NR 305 Week 1 Discussion

NR 305 Week 1 Discussion Healthy People Initiative (graded) The topic this week asks you to apply what you have learned to the following case study. As the school nurse working in a college health clinic, you see many opportunities to promote health. Maria is a 40-year-old Hispanic 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 conducting 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 attends class a total of 15 hours per week, plus she must be present for 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 1 hour from campus and commutes each day. Using Healthy People 2020 and your text as a guide, answer the following questions. What additional information would you like to gather from Maria? What are Maria's real and potential health risks? Why is Maria's culture important when obtaining the health assessment? Pick one of Maria's health risks. What would be one reasonable short-term goal for this risk? What nursing interventions would you incorporate into Maria's plan of care to assist her with meeting your chosen goal? Please provide rationale for your selections.. Respond Topic responses Discussion Questions Search Collapse All More Sort By:      Instructor Cork Instructor Cork 10/13/2016 8:32:38 PM RE: Class begins Mon, Oct 24th Modified: 10/19/2016 5:54 PM Class - You may begin posting in this TD on Sunday, October 23th, 2016 for credit. Class officially begins Monday, October 24th. Thank you. Missy ReplyShow Less Lilian Galaviz Lilian Galavizreply to Instructor Cork 10/23/2016 1:53:08 PM RE: Class begins Mon, Oct 24th Hello, I'm really excited to begin this new class. I just wanted to let you know I posted my first answer twice, given that I posted the first one before the 23rd so I wasn't sure if I would get credit or not. Thank you! ReplyShow Less Instructor Cork Instructor Corkreply to Lilian Galaviz 10/24/2016 10:26:24 AM RE: Class begins Mon, Oct 24th Thank you, Lilian. I appreciate that. I will certainly accept the early posts for week one due to my error. :) Missy ReplyShow Less Instructor Cork Instructor Cork 10/13/2016 8:34:29 PM Additional questions for Week 1 As you respond to this scenario on Maria, you may also want to consider the following questions as you develop responses throughout the week: a) Look at the Healthy People 2020 areas of concern. Which of these factors are of greatest concern to your community? b) What is your definition of wellness? Compare it to the WHO definition. How does it compare with other definitions of wellness? c) What are some of the established tools that can be used to assess health risks and lifestyle? Which one do you find most helpful? Thank you! Missy ReplyShow Less Dorothy Cochran Dorothy Cochranreply to Instructor Cork 10/30/2016 8:18:51 PM QuestionRE: Additional questions for Week 1 Hello Professor and Class, I believe that the greatest Healthy People 2020 concern in my community is substance abuse. I personally know a handful of people who have died of overdoses and several more that have been personally affected by such deaths. Recently a task force has been formed in my community with a goal of decreasing distribution of and increasing education on recent batches of heroin that are laced with fentanyl. The number of associated deaths have been devastating. My definition of wellness, which I thought was different than most, is optimal quality of life in the presence of disease. This would include remaining free of or managing symptoms as best as possible for as long as possible. My definition is highly defined by my experience with multiple auto-immune diseases. The WHO definition of health and wellness is much the same. Culture and society also influence how health is perceived. People who live in poverty may well think that illness, disease, and debility are a regular part of life, along with mot having access to health care. There are many tools that are useful is assessing health and life style risks. The BMI scale is useful for measuring obesity. Obesity has a very long list of related health conditions. At work we use the BRADEN scale to assess risk of skin break down, the resulting score determines how we monitor the patients skin and what interventions may be necessary. Personally, I use an app to track my fitness, weight, and nutrition to promote a healthier lifestyle and to hopefully prevent associated obesity risks. Dottie Cochran References Jarvis, C. (2016) Physical examination & health assessment (7th ed.). St. Louis, MO: Elsevier U.S. Department of Health and Human Services (2014). Healthy People 2020. Retrieved from: ReplyShow Less Shiara Kaye Peart Shiara Kaye Peart 10/18/2016 1:39:10 PM Healthy People Initiative Hi Prof and Class, Additional information I would try and gather from Maria would be her eating habits. First, I would want to know how much and when does she eat her meals? This will help me determine what nutritional suggestions I can offer her. Second, what activities/exercises has she tried ever since she noticed she had gained weight? If Maria has not done any type of exercises/diet to help reduce her weight, then this will help me identify an appropriate activity/diet for her. And lastly, with the consideration of her cultural background, gathering information about her support system at home. This will help me determine if Maria will need additional support to help push her to lose and maintain her ideal weight. With Maria’s lifestyle and eating habits the way it is, Maria is definitely at risk for conditions such a heart disease, HTN, and diabetes as stated in Healthy People 2020. Living a healthy lifestyle will help promote and reduce the risk of acquiring many of these conditions. In continuation, in helping Maria reach her goal, her cultural background must also be considered prior to because her culture may think that being 14pounds overweight is completely normal while we think different here in America. With Maria being at a high risk for HTN, a short term I have for would be to demonstrate change in eating pattern within a week of starting the weight loss program. Nursing interventions I would incorporate into her plan of care would include the following: 1. Identify her desire to lose weight- Motivation can affect her weight loss program. She must want to lose weight or otherwise the program will not succeed. 2. Encourage Maria to keep a daily food diary including when, what, and how much she ate- This will help Maria focus on factors that she can control and change. And 3. Instruct and assist Maria in appropriate food selections especially avoiding foods that are high in saturated fat- Avoiding saturated fat will help reduce the risk of developing HTN. Jarvis, C. (2016). Physical examination & health assessment (7th ed.) Philadelphia, PA: Saunders. Nutrition and Weight Status. Healthy People 2020. Retrieved from Jakulj, F., Zernicke, K., Bacon, s., van Wielingen, L., Key, B., West, S., and Campell, T. (2007). A High-Fat Meal Increases Cardiovascular Reactivity to Psychological Stress in Healthy Young Adults. The Journal of Nutrition. 