do you have? Are they self-imposed or medically imposed? Discuss how these impact your daily routine. I currently have no dietary restrictions either medically or self-imposed.
Have you had any weight gain/loss within the last month? Please discuss. Over the past 6 months, I’ve had a slow weight loss and in the past month, I’ve probably lost about three pounds. I’ve had a lot of stress in my life and don’t always eat as I should and because of nerves, I think my metabolism may have risen a slight bit.

Complete a 24 hour recall of food and fluid intake. Include any snakes that you consume. Determine fat, protein, carbohydrate, sodium content. 3:00 pm March 13 – Tuna Salad Sandwich, Diet coke
Fat=7 grams, Protein =20 grams Carbohydrates =27 grams Sodium = 1 gram 10:00 pm Lemon Pepper Chicken, Baked Potato, Bottled Water
Fat = 4 grams, Protein = 10 grams, Carbohydrates =7 grams Sodium= 10 grams 8:00 am Bacon Biscuit and Diet Coke
Fat = 31 grams, Protein = 21 grams, Carbohydrates = 31 grams Sodium = 1360 mg 1:00 pm Tuna Sandwich, Water
Fat = 7 grams, Protein=20 grams Carbohydrates= 27 grams Sodium = 1 gram

How does the 24 hour recall record compare to the American Dietetic Association recommendations for eating healthy? My 24 hour recall record doesn’t compare to what the ADA recommends at all. I don’t have nearly enough vegetables, dairy, or fruits included. I need to try to incorporate these things into my diet daily.

How does the 24 hour recall record compare to the food pyramid of the USDA? Again, I’ve not had the right foods to make a healthy diet. I really need to concentrate on what I’m eating and keeping a diary will show me what I’m getting too much of and not enough of. Without this record, we don’t pay attention to what we are eating and don’t get in the right foods every day. Good resources for proper nutrient consumption can be found at www.choosemyplate.gov and www.mypyramid.gov.

How do the following factors influence your personal eating behavior? Be specific about your own eating.
Genetic-biologic factors (Pender, p, 179) According to Pender, p. 175, heredity contributes to more than half of the variation of weight among different people. This explains why some people gain weight and others don’t, (Bloom, 2007). Genetic factors influence my eating behavior by growing up with country cooking that I crave. All the women in my family are used to cooking fried, fatty foods, and it has been instilled in me. Also, the women in my family don’t seem to have very high metabolism. By not having a rapid metabolism, fighting weight gain is a constant battle. It gets harder every year to eat the things I love and not gain weight due to my inactivity and genetic metabolism.
Psychological factors: I tend to stress eat. If I’m down or depressed, I look for comfort foods. There is something eating when I’m sad that makes me feel better. Our textbook, Pender, pg 177, explains that depression and low self esteem cause us to turn to food for comfort and of course, comfort foods are the most fattening and bad for my health. They are bad choices, but they make us feel so much better for a short time. However, later, I always wonder why I ate that when my clothes are tight. This makes me feel bad about myself and it’s depressing, and then the cycle begins again to help with the depression.
Socio-cultural factors: Social factors also influence my eating. If I’m with friends or even at work, it’s easy to order things that aren’t good for me just because everyone else is. Social eating has a big influence on me because it is fun to eat with others. Our culture has the belief that no matter what is planned, eating needs to be involved.
Environmental factors: We live in a world that is full of fast food, quick meal restaurants. Our lives are so hectic that it’s easy to go through the drive through and pick up something that we know isn’t good for us, but it is so convenient that we do it anyway to save time and take away some of our stress. Commercials add to our desire for these foods. They make them look so good that we have to try them. Our environment is full of obese people and we know that these fast food places add to the problem, but still it’s there, it’s quick and relieves some of our everyday stress.

What specific nutritional needs do you have based on developmental level or activity level? Refer to Pender. Pender pg.182-83, explains that aging alters our nutrient requirements. As we age our nutritional needs change. We need more protein for muscle mass that we are losing, we need less fat because of the risk of diabetes and hypertension. One important nutritional need that I have is to incorporate more fiber in my diet. As we age, there are so many more intestinal and digestive issues due to the slowing of motility. I also need to add more calcium due to the incidence of more brittle bones. Being more active will also help me with both the intestinal issues and bone issues.

