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Risk Reduction Paper

Shannon Vandenberg
Ferris State University













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Abstract
The patient completed a Real Age Test that covered the areas of health, feelings, diet, and
fitness. By using the Real Age as a tool, it allowed for a comprehensive assessment and plan for
the patient. The patients results were a three year difference younger than her chronological age.
The patients categories of health, feelings, and fitness had outstanding outcomes that were the
main aspects helping her physiological age younger. However, she was not incorporating enough
nutrition in her diet and was snacking more on junk food. This was an opportunity to educate the
patient on the health risks that are a concern and the complications that could come about with
her current diet. The patient presented with two wellness diagnosis of readiness for enhanced
self-care and readiness for enhanced knowledge. A plan was reviewed and developed to improve
her current diet and decrease her health risks. The Transtheoretical Theory was used to
understand how ready the patient was to implement this change and create an effective outcome.
The patient was at a stage where she was ready to change her health behaviors and successfully
start the plan. During evaluation, the patient had a positive outlook of the plan and had results
that proved the goal had been achieve.








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Assessment
The Real Age Test results the patient displayed were shared with positive health
behaviors. Her physiological age is 18.7 years old making an actual difference of three years
younger than her chronological age, as referenced in Appendix A. This is an indication that the
patient is relatively healthy and should continue their current state with a few moderate
improvements. There were positive factors that were identified in the Real Age Test that the
patient should maintain. In her health, her sleep schedule is keeping her younger due to the
adequate amount of sleep, but she is not feeling rested during the day. What she should do to stay
on track includes healthy maintenance such as protecting joints, good cholesterol HDL levels,
and avoiding sunburns. The patients feelings segment is contributing to her physiological age
being younger. She was able to exhibit manageable stress levels due to the social support
network with her friends and family, financial status, keeping a positive attitude, having a sense
of purpose, and the absence of life-disrupting events. Her fitness factors correlate with a
younger age result because her physical health is prevalent. The patient exceeded all expectations
by having an active job, strength building workout plan, flexibility, and incorporating sufficient
walking.
There were some negative factors that were identified in the Real Age Test that the
patient should address. The test suggests that her waist size of 33 is within the healthy range.
However, her BMI of 28.6 is above ideal and increases her health risks which, in turn, made her
Real Age older. The patients diet is sporadic and a main area of focus that should be improved.
Nutrition and lifestyle habits contribute substantially to the development and management of
many chronic diseases and conditions (Zdaniewicz et al., 2013). Her diet needs to include more
vegetables, fruits, whole grains, nuts, and fish to promote a healthy, purposeful diet. The patient
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should restrict her diet of junk foods because it contributes to the aging of her arteries and
immune system. She does not include breakfast every morning, and breakfast is the ideal way to
begin the daily nutrition quota and energize the body. The patient lacks the nutrient of vitamin D
which puts her at risk for several forms of cancer as well as heart disease, osteoporosis, asthma,
multiple sclerosis, and high blood pressure. The Real Age recommends that the patient expands
her diet by covering the basic food groups in her daily diet because without them it is making her
older. She should eat a variety of healthy foods to minimize her risk of health diseases and
overall exhibit a younger Real Age.
Wellness Diagnosis
The first wellness diagnosis that correlated with the patient is readiness for enhanced self-
care. The patient expresses the desire to enhance independence in maintaining life, health, well-
being, and personal development. She exudes to enhance the knowledge of responsibility and
strategies for self-care. These are defining characteristics of the wellness diagnosis that the
patient is presenting. The piece of information that was useful when evaluating the diagnosis was
her Real Age results under the feelings category showing a strong support system from family
and friends. The patient can use this support system to maintain the healthy behavior change.
The patient felt this was an accurate diagnosis because she desires to become satisfied with her
independence in planning self-care responsibilities. (Sparks, & Taylor, 2010)
The second wellness diagnosis for the patient to focus on is readiness for enhanced
knowledge. The patient has sufficient knowledge related to a healthy ideal diet. She expresses an
interest in learning by providing a previous experience related to this topic. She had taken a
nutritional course one year ago at Ferris State University to use as a resource to achieve her
success. The patient is ready to seek out the use of relevant resources to enhance her knowledge
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on healthy behaviors. The patient felt she was willing to ask questions and seek clarification
independently to retain a new outlook. To effectively implement the change, knowledge works to
enhance the outcomes and makes the process easier to understand. (Sparks & Taylor, 2010.)
Planning
A plan was developed with the concern that the patients diet was of a possible health
issue. The patient, according to Ladwig and Ackley (2010), is to design a dietary plan that will
enable her to meet individual long term-goals of health, eating varieties of food, how to balance,
and eating in moderation (Ackley & Ladwig, 2010, pg.538-539). Being able to eat a different
variety of foods will allow the patient to introduce colorful vegetables and fruits to her diet to
decrease her risk of possible health issues. According to Huerta and Maville, The relationship
between being overweight and developing onset diabetes, hypertension, and cardiac disease has
been well documented (Maville & Huerta, 2013 pg. 237). The patient feels that her overall
snacking is her biggest downfall. The goal is to eliminate the junk food and find reasonable
replacements to have more nutritious options to snack on. The patient will become understanding
of the importance of a proper diet and incorporate a healthier approach to her daily diet.
To begin nursing interventions, the plan includes reinforcement of the topics related to
dietary guidelines and healthy behaviors. Nursing interventions are a large part in patient care
and they may be the deciding factor to see if the patient complies with the desired care plan. The
patient will include important information from a previous nutritional course to further her
education. Authors Huerta and Maville state, The health-promotion strategy to promote the
intake of a balanced and nutritious diet to appeal to the young adults sense of social approval
and self-esteem (Maville & Huerta, 2013 pg. 237). A plan was conducted to start a food log
where the patient must include one week of their ordinary diet and a one week trial of a new diet.
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After the first week of recording her habits, a handout of standard serving sizes and
recommendations will be provided to be included in the second week diet. To incorporate the
definition provided of a nutritional approach to the patients age group the patient will reflect on
the diet after each food log is completed. This will address a concrete focus on how she felt
about her diet and why she felt her diet was that way. For example, if the patient chooses junk
food for a snack, she should explain her reasoning behind that decision (such as craving or
convenience).
The insight of this plan was formulated by two EBP studies found upon the research for
proper interventions to take for the patients diet. One study focused on the successful weight