137(4) 935-939. Kaye ReplyShow Less Instructor Cork Instructor Corkreply to Shiara Kaye Peart 10/24/2016 10:29:14 AM RE: Healthy People Initiative Shiara - you shared some very good points as far as Maria's plan of care. Evaluating Maria's desire to make changes will be necessary. She must make the decision and then the decision can be supported and encouraged. Missy ReplyShow Less Cailee Christman Cailee Christmanreply to Shiara Kaye Peart 10/26/2016 9:17:40 PM RE: Healthy People Initiative Shiara, Great post! I could not agree more with your discussion this week in its entirety. You really did a great job pinpointing the barriers within the Hispanic culture as a whole and provided excellent POC examples. I look forward to reading you future posts :) ReplyShow Less Karen Eyler Karen Eylerreply to Shiara Kaye Peart 10/27/2016 9:49:54 AM RE: Healthy People Initiative Dear Kaye, I agree with your suggestions, especially assessing her support system. It sounds as though Maria takes on a lot and doesn't have much help at home. Being able to delegate some of her daily tasks would be helpful in alleviating her responsibilities, if she has someone that can help. It may also be that she is just an over-achiever who feels like she needs to do all of this on her own. In the Hispanic culture the women take on more of the mothering, care taking role and the men are more the provider and financial supporter. In this day in age, with women in the workforce, and Maria wanting to further her education to also become a financial provider, it requires a teamwork approach. Realistically, Maria's weight gain will not improve if she doesn't change her routine. Hopefully her family will be supportive and also change some of their habits. Interesting conversation.... Karen Eyler ReplyShow Less Enrique Gonzalez Enrique Gonzalez 10/18/2016 1:45:58 PM Questions to Maria Hi Professor Cork and fellow classmates, Maria has a very interesting but common story which many students have obstacles to hurdle. When you hear Maria story most of us will think that she is overwhelmed. One of my questions to her would be does the stressors of life stop her from getting assignments done. In the reading were told that in order we must understand our own culture to respect other cultures around us (p13). There is another question I would like to ask Maria, how does her husband help accomplish some of her goals in school. Coming from a Spanish culture traditionally the women stays at home takes care of the kids and does all the cooking and takes care of her husband needs. When I was in school I had a classmate that had very similar issues but did not have any help or support of others that accomplish this great feet over there adversities. I am concern about the running around that she is doing and hope that she is hydrating herself , because as dehydration can lead to syncopal episodes . Javis Carolyn, P. (2016). Physical Examination and Health Assessment.(p.13) Reply EditShow Less Shiara Kaye Peart Shiara Kaye Peartreply to Enrique Gonzalez 10/18/2016 3:34:08 PM RE:Questions to Maria Hi Enrique, you bring up a very good point... it does seem like Maria is overwhelmed... I never thought of it that way... I definitely agree with you about addressing the stressors in her life, however I do want to add to your question and actually addressing the problem she came up with (14lb wt gain). Maybe asking her on what she thinks on what could've caused the weight gain? This will probably give us a little bit more insight on what is really going on.. Kaye ReplyShow Less Jennifer Branham Jennifer Branhamreply to Shiara Kaye Peart 10/25/2016 12:26:37 PM RE:Questions to Maria Hello Enrique and Kaye, I think her emotions are an important priority because like you both stated, she is overwhelmed and if it is not considered appropriate in her family for her to be going to school, then she may be silently reaching for help. She came because of concerns for weight gain, which is unusual to see a physician for a 14 lb gain over 2 years. I believe maybe she may be slightly depressed because of not having any help with school and household duties along with getting little sleep. She may be fine, but this would send a little flag up to me. Am I the only one? ReplyShow Less Shiara Kaye Peart Shiara Kaye Peartreply to Jennifer Branham 10/25/2016 4:35:29 PM RE:Questions to Maria Hi Jennifer, I think you also made a great point. Yes, her life situation does send a little red flag. I do agree that she maybe silently asking for help but we can not really just assume that she is depressed until we actually get a little bit more information. We can probably try and get her a psych consult but I think we need to address the "actual" problem first. Kaye ReplyShow Less Karen Eyler Karen Eylerreply to Jennifer Branham 10/27/2016 9:58:05 AM RE:Questions to Maria Jennifer, You bring up a very good point. She may definitely be seeking help from an abusive situation. But as we know it takes an abused person approximately 7 times of being asked before they may admit to their abuse. The fact that she is reaching out is step one in the process of change. As a provider I would bring Maria back frequently to be able to assess her physical and mental state to see if any signs of abuse were occurring. It may just be that her husband has a demanding job that requires a lot of his time and he doesn't have time for himself, but without knowing for sure, it will be hard to assess with just one visit. Having been in an abusive relationship myself, I am proud of her for wanting to further her education and to become an independent woman and mother, setting an example for her young children. I would also like to assess her support system with friends, to see if she has anyone she could rely on in an emergent situation. Providing her with information on support groups and shelters may be necessary if abuse is highly suspected. Thank you for your thoughts, it puts things into a different perspective. Karen Eyler ReplyShow Less Enrique Gonzalez Enrique Gonzalezreply to Shiara Kaye Peart 10/27/2016 12:01:53 PM RE:Questions to Maria Yea that is not a bad comment and I appreciate your input, thanks. Reply EditShow Less Joan Taylor Joan Taylorreply to Enrique Gonzalez 10/28/2016 11:06:18 PM RE: Questions to Maria Enrique and Class, You are absolutely right when you state that Maria story is very common with many students. Having a support system as a student is so vital and many students don't realize it until the stress level is increased. ReplyShow Less Lilian Galaviz Lilian Galaviz 10/19/2016 11:04:48 AM Week 1 1. Things I would like to know about Maria: more about her reasons for seeking care, the perception she has of her health and why she wants to do something about her weight. I would also like to know any past medical history, as well as any family history. I would like to know if she is on any medications, if she has any allergies, and a functional assessment. Lastly I would like to have more objective information regarding her systems. I would also like to find out how she cooks her meals (ingredients, spices, etc) and how often and how much she is eating. Jarvis (1993), states that “the following health history provides a complete picture of the person’s past and present health. It describes the individual as a whole and how the person interacts with the environment: a) Biographic data b) Reason for seeking care c) Present health or history of present illness d) Past history e) Medication reconciliation f) Family history g) Review of systems h) Functional assessments”. 2. Given that we don’t really know whether Maria is at a healthy weight or not, a potential risk would be obesity and unhealthy weight status. According to Healthy People 2020, individuals who are at a healthy weight are less likely to: • Develop chronic disease risk factors, such as high blood pressure and dyslipidemia. • Develop chronic diseases, such as type 2 diabetes, heart disease, osteoarthritis, and some cancers. • Experience complications during pregnancy. • Die at an earlier age. Due to her Hispanic heritage, Maria is at higher risk for cardiovascular diseases and type 2 diabetes. 3. Culture plays a big part of how people perceive and treat illness. It can also affect the way we eat, dress, socialize, etc. Having all that information in mind can help us make better decisions regarding our patient’s health because we can customize our care plans so that our interventions fit their way of life, which increases the likelihood of their compliance. 