Learning Outcomes
By the end of this section, you should be able to:
- 7.4.1 Evaluate a nutritional plan for its effect on endocrine wellness.
- 7.4.2 Modify a nutritional plan to promote endocrine wellness.
Evaluating the Client’s Compliance with the Meal Plan
It is important to determine how well the client has followed the prescribed diet. Self-monitoring of food intake through a food diary (either paper-based documentation or through an app) is one way to determine this. Diet recalls and food frequency questionnaires are other diet assessment tools that rely upon self-reported data. The nurse should consider that self-kept food records are not always accurate as self-reported food consumption is likely to be misreported in some way (Ravelli & Scholeller, 2020). However, reviewing the food diary with the client is still beneficial because it can encourage discussion and provide an opportunity for additional instruction on food choices and portion control. For clients with diabetes, an additional method of monitoring compliance is maintaining and reviewing home blood glucose checks to determine if they are within the recommended ranges for the client.
Clinical Tip
Food Journals
Despite potential inaccuracies, it is still helpful to review a client’s food journal as part of their assessment to learn more about dietary patterns, food preferences, and issues. To promote consistency with the journaling task, help the client select the method of journaling that is most feasible for them to use—either a paper journal (notebook, diary, or single pages like the journal sample here developed by the CDC My Food Diary or electronic method (phone application, spreadsheet, or other software). This will make the process easier for the client and increase the client’s likelihood of following through.
Evaluating the Effectiveness of the Nutritional Plan
The plan’s effectiveness is evaluated by measuring expected clinical outcomes. If the nutritional plan (meal plan) has been effective, the client should report an improvement in their symptoms. There are objective measures that can be evaluated as well. Clients with endocrine disorders typically have laboratory tests performed regularly to measure the relevant electrolyte and hormone levels. For example, clients with diabetes will have HbA1c levels drawn that indicate the client’s glucose control over time. Clients with thyroid conditions will have thyroid panel drawn. A thyroid panel is a group of laboratory tests that measure hormones and proteins that indicate thyroid functioning. Noninvasive means of measuring effectiveness include measuring the client’s weight and vital signs to determine if there have been improvements. If the goals were not met, the plan needs to be adjusted. Perhaps the plan was too difficult for the client to follow and involved too many dietary changes all at once. The updated plan could focus on prioritizing and managing fewer nutrients initially and then expand as the client is able to manage the changes. If the client followed the plan but did not see the expected outcomes, work with the health care provider and dietician to adjust the plan.
Clinical Tip
Assessing Blood Glucose Levels
Measuring blood glucose levels is a routine part of evaluating the effectiveness of the treatment plan for a client with diabetes. When measuring a client’s blood glucose level, either by performing a point-of-care fingerstick glucose measurement or a venous lab drawn, always note the last time the client ate. This is important to know when interpreting the result as glucose levels fluctuate with meals.
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.
To improve her endocrine health, the nursing team encourages Meena to engage in regular physical activity and provides education on a balanced diet and portion control. They also refer her to a registered dietitian for personalized nutritional guidance. In addition to these lifestyle changes, Meena is advised to monitor her blood glucose levels regularly to help manage her type 2 diabetes and maintain better glycemic control.
For her hypothyroidism management, the nursing team educates Meena about incorporating iodine-rich foods, such as seafood, dairy products, and iodized salt, into her diet to support thyroid function. Meena is receptive to this but is concerned because her family traditionally has not eaten much meat or seafood. She has eaten some fish, but reports she has a limited grocery budget, and she does not think she can afford to eat it regularly. The team works with Meena to identify budget-conscious ways to incorporate seafood consistent with her cultural practices into her diet. They also collaborate with an endocrinologist to ensure that Meena receives appropriate thyroid hormone replacement therapy and ongoing monitoring.
Through this comprehensive care plan, Meena is supported in her efforts to improve her endocrine health and overall well-being. The nursing team continues to follow up with Meena and assess her progress, adjusting the care plan as needed.