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 5 hours of sleep per night, but that is okay with her. She drinks coffee all morning to “keep her going.” She lives 1 hour from campus and commutes each day, and often drinks diet cola to “stay awake.” When asked what she does to relax and de-stress, Maria states she “doesn’t even have time to think about that.”
Maria’s vitals today are as follows; T 98.6, R 20, HR 88, BP 148/90
What additional assessment data (subjective and/or objective) would you like to gather from Maria?
Objective data would be comprehensive lab work (CMP, CBC, lipid profile, thyroid profile), BMI, current medication list, and PMH
Behaviorally, I would determine her mood, affect and anxiety level. I would ask her about any history of mental illness including depression and substance abuse. I would also perform a PHQ-9 for a baseline. Additionally, I would explore her concerns about her appearance and what are, her concerns about her health specifically? I would like know her social support system. Does she feel supported by her family, husband, extended family if any? How is her marriage, how does her husband help her? What type of activities are the children involved in?
Nutritionally, I would also ask an open ended questions about her cooking ethnic foods, her favorite foods and what her family likes. Is she currently cooking for the family or relying on take-out? What does she eat for snacks? I would ask her about her daily coffee intake and the amount of cola she drinks per day. Also review intake of alcohol and/or use of other illicit drugs.
Overall, I would like to know, what does her typical day look like? When does she study? I would also like to discuss sleep hygiene and what are her habits related to sleep? Also, how are her finances and the effect of going to school on those finances?. My opinion – it is cheaper to eat unhealthy then it is eat healthy.
A thorough family medical history can also provide insight into potential medical conditions which could also affect her or her children. Additionally, her husband’s medical history could also provide further insight (Chamberlain College of Nursing, 2018).
Critical is all of this to determine Maria’s readiness for change. She may simply be reactionary by presenting to the clinic. She may not be ready to change any aspect of her life.
What actual health concerns and risk factors have you identified?
Maria is at risk for multiple co-morbidities, including but not limited to, obesity, hypertension and initially metabolic syndrome if not T2DM. Maria is also at risk for depression, anxiety, or other behavioral issues due to stress and reliance on external sources (caffeine, colas) to cope
What are some opportunities to promote health and wellness for Maria?
Discuss stress management, alternatives to caffeine intake or attempt to decrease, provide information re mood/depression and resources for counseling, support and further treatment. Discuss time management as a way to manage her stress in addition to exercise.
Physical activity and support are essential as nursing students require encouragement to engage in exercise and lack self-confidence in their ability to exercise (Blake , Stanulewicz, & Mcgill, 2017).
Nursing Diagnosis: Risk for diabetes and depression related to lifestyle choices, ineffective coping, increased stressors and limited support.
Blake , H., Stanulewicz, N., & Mcgill, F. (2017). Predictor of physical activity and barrier to exercise in nursing and medical students. Journal of Advance Nursing, 73(4), 917-929.
Chamberlain College of Nursing. (2018). Health Assessment for the Practicing RN; Week 2 Lesson. Downers Grove, IL.