4. A goal that I would choose is to maintain Maria’s A1C under 5.7. Given that Maria is concerned and seems like she wants to do something about her weight, my first intervention would be education. I would teach her about DM, her risks and how to prevent it. I would then develop a plan for her regarding her diet and how to make healthy versions of her favorite dishes. I would also try to help her develop an exercise regimen. She is a busy mom, but she needs to take care of herself to be able to take care of her family. “Lifestyle change has been proven effective in preventing or delaying the onset of type 2 diabetes in high-risk individuals. Based on this, new public health approaches are emerging that may deserve monitoring at the national level. For example, the Diabetes Prevention Program research trial demonstrated that lifestyle intervention had its greatest impact in older adults and was effective in all racial and ethnic groups.” (). I would also help her select a PCP or a clinic where she could go for follow up appointments and monitoring. Reference Jarvis, C. (7th Ed.). (1993). Physical Examination and Health Assessment. Retrieved from U.S. Department of Health and Human Services (2010). HealthyPeople2020. Retrieved October 19th, 2016, from ReplyShow Less Shiara Kaye Peart Shiara Kaye Peartreply to Lilian Galaviz 10/19/2016 12:56:21 PM RE: Week 1 Hi Lilian, Nice to meet you, I agree with what you said about finding out the reason why Maria came to seek help first before doing anything else. When we do physical assessments, we certainly do not want to just "assume" what she is seeking help for. We want to make sure that we are addressing the "actual" problem and deal with the rest of the problems that comes along with it later. I also think that Maria's goal you mentioned is a great start however, I do think that it should be a long term goal. With Maria just starting to ask for help with her weight gain, maybe a better goal for her would be changing her eating pattern first. Kaye ReplyShow Less Michelle Reid Michelle Reidreply to Lilian Galaviz 10/27/2016 10:26:44 AM RE: Week 1 Modified: 10/27/2016 10:28 AM Lilian, I think a major part of our job as nurses is the interventions we provide to our patients. Education is a key element in providing proper care to our patients. Patients must be thoroughly educated in order to sustain a healthy life. Maria definitely needs education regarding diabetes, the risk factors and prevention opportunities. Maria is at a stage in her life where she is probably going through a lot of stress between school, work, family, kids, etc. Lifestyle changes are going to help Maria in the most positive way. I would also recommend to her she needs to continue to see her Primary Care Provider more often. ReplyShow Less Nichole Goodin Nichole Goodinreply to Lilian Galaviz 10/28/2016 10:26:17 AM RE: Week 1 Hi Lilian, I found that your post was very thorough. I really agreed with the questions that you would ask Maria. I also posted that I would inform her of the higher risk and predisposition of developing medical issues and certain disease with having a Hispanic heritage. Maria’s primary concern, according to the case study was her 14 pound weight gain, and how that may affect her appearance and her health. As a Nurse working in the college health services, I would establish a complete data base on Maria, so that I could see the whole picture of her health, thoughts, and beliefs. According to Jarvis, “When you work in these settings, you are the first health professional to see the patient and have primary responsibility for monitoring the person's health care. Collecting the complete database is an opportunity to build and strengthen your relationship with the patient”. (Jarvis, 2016, p.5). I would assess her family dynamic as well, and educate her on the importance of not only making a lifestyle change for herself, but that she will also need to include her family as well. According to Healthy People many social factors influence diet such as: · Knowledge and attitudes · Skills · Social support · Societal and cultural norms · Food and agricultural policies · Food assistance programs · Economic price systems8 References: Jarvis, C. (2016). Physical examination & health assessment (7th ed.) Philadelphia, PA: Saunders. U.S. Department of Health and Human Services (2010). HealthyPeople2020. Retrieved October 19th, 2016, from ReplyShow Less Instructor Cork Instructor Corkreply to Nichole Goodin 10/29/2016 6:36:25 AM RE: Week 1 Nichole - it is a good suggestion for Maria to include her family in her decision to make lifestyle changes. She will benefit from their support, encouragement and involvement. Thank you for sharing the social factors that can influence diet in your post. Missy ReplyShow Less Antonio Thomas Antonio Thomas 10/19/2016 3:06:20 PM Healthy People Initiative Good Day, There is additional information that I would like to gather from Maria. One of the most important aspects or focuses of nursing is providing holistic care to patients and patients’ families. “In a holistic model of health care, assessment factors must include culture” (Jarvis, 2016). Also, “Holistic health views the mind, body, and spirit as interdependent and functioning as a whole within the environment” (Jarvis, 2016). The patient has provided heaps of subjective data as far as possible health complications and risks. Nursing school is the first piece of information that promoted to know that the patient is under some new stress and possible anxiety. This new stress amongst other personal matters and responsibilities in the patient’s life could be conclusions as to why the patient is gaining weight. I would like to ask the patient for more detailed information about her food preferences and outline what her prepared meals and diet. Culture consideration is vital to ascertain when considering health risks and food choices. “Despite the heterogeneous ancestral backgrounds of Hispanic Americans, many Hispanics still retain core elements of the traditional Hispanic diet, including a reliance on grains and beans and the incorporation of fresh fruits and vegetables in the diet” (Diet Health, 2004). I would also ask the patient what exactly is her Hispanic heritage as well. For instance, is the patient Cuban, Puerto Rican, Columbian, etc.? Hispanic cultures are different that information may needed to be taken into consideration. I would ask Maria about her support system because based upon the initial assessment and evaluation of the information, the patient seems to be a single parent or does have any outside assistance especially with her children. Lastly, I would ask to have some blood work done to further evaluate the patient’s health. Maria’s real and potential health risks based upon her initial visit and assessment. Let’s start with the potential risks. Various ethnicities are predisposed or carry the risks of obtaining diseases. In the case of Maria and her Hispanic heritage, she has a high risk of diabetes, cancer, and hypertension. With collection of blood and other testing, risks can be ruled out or the patient find out new information. The real risks the patient are having weight gain, sleep deprivation, and role strain. Maria necessitates some help from the spouse with the children and tasks around the house, so that Maria can get adequate rest and time for herself and her studies. As I have mentioned previously, culture is very important to consider when conducting a health history. Many ethnicities and cultures have higher potential risks of having certain diseases than others; meanwhile, have different diets and lifestyles choices to respect. Cultures may have different beliefs and perspectives which may have affect treatment processes. Lastly, nurses may have to take a different approach to treating patients of different cultures as far as verbal and nonverbal communication. I would like for