Learning Outcomes
By the end of this section, you should be able to:
- 5.4.1 Evaluate a nutritional plan for its effect on neurologic wellness.
- 5.4.2 Modify a nutritional plan to promote neurologic wellness.
Evaluating the Client’s Adherence to the Nutritional Plan
Changing nutritional intake can be extremely challenging for clients because it often involves factors such as culture, habits, and preferences that are formed over time. To ensure optimal health, the nurse should evaluate the effectiveness of the plan. The nurse should not only review subjective data provided by the client but also incorporate it with objective data to gain the entire picture. Data such as laboratory test results, weight loss or gain, and vital signs can aid in evaluating the effectiveness of the plan and the client’s adherence to it.
Unfolding Case Study
Part C
Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up to Case Study Parts A and B.
Jamal and their spouse attended the appointment with the dietitian. Jamal is now back in the clinic 6 months after the last visit. The nurse is evaluating the client’s adherence to the new nutritional plan (meal plan) that was formulated with Jamal, their spouse, and the dietitian 3 months previously. The client has gained 10 lb (4.54 kg) over this time.
| Vital Signs | Laboratory Values | |
|---|---|---|
| Temperature: | 98.6°F (37.0°C) | Jamal had blood work drawn the previous week:
|
| Blood pressure: | 187/86 mm Hg | |
| Heart rate: | 99 beats/min | |
| Respiratory rate: | 14 breaths/min | |
| Oxygen saturation: | 97% on room air | |
Jamal’s spouse assisted the client in completing a 3-day diet history, which revealed an absence of fruits and vegetables, a high intake of foods containing processed sugar, and a minimal amount of fiber. Even though the client did not have an issue in any other prior visits, Jamal had become more depressed and started to drink alcohol. The client’s alcohol intake for the 3-day diet history was approximately a 6-pack of beer daily and a couple of bottles of wine over the 3 days.
As a follow-up study, the health care provider ordered an amyloid PET scan. The results revealed tau proteins consistent with early Alzheimer’s disease.
To optimize all aspects of possible treatments for this diagnosis, the health care provider recommends a Mediterranean diet and a weight loss regimen and prescribes donepezil 5 mg once by mouth daily at bedtime. The nurse provides Jamal and their spouse educational materials about the medication, the Mediterranean diet, and MyPlate recommendations. The nurse also advises the client to engage in a moderate exercise routine by walking for 30 minutes at least 3 times a week.
Evaluating the Effectiveness of the Nutritional Plan
When evaluating the effectiveness of a nutritional plan (meal plan), there are several considerations to evaluate once the client is shown as being adherent. The ability to change dietary habits is gradual, and as such, subsequent appointments with the health care provider, nurse, and dietitian will help the client continue adjusting strategies to improve their health and change any negative habits. Setting goals for weight loss and for blood pressure and HBA1c reduction as needed can provide later evidence as to the effectiveness of the nutritional plan. Discussing these changes with the client and any appropriate family members will help ignite diet changes that can be permanently employed and can help improve blood flow in the brain, which will slow cognitive decline.
Nutritional History
When obtaining a neurologic nutritional history, the nurse should evaluate specific considerations such as availability, budget, cultural aspects of nutrition, and specific dietary practices. The nurse needs to identify which resources are available to the client in terms of food availability and any limitations in food preparation practices, as well as identify any food intolerances or preferences. A 3-day diet history is helpful to determine the adequacy of the client’s current diet. The nurse should also determine any recent weight gain or loss, as well as the client’s typical bowel and urinary elimination patterns and any history of problems in the intestinal tract.
Physical Assessment
During the physical assessment of nutritional status, the nurse should identify the client’s hydration status and any aspects of overnutrition or undernutrition. Skin tone and color should be evaluated, the mucosal membranes should be assessed for hydration status, and the client should be weighed. An oral examination will identify any loose teeth, oral pain, swallowing difficulty, or any other barriers to food intake. The nurse should assess the abdomen for any pain, auscultate for bowel sounds, and complete a focused assessment based on information gleaned during the history.
Unfolding Case Study
Part D
Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up to Case Study Parts A, B, and C.
Jamal returns for a follow-up appointment 2 months later so the nutritional plan can be evaluated and changed if necessary. The check-in revealed a weight loss of 4 lb over the previous 2 months. Jamal states that they like and are following the currently prescribed diet because it is easier than eating separate meals. However, Jamal and their spouse still have some questions regarding food preparation and meal planning. Jamal has been very adherent but is having a hard time giving up fried foods.
Jamal’s spouse reveals that the expense of groceries has risen recently, and they were trying to adjust their monthly budget to accommodate this change. The client states that they have even decreased their alcohol intake to 1 glass of red wine a day, not only for health reasons but also due to increases in grocery prices.
The nurse discusses the situation more with the client and their spouse to get all the data in order to best help them. The nurse discovers that the client retired and is living on retirement income and Social Security. The client’s spouse has not worked in 10 years and receives disability and Social Security checks each month as income.
The client has stopped driving because they felt it was unsafe, and the couple continues to live at home. Jamal’s neurologist has ordered additional diagnostic exams to further evaluate the Alzheimer’s diagnosis, as well as cognitive tests to evaluate the client’s safety.