John Nancy is a 50 year old African American man who was diagnosed with coronary heart disease on 25-06-2013. He was weighed at 100kgs and he started his medication immediately. In addition, he was given nutritional counseling on losing weight and exercising. He was also asked to keep a diary of the foods he takes and when he left the hospital, an appointment for medication refill and monitoring was scheduled for today. The doctor took his blood cholesterol levels and there was no difference with the previous serum cholesterol levels while his diet diary also showed non-compliance to nutritional treatment a fact that shows he is in denial.
Matching patient’s current condition and environment
The patient’s teaching level is denial since the characteristics exhibited at this point clearly show that he is non-compliant with the diet advised. Hence, the patient being non-compliant, we need to consider hiring the services of a nutritional therapist who can be able to visit the patient at home and teach the family on the importance of caring for the patient so as to make it more effective.
More so, the patient was given nutritional counseling but has not adhered to the required regimen of restricting fat and cholesterol in his diet. His diary shows that he still eats a lot of fast foods that are prepared with too much fat (Lagua & Claudio, 2004).
The patient is still struggling to adapt to the new diet and the required training. Although, the patient may not have accepted his condition, he is showing signs of acceptance by trying to adapt to the diet. This process will take some time for the patient to fully adapt to the new routine (Roth, 2010).
Goals and Outcomes
The goals are:
- Reduce the amount of calories consumed per day.
- Reduce the amount of cholesterol in blood before the next appointment.
- Learn how to exercise within a week.
- Understand the importance of healthy living after the teaching.
- Accept their predicament that he is sick after being counseled and taught.
Eliminating the consumption of; alcohol, ice cream, chips, bhajia, sausages, nicotine and caffeine will help reduce the amount calories in the diet. The patient should adapt to eating healthy foods such as fruits, white meat, milk, brown Chapati and beans. These foods are rich in vitamins, proteins and carbohydrates but have less fat compared to those to be eliminated. Adapting to this suggested diet will enable the patient to eat a low calorie diet 3 times a day and this will ensure they maintain a low blood pressure and low cholesterol level daily leading to healthy living.
The patient and the relatives should be able to describe the disease process of coronary heart disease and the risk factors. Understanding the disease process will ensure that the patient understands why he has to be given nutritional therapy which will aid in improving compliance.
A brochure containing information about coronary heart disease was given to ensure that the patient and his relatives remember what they were taught. A list containing different types of food and their cholesterol levels was also given to them at discharge (Roth, 2010).
The patient was also provided with a video tape that demonstrated how they are to exercise and the procedure of preparing the recommended foods which he took home.
The patient’s desire is to lose some weight and reduce their level of cholesterol in blood as well as the amount of calorie intake per day, to ensure the patient achieved these goals our community nurse was able to follow up on them regularly at home. The patient was also required to keep a record of the daily meal and the progress in exercising at home.
The patient was to visit a general practitioner before leaving the hospital to manage his blood pressure. He had expressed hardship in accessing the food that was required due to financial constraints and was to pass by the social support office to receive guidance on how to access the food.
On the last visit to the hospital, the patient was placed in a support group due to the chronic nature of his illness, although the patient did not attend the support group. The patient was encouraged to attend meetings as they would give him ideas on how to deal with some of the issues when managing chronic illnesses (American Hearts Association, 2000).
The patient gave a correct description of the disease process of coronary heart disease and together with the relatives they were both able to name the various foods with low cholesterol levels while support from the family was to increase compliance.
The patient accepted his condition in the long run and was able to adhere by the diet specification recommended. The patient also shown great effort in exercising and when they visited the clinic their blood cholesterol level was low.
In summary, I learnt that every procedure requires the nursing process. Assessment of the patient will guide the goals to be set that should be patient specific since it is the goals that guide the interventions and the kind of information to be taught to the patient.
American Hearts Association. (2000). Diet and Lifestyle Recommendations. Web.
Lagua, T. R. & Claudio S. V. (2004). Nutrition and Diet Therapy Dictionary. Iowa, USA: Blackwell Publishing.
Roth, R. (2010). Nutrition and Diet Therapy. New York, NY: Cengage Learning