Maria to make sure she sets aside at least seven to eight hours for sleep. It will be a family effort in order for Maria to achieve the goal, but Maria needs to get adequate rest for her body. I sit with Maria and possibly the spouse in order to try and assist the family with scheduling and splitting tasks at home. Currently, Maria has so much to do that she not able to incorporate sleep, so time for exercising would be out of question at the moment. If Maria can have some additional assistance from family at home, there alone I feel Maria can better able to manage her weight and her health amongst school and her family. References Diet Health. (2004). Hispanic and Latino Diet. Retrieved from D: Jarvis, C. (2016). Physical Examination and Health Assessment. Philadelphia, PA: Saunders. ReplyShow Less Lilian Galaviz Lilian Galavizreply to Antonio Thomas 10/23/2016 2:04:20 PM RE: Healthy People Initiative Antonio, I think the goal you chose is very important. Maria is overworked and strained, and she needs to take care of herself. A key component of taking care of herself is resting. Time and time again we read about the benefits of sleeping, and many studies even correlate diseases such as diabetes and obesity to lack of sleeping. Changing her lifestyle might be a very complicated task, and as you mention, it would be a family effort, but one that in the end would benefit everyone. ReplyShow Less Instructor Cork Instructor Corkreply to Antonio Thomas 10/24/2016 10:31:27 AM RE: Healthy People Initiative Antonio - I'm glad you addressed Maria's sleep. We know how essential adequate sleep is. This could definitely be a factor in her weight gain. Talking through the relationship between sleep, energy, nutrition, exercise and weight would be relevant. Missy ReplyShow Less Rachele Magnarelli Rachele Magnarellireply to Antonio Thomas 10/24/2016 8:09:14 PM RE: Healthy People Initiative Modified: 10/24/2016 8:48 PM Hello, Antonio! I enjoyed reading your reply. I do, however, think that physical activity can be attained by Maria. According to the U.S. Department of Health and Human Services (2014), “For people who are inactive, even small increases in physical activity are associated with health benefits”. Thirty minutes of brisk walking would allow her to decompress from her day and will help to improve sleep. U.S. Department of Health and Human Services (2014). Healthy People 2020. Retrieved from: ReplyShow Less Patricia Curry Patricia Curryreply to Antonio Thomas 10/25/2016 6:34:41 PM RE: Healthy People Initiative Hi Antonio, I agree that sleep habits are important to gaining more insight into Maria’s routine and health concerns and risks. As Casey (2015) states, “People suffering chronic sleep impairment are more likely to be obese or have type 2 diabetes.” Health promotion and disease prevention, as Jarvis mentions, are important as primary clinicians to counsel the patient in order to achieve a desirable outcome. By getting an appropriate amount of sleep, many other things can fall into place. Many times people eat more when they are sleep deprived, as the brain craves more sugar-type foods. That may be the case for Maria. Therefore, by inquiring more on what, when and how she sleeps is important to consider as well. I also agree that by incorporating her family into her support system would be beneficial to her and her health. If she has a large family or extended family living with her, she could assign certain tasks or chores into their daily plan to help out while Maria is commuting or carrying on the other household responsibilities. Casey, G. (2015). Resting easy in sleep. Kai Tiaki Nursing New Zealand, 21(11), 20-24. Jarvis, C. (2016). Physical examination & health assessment (7th ed.) Philadelphia, PA: Saunders. ReplyShow Less Instructor Cork Instructor Corkreply to Patricia Curry 10/26/2016 9:42:38 PM RE: Healthy People Initiative Patricia - thank you sharing research that helps to explain why sleep deprivation can contribute to weight gain. This is important information to ensure Maria understands, as lack of sleep needs to be addressed. Missy ReplyShow Less Nichole Goodin Nichole Goodinreply to Antonio Thomas 10/28/2016 10:36:18 AM RE: Healthy People Initiative Hello Antonio, I agree spot on this your post as mine was also very similar. According to Healthy People, “Sleep, like nutrition and physical activity, is a critical determinant of health and well-being. Sleep timing and duration affect a number of endocrine, metabolic, and neurological functions that are critical to the maintenance of individual health. If left untreated, sleep disorders and chronic short sleep are associated with an increased risk of: · Heart disease · High blood pressure · Obesity · Diabetes · All-cause mortality Maria needs to make getting an adequate amount of sleep a priority and she will have to enlist the help of her husband and children in order to achieve this goal. A family session to discuss helpful tips and family-sharing of responsibilities may be a good option. References: U.S. Department of Health and Human Services (2010). HealthyPeople2020. Retrieved October 19th, 2016, from ReplyShow Less Lilian Galaviz Lilian Galaviz 10/23/2016 1:51:44 PM WEEK 1 1. Things I would like to know about Maria: more about her reasons for seeking care, the perception she has of her health and why she wants to do something about her weight. I would also like to know any past medical history, as well as any family history. I would like to know if she is on any medications, if she has any allergies, and a functional assessment. Lastly I would like to have more objective information regarding her systems. I would also like to find out how she cooks her meals (ingredients, spices, etc) and how often and how much she is eating. Jarvis (1993), states that “the following health history provides a complete picture of the person’s past and present health. It describes the individual as a whole and how the person interacts with the environment: a) Biographic data b) Reason for seeking care c) Present health or history of present illness d) Past history e) Medication reconciliation f) Family history g) Review of systems h) Functional assessments”. 2. Given that we don’t really know whether Maria is at a healthy weight or not, a potential risk would be obesity and unhealthy weight status. According to Healthy People 2020, individuals who are at a healthy weight are less likely to: • Develop chronic disease risk factors, such as high blood pressure and dyslipidemia. • Develop chronic diseases, such as type 2 diabetes, heart disease, osteoarthritis, and some cancers. • Experience complications during pregnancy. • Die at an earlier age. Due to her Hispanic heritage, Maria is at higher risk for cardiovascular diseases and type 2 diabetes. 