loss and maintenance in everyday clinical practice. This was a nonsurgical approach that took
concepts of dietary interventions that have been advocated to demonstrate the importance of food
energy density. Energy density refers to the amount of energy in a given weight determined by
food by fat and/or water content of food (Schusdziarra, 2010). The protocol of their treatment
included a food diary of at least ten days to gain an insight of their old eat habits, followed by
counseling sessions regarding dietary guidelines, and education on healthy behaviors. After each
visit over four weeks, they would determine their weight and provide another food diary for at
least ten days. The weight loss was effective with independent treatment, meaning it was solely
up to the patient to incorporate the changes (2010). A substantially better long-term result is
ascribed to an increased motivation created by the perspective to lose major life-threatening
diseases (Schusdziarra, 2010). The motivation to lose weight depends on the willingness to
incorporate change. This is when the Transtheoretical Theory helps evaluate the patients
readiness as discussed later on.
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To make this plan effective for the patient, further research was conducted to find how to
make this more of an appealing and self-approval method. This is when the second study was
integrated into the personal treatment. This research study included more of a mindfulness and
self-compassion for dieting. However, Mantzios and Wilsons (2014) conducted their study
towards meditative practices. They still attempted to use food diaries that focus on concrete or
abstract understandings such as required logs including how and why they are eating (Mantzios
& Wilson, 2014). There were three studies to promote a long-term weight loss goal. The first
study consisted of logs found with more negative thoughts relating to weight loss and avoidance.
The second study showed food diaries with concrete understandings that supported weight loss
decreasing avoidance and negative thoughts. They realized the importance of the diaries and
didnt neglect the abstract of the studies. The third study then compared the diaries. There was no
significant weight loss but in a three-month follow-up with diaries displayed a better
performance in weight maintenance (Mantzios & Wilson, 2014). The concluded, Thus the
concrete construal diaries may promote mindfulness and self-compassion and potentially
promote long-term weight loss (Mantzios & Wilson, 2014). Their reflective portion to the study
created more of a personal and self-appealing approach involving the client to make an
independent proactive change.
The specific plan developed for the patient was to take interventions that recommend
reinforcing the learning process of becoming acquainted with the new eating habits. As a nursing
intervention, encouraging a varied and balanced diet in maintaining health and quality of life
starts with education. The appropriate serving sizes of each food group and recommended eating
habits that the patient should incorporate in her diet are included in Appendix B. Being able to
see what she is consuming will allow the patient to exhibit control and help limit his
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consumption of unhealthy food items. Accordingly, the recommended dietary changes must be
appealing not only for weeks or months but rather for many years or a life-long management
(Schusdziarra, 2010). She will be able to fulfill the goals by logging all of her food consumption
into a food diary as discussed previously with a reflection.
Transtheoretical Theory
Before reviewing a plan, the evaluation of how the patient felt developing health behavior
changes is a vital integration to consider. This will indicate how effective the outcome of the
plan will be. The Transtheoretical Theory is a model of intentional change. It is a model that
focuses on the decision making of the individual (Redding et al., 1998). This theory is a
valuable tool to use when implementing change into the patients life. According to authors
Huerta and Maville, Helping understand why individuals do or do not become involved in
making healthy behavior change, in evaluating their personal situations, and in tailoring efforts
and strategies according to each individuals stage of change (Maville & Huerta, 2013, pg. 45).
There are five stages that construct the Transtheoretical Theory. The first stage is
precontemplation where there is no intention to make a change or action within the next six
months. The second stage is contemplation in which there is some intention to change,
considering actions, and within the next six months. The third stage called preparation is when
significant action is being taken and usually within the next month. The fourth stage is action
where the change is involved in their life-styles for six months. The last stage is maintenance in
which the continuation of the behavior change occurs and relapse is being prevented. (Redding et
al., 1998)
After reviewing the different stages of Transtheroretical Theory, the patient exhibits the
stage of preparation. This is because the patient was previously considering a change in her diet
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(which would have been the contemplation stage), but didnt know how to effectively implement
the change. Now actions are identified and the patient is ready to move into the stage of action
where she can actively involve the behavior change into her diet. She had a firm readiness for
change once the health risks were identified and the determination to rid herself of any future
complications had begun. (Maville & Huerta, 2013, pg. 45)
Evaluation
The patient felt motivated after discussing the health disparities that were present. This
allowed her to see firsthand where she was lacking and what needed to be improved. After
reviewing and setting a strict plan that could be a reasonable effort for a long term change with
the patient, she began to implement the changes into her life. The patient participated in a food
log including one week of logging old eating habits, then the next week recording her intake with
the new diet. She was provided a standard of serving sizes for each food group and
recommendations. There was a reflection provided by the patient where she explained the
thought process of her diet each day. Being educated on the health hazards with her current diet,
the patient was determined to incorporate this new plan and offered to share her results.
The patient was able to maintain an accurate food log for two weeks, including all the
necessary data as seen in Appendix B and C. The results were conclusive with the goals that
were created. She was able to implement a change the second week, focusing on substituting the
original junk food as a snack with a healthier alternative. The patient felt she had an open mind
to different types of foods and incorporated numerous types of fruits and vegetables that she
would have never consumed prior to the assessment. The patient found some information
valuable that was not addressed because her consumption of red meat was already at a minimum
making her Real Age younger and not an area of focus. She advanced her knowledge about red
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meat being an unhealthy option for protein. Red meat, according to Lee and Gelfand (2011), has
high levels of saturated fat, increasing LDL and the risk for heart disease. Having this awareness
of these risks the patient realized that eating red meat less frequently was an important health
behavior to maintain.
After review the food logs provided by the patient, it was evident that the patient
was ready to make a change for the better. As seen on the food logs reflection portion, the
patients views of eating healthier are in a more positive manner as seen in Appendix C
compared to the feelings in Appendix B. The patient felt that the serving sizes and
recommendations (Appendix A) made it easier to understand how to include the diet change. She
was able to choose foods that were healthier once provided with the information before the
second week. This allowed the patient to have a broad selection of food to choose from, resulting
in a healthier lifestyle and decreasing risks. The patient concluded that the change is going to be
permanent, while still allowing some cheating days.










