Case Study for Sixty-eight Year Old Client

Unfortunately, not all our bodies are composed and function the same, which is why our bodies differ in shape. Some individuals must monitor their intake closely in order to maintain their satisfactory weight while others can eat freely and be as thin as a feather. The human body is a reflection of the foods we ingest, and how active we keep ourselves. For most, a well-balanced diet and an exercise program will positively impact the human body. Some positive results include, decreases risk for developing chronic health conditions such as, coronary heart disease, high blood pressure, colon cancer and diabetes ("Older Adults| Surgeon General Report | CDC," n.d.). As people age they become less active, metabolism slows down, energy requirement decrease, all factors combined lead to weight gain and other issues if not controlled ("Nutrition Concerns," n.d.). Statistics show that individuals from African American and Hispanic descent tend to be more obese than Caucasians. Risk factors can also predispose an individual to obesity, such as, sedentary lifestyles, genetics, emotional factors linked to dysfunctional eating, and certain medical conditions ("Imbalanced Nutrition: More," 2017)

On the other hand, technology advances, has enabled Americans to be able to access tools for help with weight loss, and activity tracking. Now a day, almost anyone owns some type of smart device. Smart devices give anyone the luxury to monitor his/her intake in calories, monitor distance walked and even monitor calories burned during the day. Trained professionals such as nutritionist and personal trainers can assist individuals achieve their desired weight loss goal by creating an individualized meal and exercise plan.

This sixty-eight year-old client lives alone and is independent with all self-care and activities of daily living (ADLs). It is reported that she ambulates well, exhibits no impairments with function of extremities, alert and oriented to person, place, time, and situations. Her height is 5”-6” and weighs 210 pounds/95.25 kg. According to her weight, and height, her Body Mass Index (BMI) is 33.9. According to the breakdown of BMI, 33.9 correspond to a BMI of an obese individual. BMI is a measurement of body fat accordingly to your height and weight. BMI is universal and can be used for most adult men and women aged 20 and older. BMI is standard and does not consider factors such as, age, sex, and ethnicity. There are more precise measurements of body fat such as, bioelectrical impedance, underwater weighing, dual energy x-ray absorption, and even skinfold thickness ("BMI (Body Mass Index): What Is BMI?” n.d. ). As reported, the client is on a fixed income, lives a modest lifestyle and appears to be satisfied with her independency. She has family and social support, but lives an autonomous lifestyle.

Just like any nursing encounter, a through nursing assessment is ideal in order to formulate a complete and ideal care plan. Once my assessment has been completed, I will use tools to generate my care plan for this client, the tools I will be utilizing will include, BMI chart, diet analysis, diet journal, and portion size education. A diet analysis is a tool used to pinpoint every piece of food that you ingest, and the amount of calories, fat, protein and carbohydrates consumed (Johnson, 2015). Portion size is important, as studies suggest present-day portion sizes have added an extra 50 to 150 calories. As this may not seem like a bid deal, it can end up causing ten pounds of weight gain per year ("Correct Portion Sizes," n.d.).

Care plan for this client will be geared towards weight loss. This particular client has a BMI of 33.9, which is consistent with obesity. Her Imbalanced Nutrition (More than body Requirements) is related to eating in response to her social situation, as client reportedly lives alone.

Outcomes will include, client will be able to identify inappropriate behaviors and consequences with overeating or weight gain. Client will exhibit better meal selection and/or meal planning concerning weight loss ("4 Obesity Nursing Care Plans • Nurseslabs," n.d.). It is important to provide education to this client, ensuring she understands what the consequences are of weight gain, and why she must loose weight.

First intervention will include assessing the effects of complications of being obese, medical complication and poor self-esteem may result in obesity. Second, nursing intervention will be assessing clients dietary intake using a journal and asking client to write food intake for at least 3 days. This information will help develop an individualized eating plan. Lastly, establishing her current activity levels and plan a progressive exercise program such as walking, personalized to the client’s goals and choice will help client with weight loss. ("4 Obesity Nursing Care Plans • Nurseslabs," n.d.).

As there is no broad and ideal diet over another, an ideal diet must contain foods from all basic food groups with an emphasis on low-fat intake and sufficient protein intake to avoid loss of lean muscle mass. It is important to maintain the diet plan as comparable to patient’s usual eating pattern as possible. A plan designed with and approved by the client is more likely to be profitable with positive results. In the other hand, exercise promotes weight loss by decreasing appetite, increasing energy, toning muscles, enhances cardiac fitness, and creating a sense of well being to the human brain. Developing an exercise program approved by the client will increase chances of client participation and attachment to it ("4 Obesity Nursing Care Plans • Nurseslabs," n.d.). Due to the age of this client, I would ensure exercise is moderate in intensity. Walking is always an effective exercise for individuals who may experience difficulties performing more strenuous exercises. If client has access to a swimming pool, then low-impact water exercises will be included as well. Asking the client about her preferences is important, as clients will most likely participate if it is something of their interest. Sometimes, desired activities by the client such as gardening, fishing and water exercises can be implemented into their exercise program and at the same time promote personal gratification.

As reported, this 68-year-old client lives along and is independent with her care. This may be a factor leading to noncompliance with her exercise and diet plan. One of the most common complications with older adults who live alone is lack of transportation. Many older adults stop driving due to safety, health and even economic issues. She many not have a vehicle and/or the finances required to purchase the required meals for her weight loss meal plan, or pay for the fees of a personal trainer and nutritionist. Many times older adults lack a drivers license due to vision issues. Another common problem with older adults is depression. It is important that she is self-motivated and understands the importance of her adherence to her diet and exercise plan in order for her to achieve success. As reported the client has family and social supports, and is proud of her self-reliance, these positive aspects in her life will aid in her participation and adherence with her health management plans.

One of my referrals for this particular client would be the Nutritionist. Weight loss is not an easy task to accomplish, especially for older adults, who many lack knowledge, have slower metabolisms, and low energy levels. Additionally, chronic conditions and medications can alter nutrition requirements ("Nutrition Concerns," n.d.). A Nutritionist is an educated individual and a subject matter expert who will educate the client in proper foods and formulate and adequate meal plan based on the clients needs. Deciding which types of Professional Nutritionist advice will best fulfill the clients need, will be important, as there are two types. This client can obtain nutrition counseling from a registered dietitian, a degreed nutritionist or a certified clinical nutritionist (Davis, 2015). The other referral would be to a personal trainer. A personal trainer will help the client formulate an exercise plan ideal for her, which will help her reach her weight loss goals. A personal trainer works with an individual to help him/her define their fitness goals. He/she takes into account your current fitness level and discusses what you want to achieve through your workouts (Frost, 2015).

Conclusion

In conclusion, proper diet and exercise are key factors to weight loss and health maintenance. Commitment and adherence to treatment plans is crucial in order to achieve weight loss goals. Professional help such as Nutritionist and Registered Dieticians is encouraged for individuals who struggle defining the most appropriate foods. Personal trainers, on the other hand, are important for those who desire and need to lose weight and are unaware of the types of exercise that will help them achieve their desired weight. Self-Motivation, education and commitment will lead to weight loss and/or weight control thus reducing risks for developing health conditions. As a nurse follow-up care for this client will be important to monitor her progress and commitment to plan of care and if necessary make changes to her plan of care.