3. Culture plays a big part of how people perceive and treat illness. It can also affect the way we eat, dress, socialize, etc. Having all that in mind can help us make better decisions regarding our patient’s health because we can customize our care plans so that our interventions fit their way of life, which increases the likelihood of their compliance. Also, according to our lesson, "illness is a stressful time when patients rely on traditions and cultural beliefs", so in order for us to help them achieve an optimal outcome, we must respect and integrate their culture in their care. 4. A goal that I would choose is to maintain Maria’s A1C under 5.7. Given that Maria is concerned and seems like she wants to do something about her weight, my first intervention would be education. I would teach her about DM, her risks and how to prevent it. I would then develop a plan for her regarding her diet and how to make healthy versions of her favorite dishes. I would also try to help her develop an exercise regimen. She is a busy mom, but she needs to take care of herself to be able to take care of her family. “Lifestyle change has been proven effective in preventing or delaying the onset of type 2 diabetes in high-risk individuals. Based on this, new public health approaches are emerging that may deserve monitoring at the national level. For example, the Diabetes Prevention Program research trial demonstrated that lifestyle intervention had its greatest impact in older adults and was effective in all racial and ethnic groups.” (). I would also help her select a PCP or a clinic where she could go for follow up appointments and monitoring. Reference Jarvis, C. (7th Ed.). (1993). Physical Examination and Health Assessment. Retrieved from U.S. Department of Health and Human Services (2010). HealthyPeople2020. Retrieved October 19th, 2016, from ReplyShow Less Corinna Holden Corinna Holdenreply to Lilian Galaviz 10/24/2016 1:39:31 PM RE: WEEK 1 Lilian, Great research and very detailed. I agree that culture plays an important role in health and wellness and the way people perceive their own health. I also believe that this is one of the most important aspects of information because it examines personal beliefs around health and allows the patient to expand on their health and why they choose to do certain things in regards to their health. Some other things in addition to what was posted that could be pertinent to ask is about stress relievers. Stress relief is important because stress can increase weight gain. It's also important to know if Maria does any physical exercise on a regular basis. Physical exercise can lead to more energy and less fatigue, which is she currently suffering from. Physical exercise can also lower her blood glucose if she is suffering with hyperglycemia. Corinna ReplyShow Less Kimberly Dietrich Kimberly Dietrichreply to Lilian Galaviz 10/24/2016 6:26:35 PM RE: WEEK 1 Lillian, A great post! I like the way that you stated the problem and immediately commented on what you would do for an intervention. I also liked how you related spices that she may use while cooking. I really didn't realize that spices has so much fat potential in them. I cook to what I was brought up with (biscuits, gravy, bacon, fried chicken in shortening, etc...) and it's a very hard habit to break. ReplyShow Less Sheryll Saballa Sheryll Saballareply to Lilian Galaviz 10/27/2016 2:03:08 PM RE: WEEK 1 I agree that culture plays a vital role in a person's health. According to a study on Hispanic women toward their attitude on physical activity, "the women considered their family the highest priority in their lives and hardly found time for physical activity for themselves" (Im et al, 2010).Compliance would be difficult considering that in her culture, Hispanic women believe exercise is luxury that they do not have since family comes first. Educating her is a great intervention to help her adhere to treatment. Im, E.-O., Lee, B., Hwang, H., Yoo, K. H., Chee, W., Stuifbergen, A., … Chee, E. (2010). “A Waste of Time”: Hispanic Women’s Attitudes toward Physical Activity. Women & Health, 50(6), 563–579. ReplyShow Less Rachele Magnarelli Rachele Magnarelli 10/23/2016 3:30:16 PM RE: week 1: Healthy People Initiative Modified: 10/23/2016 3:31 PM Hello Professor and classmates. As Maria’s school nurse, there are many additional pieces of information that I’d like to gather. First, I’d like to find out how much stress she is under, and her perceived stress. I’ll ask her the age of her children and how independent around the house they are. Are they able to help with chores? How is her relationship with her husband and can some of the household duties be transferred to him? When adult women/parents go back to school, there must be a shift in the home. Chores around the house, chauffeuring the children to activities, shopping and cooking duties need to be shared for her to succeed academically. School alone takes up 27 hours of her week, then add on two hours/day for travel time. I’ll also ask Maria how much time per week she designates for self-care. I would like to obtain a complete (total health) database. “For the well person, this database must describe the person’s health state; perception of health; strengths or assets such as health maintenance behaviors, individual coping patterns, support systems, and current developmental tasks; and any risk factors or lifestyle changes” (Jarvis, 2016, p. 6). Maris’s real health risks are increased stress and depending on her BMI, obesity. She has the potential to develop hypertension, heart disease and type 2 diabetes with increasing weight. Maria’s Hispanic culture must be taken into consideration when obtaining the health assessment. She and her family enjoy eating culturally specific foods which may be adding to her weight gain when paired with increased stress, lack of adequate sleep, increasing age and lack of aerobic activity. As Jarvis (2016) stated, “…we need to understand a patient’s cultural and religious beliefs because countless health-related behaviors are promoted by nearly all cultures and religions. Mediating, exercising and maintaining physical fitness, getting enough sleep, being willing to have the body examined, telling the truth about how you fell, maintaining family viability, hoping for recovery, coping with stress, being able to live with a disability, and caring for children are all intricately related to one’s core values and beliefs.” (p. 17) Maria’s culture may also influence how much her husband is willing to help with household duties. A reasonable short-term goal I’d like to see for Maria will be for her to lose 5-7 pounds over the course of 4-6 weeks and increase her aerobic activity. According to Healthy People 2020, less than 20 percent of Americans meet the guidelines for both muscle-strengthening and aerobic activities. “Among adults and older adults, physical activity can lower the risk of: · Early death · Coronary heart disease · Stroke · High blood pressure · Type 2 diabetes · Breast and colon cancer · Falls · Depression U.S. Department of Health and Human Services (2014). To help Maria meet my chosen goal for her, I’d like her to keep a food diary. If she can be honest with herself, seeing her food intake on paper can be eye-opening. I’d like to have her talk with a registered nutritionist and have her learn more about food labels, daily requirements and the possibility that she may be eating more than her daily dietary needs. A daily thirty-minute aerobic walk is another intervention I’d like to see her take on. It will help to burn calories, create healthy habits, and reduce stress. Ideally, if she has her husband join her, she can talk to him about the stressors she has. This will strengthen their relationship and can be beneficial for both. I believe that if Maria can reduce her weight and add some exercise to her daily routine, her risks for type 2 diabetes, hypertension, and heart disease will be reduced. Given her culture, I know this will be a challenge. Jarvis, C. (2016) Physical examination & health assessment (7th ed.). St. Louis, MO: Elsevier U.S. Department of Health and Human Services (2014). Healthy People 2020. Retrieved from: ReplyShow Less Liyuwork Tegegn Liyuwork Tegegnreply to Rachele Magnarelli 10/25/2016 3:51:07 PM RE: week 1: Healthy People Initiative Hello Rachel You brought up good points about keeping a food diary for Maria because she have to track her nutrition intake on a daily base and that will motivate her more to control her diet. I think it is also good for Maria if she can participate in support groups. ReplyShow Less Enrique Gonzalez Enrique Gonzalezreply to Rachele Magnarelli 10/27/2016 12:11:06 PM RE: week 1: Healthy People Initiative Hi Rachele I enjoyed reading your post and its right on point . Maria neither way she is not saying outright her life is very overwhelming and the additional weight could lead to other problems like HTN or DM. Good post. Reply EditShow Less Patricia Curry Patricia Curry 10/23/2016 7:34:46 PM Healthy People Initiative During the exam I would want to make sure that I recognized Maria for what she was doing well. Additional information necessary to gather during the exam from Maria would be to inquire what she thinks about the weight gain and how it has affected her and her family. Ask her what she thinks the reason is for her weight gain and what health concerns she has in relation to the weight. What she thinks about exercise and what her portions are like with her meals. Asking what she has attempted to do in regards to the weight gain and ask her what her idea of a healthy diet entails (Jarvis, 2016). It is important not to assume how she feels or what she thinks, but to take a nonjudgmental approach on the situation (Jarvis, 2016). It is important to treat Maria from a holistic approach. She has real health risks, both physically and emotionally. Emotional risk factors include depression and anxiety. Physical risk factors consist of diabetes, hypertension, high cholesterol and heart disease. Especially the risk of type 2 diabetes, since Hispanics are at higher risk than non-Hispanics. And being diabetic, “doubles the mortality risk when compared with the risk of patients without diabetes” (Maez, et. al., p. 2). A short-term goal for her risk of diabetes would be portion control. Start by cutting back on carbohydrates and increasing fruits and vegetables. Because Maria does the grocery shopping and cooking, this may be achievable. Exercise would be ideal, but in Maria’s situation, this is likely not easy to obtain at this time in her life. I wouldn’t want to overwhelm her with more than she can handle at the present time. I would assist her in her goal through teaching her what a portion of each food group looks like and equates to. Having her keep a food diary will helpful when she follows up to better assist her in any alterations that may be helpful. I would teach her the exchange system and how many exchanges she is able to consume and maintain a healthy weight. It is essential to note Maria’s Hispanic culture to better understand what types of food her culture consumes, what diseases are higher in this culture than others and what religious beliefs are common. Knowing the cultural background will help the clinician to better treat Maria appropriately. Jarvis, C. (2016). Physical examination & health assessment (7th ed.) Philadelphia, PA: Saunders. Maez L, Erickson L, Naumuk L. Diabetic education in rural areas. Rural and Remote Health. 2014; 14: 2742. Retrieved from ReplyShow Less Instructor Cork Instructor Corkreply to Patricia Curry 10/24/2016 10:34:10 AM RE: Healthy People Initiative Patricia - wonderful point made about portion control of various foods. Incorporating more plant based foods will promote the healthy goals. Discussing ideal intake from the various food groups would be a helpful review. Maria can then compare what she should strive for against what she is currently consuming to see the types of adjustments that may be necessary. Missy ReplyShow Less Lilian Galaviz Lilian Galavizreply to Patricia Curry 10/24/2016 1:48:58 PM RE: Healthy People Initiative Patricia, I agree that Maria is at a very high risk for developing diabetes. I do believe it is very important to teach about portion control and all the foods included in the different groups, but I believe that it is very important to show her why she needs to do this, which is to prevent diabetes. I believe that if she is conscious about what DM is and the consequences, she might be more motivated to act. A good way of aiding with her education on portion control and food groups could be . ReplyShow Less Patricia Curry Patricia Curryreply to Lilian Galaviz 10/25/2016 6:48:08 PM RE: Healthy People Initiative Hi Lilian, I also agree that Maria would be more motivated to adhere to a particular diet plan if she is educated on the consequences of diabetes. In order to achieve this type of goal, it would be imperative to assess her willingness to change her eating habits. It would also be important to assess her availability to the internet away from her schooling. If she doesn’t readily have the internet at her fingertips, it may be difficult for her to research good eating habits. I agree is a great resource, but she doesn’t appear to have much spare time to do the research herself. I think it might be more helpful to print out and hand her the material. ReplyShow Less Kimberly Dietrich Kimberly Dietrichreply to Patricia Curry 10/26/2016 8:41:10 PM RE: Healthy People Initiative Hi Patricia, I do agree with all the points mentioned by you, Lilian, and Instructor Cork. The first step I would make sure is in place is that Maria is agreeable to making her changes. With Maria being agreeable, she is more apt to follow through with her changes in her diet, which is exactly what you elaborated on Patricia. We would also need to be sure that Maria is agreeable to learning about the effects of diabetes, and it's presented in a context that is easy for her to understand. When the patient is ready to learn, everything else falls into place. ReplyShow Less Instructor Cork Instructor Corkreply to Patricia Curry 10/27/2016 8:14:11 PM RE: Healthy People Initiative Patricia - helping patients to understand the potential consequences of continued lifestyle choices can provide motivation, if the risks are a significant deterrent. Providing Maria with written resources and/or verbal information are great ideas. With limited time available, it could be beneficial to make the transfer of information as easy as possible. Missy ReplyShow Less Michelle Reid Michelle Reidreply to Patricia Curry 10/27/2016 10:45:32 AM RE: Healthy People Initiative Hi Patricia, You make a good point. Recognizing the good and positive things in Maria’s life is important too. Also her views on her weight gain would be helpful. Maria needs to know we as healthcare providers are here to help her and get her through this time. We need as much information, not only relating to the situation but background information, so we can 1provide the most accurate care. Jarvis points out “the examiner analyzes and interprets” all the data that Maria is providing, “clustering the information, sorting out which data to refer and which to treat” (2016, Ch.1). Not all data with be pertinent to Maria's current health situation but is still helpful for us to educate for future complications. ReplyShow Less Instructor Cork Instructor Corkreply to Michelle Reid 10/27/2016 8:16:26 PM RE: Healthy People Initiative Michelle - great idea to inquire as to Maria's thoughts on her weight gain. She may be able to verbalize specifically why she has sought medical attention at this time, what her concerns are, etc. Once we better understand what has propelled her to seek care, we can draw on that to help with the change needed. Missy ReplyShow Less Rachel Piszczek Rachel Piszczek 10/23/2016 7:58:02 PM Assessment of Maria Professor and class, As I complete an assessment of Maria, I would be interested to learn more about the quality of her sleep at night, and if she uses any sleep aids. 6 hours of sleep at night is not very long, if she is tossing and turning through the 6 hours that she does get, it can affect many areas of her life including the immune system, metabolism, ability to perform well in school, and the ability to work safely and effectively (DHHS, 2014). Additional information I am interested in finding out is Maria’s size prior to weight gain. Was she overweight prior to the weight gain? The 14 lb weight gain can put her at higher risk for obstructive sleep apnea, which I would assess for further, which could also affect the quality of sleep she is getting. Some other health disparities Maria is at risk for from poor sleep include heart disease, high blood pressure, obesity (which may be a real health risk instead of potential), and diabetes. A further assessment of vital signs would be helpful to rule out HTN. Assessment of cardiac history as well as blood sugar may be indicated dependent upon symptoms. Maria’s Hispanic heritage is important when obtaining a health assessment for many reasons. One reason is that the nurse realizes that family is very important in Mexican households, and they often feel a strong sense of duty to one another within the family (Hancock, 2005). Since she is a large provider for her family, she will continue to cook meals and care for her family. It is disrespectful of her culture to expect her to completely change the menu options she usually provides for herself and her family. I can encourage small, heart healthy changes such as brown rice instead of white, and using less salt in her cooking to improve her heart health. From the scenario, it seems the reason Maria is seeking care is that she is concerned with her weight gain. There are many different goals we can choose to help combat potential obesity, such as diet change, exercise, enough sleep at night, etc. Since Maria’s schedule is so busy and she dedicates much of her time to her family and school work, recommending a block time of exercise every day does not seem like a very reasonable goal. Instead, I would first recommend making small changes such as parking farther away from the grocery store or school buildings, and choosing stairs over the elevator. Another reasonable goal I think she can make would be for her to eat more green leafy vegetables. She can choose to eat a salad for lunch every day that she is in school or clinical, so it doesn’t have to affect the wonderful meals she provides for her family. She can keep with her heritage and make a taco salad with chicken and low-fat sour cream as a healthier option. I would provide her with a list of healthier substitutes she can use while cooking for her family, to maintain the delicious menu she provides them, but making it healthier for her. I would also ask her to keep a food diary over the next month recording everything she eats, and after a month, we can meet again and review the diary to see if there are healthier options she can choose. This is just a small change she can make that would be better for her health, as she continues making small steps in the right direction it will be easier and easier to live a healthier lifestyle. Hancock, T. U. (2005). Cultural Competence in the Assessment of Poor Mexican Families in the Rural Southeastern United States. Child Welfare, 84(5), 689-711. Department of Health and Human Services (DHHS). (2014). Healthy People 2020. Retrieved from ReplyShow Less Shiara Kaye Peart Shiara Kaye Peartreply to Rachel Piszczek 10/24/2016 9:55:23 AM RE: Assessment of Maria Hi Rachel, I definitely agree with what you said about Maria's sleep. I never really looked at the effects of having no sleep in nutrition. So, maybe a good suggestion for Maria would be talking to her about non-pharmacologic ways to help initiate sleep such as meditation prior to sleeping. Also, another way of helping her would be educating her about exercises that will help alleviate some of the stress she is having. We all know coming from nursing school, stress/anxiety can induce insomia. Maybe educating her on exercises such as yoga would help ease her mind a little. I think once we address her sleep problems, it will help boost her immunity and thinking skills. Kaye ReplyShow Less Rachel Piszczek Rachel Piszczekreply to Shiara Kaye Peart 10/27/2016 12:57:21 PM RE: Assessment of Maria Kaye, Thank you for your response. I agree, sleep is so important for so many aspects in her life. I am glad that you mentioned better sleep boosts immunity and thinking skills. It's amazing how just a little extra sleep can be so beneficial. I believe that overall wellness is strongly impacted by diet, ability to rest & manage stress, exercise, and managing overall toxic load that is taken in by the body. If we help Maria find a non-pharmacologic way of promoting sleep & managing stress, we can reduce the number of drugs she takes in, thereby reducing toxic load. I am also interested in how much caffeine she uses on a daily basis since she has so many duties in a day and is unable to sleep much at night. Limiting the amount of caffeine can help promote sleep at night. Intake of power foods like chia seeds and more green vegetables in her diet, as well as adequate water intake helps boost energy. Exercise can also help with energy and she might also shed some unwanted pounds. ReplyShow Less Instructor Cork Instructor Corkreply to Rachel Piszczek 10/24/2016 7:10:32 PM RE: Assessment of Maria Rachel - a food diary could be very helpful. Often times surprises are identified when you can look back to see where calories are coming from and what adjustments may be most beneficial. Thank you for a nice post! Missy ReplyShow Less Kimberly Dietrich Kimberly Dietrich 10/24/2016 6:19:29 PM Case Study Week 1 Good evening Class and Instructor Cork, After being traumatized from last nights premiere of "The Walking Dead" I think I can finally concentrate on answering questions for this weeks case study. I would like gather additional information from Maria such as: How often does Maria eat (Is Maria bringing meals to school with her or just grabbing from the vending machine) and how much does she eat? What type of medications is Maria taking? For example, Prednisone causes weight gain. I would like to inquire about family history and weight issues. Does Maria have health issues such as Asthma? If she has asthma, as previously stated, steroids can cause weight gain. Maria could be at risk for Type 2 diabetes, high blood pressure, kidney disease, and heart disease. In Maria's culture, foods that are rich in complex carbohydrates are one of the main foods consumed, such as corn and corn products (tortillas, beans, rice, and breads). Because food is usually cooked in spicy sauces or herbs, the food is probably also high in fat. Maria is a very busy woman, and I'm concerned that with all she is doing, she is compromising her immune system. Does she have a support system that is willing to help her out and take some of the stress off of her? Can her husband help with laundry, cooking, helping the kids with any homework, or is there a neighbor that can help with her children and any school functions that are going on? Maybe the neighbor has children that are involved in the same activities that Maria's children are. Maria is tired, overwhelmed, stressed, a wife, a mother, and a student. I would let Maria know that she is doing a wonderful job with everything, but it's time to take care of herself too. Make lunches to take with her along with snacks, (fruits, vegetables) and eat smaller meals more often so her body doesn't think she's trying to starve it with everything she is doing. If she's only eating 1-2 times a day, her body will store fat because it doesn't know when it's going to be fed again. Listen to Maria's concerns and let her know that it's ok to delegate some of her daily rituals to her spouse and children. By freeing up just a little time, Maria can have a little "relax" time. When talking to Maria, I would ask her what is the first thing she would like to do for herself? Is it lose weight? If so, have Maria keep a journal of all food that she consumes and review it together to see what adjustments can be made. If Maria is overwhelmed with shopping, housework, cooking and cleaning, then ask if her spouse and children would be willing to help by taking over a few things for her. Even if Maria's husband cooked a couple nights a week, this can make a huge difference. Finding out what is most important to Maria would be the first step and offer suggestions from there. Just to make sure Maria's health is stable, I would order routine blood work to check for any abnormalities. I would also include blood work for her Thyroid. If Maria has asthma and is on steroids, then Cushing's could be a factor for weight gain. Jarvis, C. (2016). Physical examination & health assessment (7th ed.) Philadelphia, PA: Saunders. ReplyShow Less Rachele Magnarelli Rachele Magnarellireply to Kimberly Dietrich 10/24/2016 8:29:09 PM RE: Case Study Week 1 Hi, Kimberly! I completely agree. Packing healthy snacks and lunches would greatly impact Maria’s weight and nutritional status. As stated by the U.S. Department of Health and Human Services (2014) in Healthy People 2020, “The places where people eat appear to influence their diet. For example, foods eaten away from home often have more calories and are of lower nutritional quality than foods prepared at home” U.S. Department of Health and Human Services (2014). Healthy People 2020, Retrieved from : ReplyShow Less Drew Zindell Drew Zindell 10/24/2016 9:23:58 PM Week 1 Discussion A few more questions that Maria could answer could include what her diet actually consists of, what does she do in order to decrease stress, etc. A good idea for Maria would be to communicate with her significant other to see if they could help with chauffeuring kids to and from events, help alternate fixing dinner on different nights, also Maria could try forming a calendar to better organize her time and prioritize. Maria is at an increased for developing diabetes, heart disease, hypertension, a lipid disorder, etc. Also, Maria’s reaction time can become increasingly prolonged in situations where a short reaction time is needed. Maria’s ethnicity and spirituality can be an important factor when completing her health assessment. This will enable the nurse to develop risk factors based on her ethnicity, as well as assess Maria’s feelings and beliefs of treatment plans. As stated by Jarvis (2016), it is important for the practitioner or nurse to understand the roles of the patient’s religion and how this allows them to cope and take part in treatment (pp. 17). According to the Office of Disease Prevention and Health Promotion (2014), interventions such as diet change and an increase in physical activity can prevent unhealthy weight gain or can facility weight loss in obese people. Weight loss and a diet change can help manage pre-diabetes which Maria will more than likely develop if something doesn’t change. In order for Maria to stick with a diet change, it would be a good idea for her to plan meals for the week, this way she is consciously choosing healthy foods that have a high nutritional quality. Planning the dinner meals for the week would help decrease the time spent each night figuring out what to prepare for dinner, this way she can optimally utilizer her time at night for activities such as homework, household chores, and spending time with her children. References Jarvis, C. (2016). Physical examination & health assessment (7th ed.) Philadelphia, PA: Saunders. Office of Disease Prevention and Health Promotion (2014). Healthy People 2020. Retrieved from ReplyShow Less Instructor Cork Instructor Corkreply to Drew Zindell 10/25/2016 1:55:20 PM RE: Week 1 Discussion Drew - terrific suggestion to help Maria with weekly meal planning. I know that in my own home, when I prepare ahead of time, I am much more likely to have a healthy meal and/or snacks available. Thank you! Missy ReplyShow Less Sheryll Saballa Sheryll Saballareply to Drew Zindell 10/30/2016 5:31:07 AM RE: Week 1 Discussion I agree, meal planning is an excellent idea for Maria. "...weight is influenced by energy (calories) consumed and expended, interventions to improve weight can support changes in diet or physical activity" (). Meal planning will help her control her calorie intake and help her plan nutritious meals that will keep not only her, but also her family healthy. Retrieved from ReplyShow Less Melissa Melvin Melissa Melvin 10/25/2016 12:47:26 AM Healthy People Initiative Maria appears to have several stressors in her life and she appears very busy. The additional Information I want to Know: -How many times a day does she eat with her busy schedule? -What time of day does she eat does she eat with her family or at night before she goes to bed? -What foods does she eat how big are the portion sizes? (Coming from a Hispanic background I understand that some foods are high in sodium and we eat several carbs) -How much stress does she feel like she has living a busy life style? -What does her family history look like is she pre-disposition to health issues? Health Risks: Obesity, Hypertension, Diabetes, Heart attack (from stress and or unhealthy eating habits), she is also at risk for depression since she is already worried about her body and living in a stressful environment. Culture is important because: Hispanic cultural there are gender roles as Maria has already stated she has her roles such as taking care of children, preparing meals, household chores. this is common for her culture for women to have more roles pertaining to home and children. She also cooks meals from her culture which are usually large meals with a variety of foods. Risk with Short term Goals: Hypertension- limit the amount of sodium in the diet, check blood pressures, allow for stress free periods (not always feasible but even it 10min in the shower just relaxing) What nursing interventions would you incorporate into Maria's plan of care to assist her with meeting your chosen goal? Please provide rationale for your selections.. Encourage healthy eating habits- encouraging healthy eating habits with her busy lifestyle will cut down on risk for obesity, heart disease, hypertension. Since she is busy encourage and suggests healthy snacks veggies, fruits, and encourages several small portions throughout the day instead of one or two large portions and encourage eating earlier throughout the day instead of late at night so the body can burn through the calories easier. Jarvis, C. (2016). Physical examination & health assessment (7th ed.) Philadelphia, PA: Saunders. ReplyShow Less Kimberly Dietrich Kimberly Dietrichreply to Melissa Melvin 10/25/2016 9:31:02 PM RE: Healthy People Initiative Hi Melissa, You bring up a great point in asking when does Maria eat in the evening. Like Maria, I am very guilty in coming home late from my shift (tonight it was 7a-10p) and my husband had dinner ready for me. I eat and go to bed and just let all that food sit in my belly and turn to fat since I'm not up and active at that time. Pounds will certainly pack on fast. It is so easy to gain weight and so hard to take it off. ReplyShow Less Melissa Melvin Melissa Melvinreply to Kimberly Dietrich 10/29/2016 8:58:05 PM RE: Healthy People Initiative Modified: 10/29/2016 9:15 PM I went to a dietician I used to work 7-7p and eat supper at night when I got home after my shower which was around 9pm. Then I would go to bed at 10:20pm at night. My dietician explained that I was eating to late to burn calories and motility slows when the body is at rest. So she suggested I eat earlier in the day. The Washington Post has an article about how scientist studied the process of calorie breakdown and the study shows that more calories are stored at night and turned into fat to be used later. So by eating at night the body stores the fat for later which makes it harder to loose. Reference Why eating late at night may be particularly bad for you and your diet. (2015, August). Retrieved October 29, 2016, from ReplyShow Less Drew Zindell Drew Zindellreply to Melissa Melvin 10/27/2016 10:20:20 PM RE: Healthy People Initiative Melissa, I’m glad to see that you would ask about types of foods, portions, and how often she is eating. Those are very important que