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References
Ackley, B. J., & Ladwig, G. B. (2010). Mosbys guide to nursing diagnosis. (5th ed., pp. 538-
539). Mosby
Dudek, S. G. (2010). Nutrition essentials for nursing practice (6th ed.). Philadelphia, PA:
Lippincott-Raven.
Lee, E., & Gelfand, J. (2011). Webmd. Retrieved from http://www.webmd.com/food-
recipes/features/the-truth-about-red-meat
Mantzios, M., & Wilson, J. (2013, December 4). Making concrete construals mindful: A novel
approach for developing mindfulness and self-compassion to assist weight loss.
In Psychology & Health. Retrieved April 4, 2014, from PubMed
(10.1080/08870446.2013.863883).
Maville, J., & Huerta, C. (2013). Health Promotion in Nursing (3rd ed., pp. 45-237). Clifton
Park, NY: Delmar.
Oz, M., Chopra, D., & Roizen, M. (2010). RealAge Test. In Sharecare. Retrieved April 7, 2014,
from www.sharecare.com/assessments/realagetest/taketest
Redding, C., Velicer, W., Prochaska, J., Fava, J., & Norman, G. (1998). Detailed Overview of
the Transtheoretical Model. In Cancer Prevention Research Center. Retrieved April 3,
2014, from http://www.uri.edu/research/cprc/TTM/detailedoverview.htm
Schusdziarra, V. (2010, December 1). Successful weight loss and maintenance in everyday
clinical practice with an individually tailored change of eating habits on the basis of food
energy density. In Springer Link. Retrieved April 3, 2014, from PubMed
(10.1007/s00394-010-0143-6).
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Sparks, S. & Taylor, C. (2010.) Nursing diagnosis reference manual. New York, NY:
Lippincott & Williams.
Zdaniewicz, M., Tykarski, A., Krasiska, B., Uruski, P., Miazga, A., Dudlik, P., & Krasiski, Z.
(2013, November). The Influence of a Physician and Patient Intervention Program on
Dietary Intake . In Journal of the Academy of Nutrition and Dietetics. Retrieved April 2,
2014, from CINAHL (http://dx.doi.org/10.1016/j.jand.2013.06.343).

