What are your objective and subjective assessments of your own diet and nutrition? Objective: My diet and nutrition are not based on a food pyramid or dietary association. I tend to eat what is fast or quick to make. I don’t think about all the food groups when preparing meals like I know that I should. I see all the ways I can make my body healthier and I know all the ways to do that, but because of social and work obligations, I don’t take the time to make the right nutritional choices. I do realize that because of health issues in my family, such as heart disease, I do need to make changes in food and exercise. I am going to try to limit my caloric intake to 1200 per day. This should help me maintain a healthy weight and reduce my risk for heart disease and diabetes.
Subjective: The USDA food pyramid and American Dietetic Association are excellent resources to consult to learn how to prepare meals. Also, adding a 30 minute walk each day would help maintain healthy weight and be good for my heart. This can give me more energy and increased stamina.

Based on your assessment, are there pertinent risk factors associated with your current diet and nutrition.
Hypertension, heart disease and diabetes.

Based on the above assessment data, what is an appropriate nursing diagnosis?
Risk for increased blood pressure

What is an appropriate goal for your own diet and nutrition?
A gradual and healthy weight loss by increasing exercise and activity level and decreasing fatty foods. Keeping caloric intake at 1200 calories per day.

Discuss the Transtheoretical Model and how it could fit within a health promotion plan for better food choices (Must be at least 2-3 paragraphs).
According to Pender pg.51-53, The Transtheorectical model is derived from psychotherapy and theories of behavior change. Its framework describes how individuals progress to adopting and maintaining behavior change (Prochaska, Johnson, & Lee, 2009). This model states that health-related behavior change progresses through five stages, regardless of whether the client is trying to quit a health-threatening behavior or adopt a healthy behavior (Prochaska & DiClemente, 1983).
The stages are:
Precontemplation: A person is not planning on making changes in behavior or adopting a new behavior in the next 6 months.
Contemplation: A person is seriously thinking about quitting or adopting a particular behavior in the next six months.
Planning or Preparation: A perrson is seriously thinking about engaging in the contemplated change within the next month and has taken some steps to do so.
Action: The person has made the behavior change and it has continued the change for less than six months.
Maintainance: The change has been in place for at least six months and is continuing.
The Transtheorectical Model can fit within a health promotion plan for because it allows for setting goals and planning. Planning and setting goals is very important to motivate a person and the person is more likely to stick with a plan if they have set a goal and are determined to make it work. Every weight loss program should utilize the Transtheoretical Model in some way.
Identify interventions that will help you meet the goal identified above. State the rationale for each nursing intervention, with credible references. Evaluation methods should also be identified. How will you determine if the interventions have been effective? You are not evaluating the outcome itself, because this is a plan that does not include implementation of the interventions. Interventions | Rationale (Use credible resources to document specific rationale for each intervention) | Evaluation Method (How will you determine if the interventions have been effective?) | 1.) Follow ADA nutritional guidelines. 2.) Create a plan utilizing the Transtheorectical model. 3.) Monitor intake and output. 4.) Increase foods and fluids high in electrolytes. 5.) Exercise. 6.) Monitor nutrition consumption. | 1.) Keep daily food diary.2.) Monitor the progress of change. (Pender)3.) Calculate fluid balance, weight daily.4.)Monitor lab values.5.) Record keeping.6.)Use nutrition counting program or record daily. | 1.) Compare food diary with ADA guidelines.2.)Is weight being lost? Is energy level increasing?3.) Keep record of I &O and compare. Monitor weight. Create a flow sheet.4.) Check electrolyte values monthly.5.)Monitor weight loss, create a flow sheet.6.) Monitor nutritional values via record or app such as Weight Watchers, www.myplate.gov or My Fitness Pal |

References

USDA, Center for Nutrition Policy and Promotion. (June 2011). Development of 2010 Dietary guidelines for Americans. Retrieved from http://www.mypyramid.gov/
Dietary guidelines retrieved from http://www.myplate.gov/
ADA guidelines retrieved from http://www.eatright.org/