Learning Outcomes
By the end of this section, you should be able to:
- 5.3.1 Assess the client for readiness to learn.
- 5.3.2 Teach nutritional strategies to optimize neurologic wellness.
Holistic Nursing Assessment of the Client
When the nurse is considering changes to a client’s diet to facilitate adequate functioning of the neurologic system, it is critical to evaluate how these changes will be affected by the client’s lifestyle and relevant socioeconomic factors. The nurse must also consider the client’s culture, beliefs, attitudes, daily eating patterns, and health conditions that may impact their approach to eating.
Daily Pattern of Food Intake and Sleep
The time of day that meals are taken can improve neurologic health. For example, recent studies suggest that narrowing the window of time during which food is consumed during the day may positively impact cognitive function (Gudden et al., 2021). Intermittent fasting, defined as either eating only between certain hours of the day (e.g., between 11 a.m. and 5 p.m.) or consuming few calories on certain days and eating normally on other days, has been shown to improve neurologic health among persons with Parkinson’s disease, ischemic stroke, mood and anxiety disorders, and epilepsy (Gudden et al., 2021). Maintaining regular hours for meals and sleep has also been associated with positive cognitive performance, and avoiding food intake in the hours before bedtime has been shown to improve cognitive performance and sleep quality (Gudden et al., 2021).
Challenges in Healthy Nutrition
For many Americans, the availability and cost of healthy foods are major concerns. Soaring prices of weekly groceries are concerning, and many Americans rely on food banks or other forms of public assistance to feed their families than ever before. In addition, food preferences and dietary patterns are often influenced by cultural norms, beliefs, family traditions, and long-term habits; therefore, changing one’s dietary intake is often challenging. Dietary preferences are very personal for many people, so making changes may be fraught with high levels of resistance. It is thus important for the nurse to ensure that changes in a client’s diet are feasible and in synergy with the client and their family.
Client Teaching
Given the complexities of dietary habits, it is critical to first understand the client and family’s health state (cognitive state and motivation, swallowing difficulties, mobility concerns), dietary history, allergies, or sensitivities to certain foods, as well as food availability and financial concerns when planning a dietary lifestyle. Client teaching should be part of an interprofessional plan of care involving the nurse, a registered dietitian, and the health care provider. The health care team will be best able to create dietary adaptations that will meet specific criteria that will allow the client to adhere to the plan of care.
Recommended Diet Plans for Comorbid Conditions
For many clients, comorbid conditions can complicate the ability to manifest a comprehensive diet plan. For example, although the Mediterranean diet and ample fluid intake may improve cognitive status, for clients in heart or kidney failure, specific modifications will be required to consider the effect of excess fluid or the correct percentage of protein intake.
Unfolding Case Study
Part B
Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up to Case Study Part A.
Jamal Powell has a normal PET scan result and is advised to follow up with the clinic regularly. The client is referred to a dietician but misses 6 separate appointments over 2 years.
Jamal is visiting the clinic today for a routine follow-up 2 years after the initial clinic visit. During this time, Jamal’s memory has progressively worsened. Jamal believes these deficits have not been obvious to friends.
The client describes a recent problem of forgetting where they put things and confusing things in their memory. However, the client’s relationship to time, as well as their skills in math and literacy, have not changed. Jamal is independent with regard to basic activities of daily living, but complex tasks are becoming more challenging.
The client states that they have started to feel less confident about driving over the past few months. Jamal appears to be irritable and becomes distressed when discussing the symptoms and recent events they have been dealing with. The client discusses their fears and frustrations surrounding these changes and feels they are becoming depressed about the situation.
The nurse discusses Jamal’s diet and activity and plans to work with the client to improve their nutritional state. Jamal’s diet is high in saturated fats and low in fresh vegetables and fruits. The client’s spouse mentions that they read that polyphenols are good for brain health and asks which foods would be best to include in their diets.
Jamal also asks why everyone keeps saying that sugar in the diet is bad, stating that they have enjoyed sweets their whole life. This is apparent with the recent HbA1c test result, which is 6.3%. (The expected range for nondiabetic clients, such as Jamal, is less than 5.7%.)
The nurse explains that the combination of Jamal’s high BMI of 40, HbA1c of 6.3%, total cholesterol level of 250 mg/dL, and diagnosis of chronic hypertension (today’s blood pressure was 156/98 mm Hg) classifies them as having a condition called metabolic syndrome. The nurse sets up another appointment with the dietitian to help Jamal correct the nutritional issues identified. Because the dietitian’s earliest appointment is 2 months away, the nurse teaches Jamal and their spouse about some basic nutritional changes they can make before the next appointment.