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Appendix A
Actual Age
21Born on 6/27/1992
Real Age
18.6Test taken on 1/18/2014
Life Gained
2.4Great Work!












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Appendix B
Serving Sizes and Recommendations
Fruits (2 cups every day) Choose whole or cut up fruits
Vegetables (2.5 cups every day) Dark greens, red, orange, beans, peas
Whole Grains (6 ounces every day) Whole grain bread, cereal, rice, pasta
Nuts (4 ounces every week) Handful, mix with food
Protein (5.5 ounces every day) Lean meats (fish, poultry) avoid red meats
Dairy (3 cups every day) Select fat-free or low-fat
Breakfast Plenty of fiber and protein
Snack Find replacement in produce aisle
Expand 100% whole grain, colorful plate
(Dudek, 2010, pg. 189)











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Appendix C
Food Log March 17, 2014 (without change)
Breakfast Lunch Dinner Snacks Reflection
Monday McDonalds egg
McMuffin with
hash brown and
small coffee
Ham sandwich with
white bread, a
handful of lays BBQ
chips, with a bottle
of water
A plate of
Spaghetti with 2
pieces of Texas
toast and a cup of
milk

Crackers and
cheese.
Chocolate chip
cookies. Two
beers

I didnt feel like
making anything
in the morning
when I bought
McDonalds. I
didnt want to
buy groceries
Tuesday White bagel with
low-fat cream
cheese and one
cup of orange juice.
Half a box of Kraft
Mac and Cheese
and a can of sprite.
Chicken breast
with chicken rice
sides and green
beans with small
glass moscato.
Celery and
ranch, later ice
cream
I thought that
the celery was a
good snack, but
when I ate the
mac and cheese
I felt too full to
do anything.
Wednesday Two scrambled
eggs with one slice
of toast and butter
with a cup of
coffee.
A small Caesar salad
and croutons with a
bottle of water.
3 slices of jets
pizza and a glass
of fruit punch.
A red apple. I felt like I ate
well today, but
once I got to
dinner I was
craving pizza.
Probably
because I ate
healthy all day.
Thursday Strawberry yogurt
with granola and a
cup of coffee.
Cup of Italian
wedding soup and
grilled cheese
Chicken cordon
bleu with a side
salad and a glass
of milk.
A cup of lays
BBQ potato
chips. Later
popcorn
I really like
yogurt in the
morning. I dont
know why I are
the chips for a
snack when we
had fruit, but it
just looked
better.
Friday English muffin with
ham and cheese
Ham and cheese
sandwich on white
bread and bottle of
Goulash with
green beans and a
Cheese and
crackers and
I ended up going
to the store, but
to buy cheez-its.
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with orange juice. water. glass of milk. later cheez-its I should have
gotten other
food but I didnt
really feel like
buying anything
else. I really
dont know why.
Saturday Two scrambled
eggs with cheese
on top and toast on
the side with
orange juice
Turkey, bacon, Swiss
sandwich on white
bread with mayo
and green tea.
Small chicken
alfredo with small
glass of moscato.
Ice cream I ate pretty bad
today. I feel like
crap when I look
back at my log
but I wasnt in
the mood to eat
healthy.
Sunday Yogurt with granola
and a banana with
glass of water
Chips and cheese
with a can of sprite.
Jimmy Johns
turkey sub with
skinny chips and
glass of grape
juice.
Banana and
cheez-its
I was doing
homework
today so I just
grabbed some
easy food. It
was convenient.











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Appendix D
Food Log March 24, 2014 (with change)
Breakfast Lunch Dinner Snacks Reflection
Monday Greek yogurt
with strawberries
and a glass of
orange juice
Spinach salad with
pecans and poppy
seed dressing with
water.
Chicken breast
with whole grain
pasta and olive oil
with a glass of milk.
Celery and
peanut
butter.
I already felt so
much better
today. I
substituted the
ranch for my dip
with peanut
butter and I
actually liked it a
lot! My salad
was delicious
and I had so
much energy.
Tuesday Two eggs with
whole grain toast
and a cup of
coffee.
Turkey on wheat
wrap with carrots
and green tea.
Tilapia fish with
sweet potato and a
glass of milk.
popcorn I really like fish! I
dont know why I
dont buy it. I
substituted a
baked potato for
sweet for the
first time and it
was good! Once
again I had so
much energy
Wednesday Oatmeal with
honey blue
berries and
banana with a
glass of orange
juice.
Tuna sandwich on
whole grain bread
and spinach with
peppers on the side
and club soda.
Vegetable stir-fry
with lemon chicken
with bottle of
water.
Carrots and
later banana.
So far when I eat
the healthy food
I am more
motivated to go
work out instead
of sit and watch
TV. I loved the
lemon chicken. It
was delicious.
Thursday Greek yogurt
with granola and
an apple and cup
Spinach salad with
pecans and poppy
seed dressing and a
Whole wheat
pasta, tomatos,
and lima beans
Apple and
peanut
butter
I had to eat my
spinach and
pecan salad
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of coffee. glass of apple juice with a glass of milk. again. Thats my
favorite lunch so
far and next time
I want to add
strawberries in
it. I also like
using peanut
butter as my
snack
Friday Two eggs and
toast with orange
juice.
Tuna salad with
green tea.
Went out to eat
had small chicken
with grilled
asparagus and
sweet potatoes.
Fruit
smoothie.
After lunch I was
still really
hungry. I decided
to have a fruit
smoothie
because I also
worked today. I
had more energy
even at work. I
felt great.
Saturday Greek yogurt
with strawberries
and blueberries
and apple juice.
Turkey sandwich on
whole grain bread
with a cup of water.
Fish with whole
grain rice and
broccoli with a
glass of milk.
Hummus
with carrots,
whole wheat
pita chips,
and
cucumber
I love hummus.
Its another great
snack and you
can dip it in
anything! I didnt
really like my
whole grain rice
so I will have to
find a substitute
for that, but I still
understood why
it was better for
me.
Sunday Oatmeal with
blueberries
raspberries with
coffee.
Peanut butter and
banana sandwich on
whole grain with
apple on the side
and green tea.
Chicken stir fry
with peppers and
onions and a glass
of milk .
Orange I was kind of
busy until night
time so I just
grabbed
something fast.
However, I used
to just grab
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some junk food
but I made a fast
lunch and it was
still good. I still
had a lot of
energy.




















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Assessment and Diagnosis
Rubric
Total Possible Points =200 Points Earned
Assessment 60
Real age test completed, results
interpreted and discussed in
paper; summarize both positive
and negative

Area of risk focus discussed in
depth

One Wellness diagnosis for area
of focus; supported by data and
research ; EBP

Planning and Intervention
Rubric
60 Points Earned
One SMART obtainable goals
should be able to measure
progress

Interventions based on EBP ~
includes one peer reviewed
journal article as a reference for
at the minimum two
interventions

Includes information re: TTM
and readiness for change

Evaluation and Reflection 50 Points Earned
Evaluate partners progress
toward SMART goals.

Reflect on any changes that are
necessary in order for partner to
reach goals; include
references/support for these
changes

APA 30
APA format and references cited
properly; scholarly writing;
spelling and grammar accurate;

Total Points Earned: