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Running head: CLIENT RISK REDUCTION: ENHANCED SELF-CARE

Client Risk Reduction Planning Focused on Enhanced Self-Care


Leigh Anne Koonmen
Ferris State University

CLIENT RISK REDUCTION: ENHANCED SELF-CARE

Abstract
The focus of this paper is the identification of health risks in an individual, especially how a
particular health risk can be resolved through risk reduction strategies and health promotion. The
client is a 26 year old female student with a significant family history of hypertension. The
Transtheoretical Model is used to identify the clients readiness for change; the client was found
to be in the contemplation stage. The nursing diagnosis used is Ineffective Health Maintenance
with a wellness diagnosis of Readiness for Enhanced Self-Health. The Transtheoretical Model,
nursing diagnosis, wellness diagnosis, and identified health risks were used in conjunction to
determine a measurable and individualize risk reduction plan, which is then evaluated for
approval by the client.

CLIENT RISK REDUCTION: ENHANCED SELF-CARE

Client Risk Reduction Planning Focused on Enhanced Self-Care


According to Mayville and Huerta (2013) the application of any health practice to better
improve the quality of ones life and well-being is health promotion. Further, a health promotion
plan is one that includes client participation to create strategies that will aid an individual in
achieving a higher quality health status through the examination of various facets of that
individuals life. This examination of various aspects of the individuals life is a method to
identify areas that health promoting strategies can be applied to achieve optimum well-being for
the individual (Mayville and Huerta, 2013).
Another method to be used to achieve optimum well-being and higher quality health
status for an individual is the utilization of strategies that promote risk reduction. Maurer and
Smith (2012) have listed a set of guidelines to aid in the creation of risk reduction strategies,
defining these strategies as individualized interventions that promote health communication,
education, and counseling that will aid a client in planning for and implementing better health
behaviors. The authors go on to further outline risk reduction strategies, defining them to be time
bound, realistic, measurable, and attainable goals that are clearly defined and provide a full
opportunity for client participation in setting the parameters of the plan (Maurer and Smith,
2012).
For a course in Health Promotion, the task of creating a risk reduction strategy for a client
has been assigned. This assignment is to focus on areas in the clients life that health promoting
strategies can be applied to improve the individuals health status. To do this, an examination of
the clients daily life and habits is conducted to identify areas of improvement as well as areas of
already established quality health practices. Those areas in the clients life that are identified as
potential health risks are further examined for the application of the best health promoting
strategies. The risk reduction plan is created in collaboration with the client to have a higher

CLIENT RISK REDUCTION: ENHANCED SELF-CARE

chance for success in achieving determined goals. The risk reduction plan is therefore completely
individualized to that client.
In identifying areas of favorable and unfavorable health behaviors in the clients life, the
RealAge test available from Dr. Oz will be utilized. This test examines a variety of areas in the
clients life through a series of questions focusing on general health statusboth past and present
as well as mental health, physical activity, and diet. The clients responses to these questions
are then used to determine an age based on their health practices, rather than chronologic
determinants (RealAge test, 2010).
Information gathered from a personal interview with the client is further utilized to
identify risk areas in the clients life through careful examination of the clients living and work
environment and family health risk factors. From these two sources of risk identification a
nursing diagnosis is used to identify a specific focus issue in addition to wellness diagnosis,
which identifies an area where the client is displaying characteristics of beneficial health
qualities. The nursing diagnosis and wellness diagnosis are key components in establishing a
source of focus for the risk reduction strategy; the ideal outcome of the proposed health
promoting strategy is to compile a plan that the client is able to participate in developing or
approves, feels is attainable, and is able to maintain. To identify the clients willingness to
participate in the proposed health promoting strategy, an assessment of the clients readiness to
change is determined using the Transtheoretical model.
Client Introduction
The client is a 26 year old female from Cadillac, Michigan, where she has resided her
entire life. She identifies herself as spiritual, stating that she attends a nondenominational
religious service, but also adds that she is not able to attend these services as frequently as she
would like. The clients hobbies include primarily outdoor activities, such as running, hiking,

CLIENT RISK REDUCTION: ENHANCED SELF-CARE

camping, and swimming in the summer and snowboarding regularly in the winter. Other hobbies
include reading, baking, and socializing.
The client has a Bachelor of Arts from Central Michigan University in Communication
Disorders. The client was employed in a low paying position in the service industry for the last
seven years, where she experienced long hours on her feet with few breaks. The low income has
been a source of stress for the client over the past several years, which she states is becoming an
even greater source of stress over the last few months.
Assessment
The client is 65 inches tall and weighs 135 lbs, yielding a body mass index (BMI) of
22.5, which is considered within the healthy range (18.0-24.4) determined by her weight and
height (Mayville and Huerta, 2013, p. 349). During the interview process the client appeared
well-dressed, well-groomed, and oriented. The client has blond hair, blue eyes, is of medium
build with an athletic body type. Her gait is balanced when she walks and does not show any
immediate visual abnormalities or disabilities.
The client is a nonsmoker who has approximately three to five drinks per week.
Currently, she follows a diet that is low in vegetables and fruits, and is high in carbohydrates and
protein. She states that she eats away from home more often than she eats at home, and rarely
cooks for herself. When she does eat away from home she tries to be mindful of healthier menu
options. For meals that she does not choose a healthier option, she tries to limit portion size.
The client is currently enrolled in an accelerated nursing program at Ferris State
University. Due to this program the client has expressed a concern for changes in daily health
promoting habits related to an increased stress load, limited personal time, and an increase in the
amount of time spent being sedentary. The client has also identified her approaching wedding,
which will be occurring during an upcoming semester break from school, as further area of stress
in her life. She has described that time not spent studying for her accelerated courses is spent

CLIENT RISK REDUCTION: ENHANCED SELF-CARE

planning for her upcoming wedding, which leaves little time for appropriate exercise and
consistent purchasing of groceries.
The client also expresses concern regarding her nutritional habits, particularly since the
beginning of the accelerated nursing program. The client explains that she ate a generally healthy
diet prior to the start of school, though she did still consume some junk food. Now that the client
is in school, she finds herself eating an increasing amount of junk food alongside meals primarily
obtained from fast food restaurants. The client expressed a desire to at the very least return to her
previous diet.
The client further discussed her limited availability to carry out regular exercise while in
school, expressing concern over the decline since the start of school. Prior to beginning the
program, the client had exercised a minimum of 30 minutes four to five days per week, jogging
being her preferred method of exercise. The client estimates her current exercise is very sporadic
lasting approximately 30 minutes one to two days per week, if at all. The client also states that
she can feel differences in her body as well as her ability to appropriately cope with her current
stress level since the decrease in her exercise regimen.
Health History
The client estimates her blood pressure to be in the average range. She cannot recall when
she last visited her primary care physician, but estimates her last visit for a physical check up to
be within the last year to year in a half. She states that she has been generally healthy and has not
experienced any serious illnesses or undergone any surgeries.
Family Health History
Both parents of the client have been diagnosed with hypertension and high cholesterol, as
well as both sets of grandparents. One grandparent on each side also has a history of cancer; the
clients maternal grandmother has had breast cancer that resulted in a double mastectomy, and
the clients paternal grandfather has had lung cancer resulting in his death. The clients paternal

CLIENT RISK REDUCTION: ENHANCED SELF-CARE

grandmother has had hypertension for the last several decades and experienced a myocardial
infarction within the last year.
Braun and Anderson (2011) state the effects of hypertension on the body are extensive.
Three primary organ systems are affected by hypertension, the first being the central nervous
system, which can be damaged by increased intracranial pressure, impaired oxygen transport,
and a reduction in brain function. The next organ system is the renal system, which is affected by
hypertension from chronic inflammation, hardening of kidney tissues, and a decreased blood
flow to the kidneys. The third system affected by hypertension is the cardiovascular system,
which is affected by hypertension through decreased perfusion of the vasculature resulting in
pulmonary edema, myocardial ischemia, and peripheral hypoxemia (Braun and Anderson, 2011,
p. 374).
The client states that while both her parents are taking their medications as prescribed,
neither of her parents are taking serious steps to reduce their hypertension or high cholesterol.
Her mother is a heavy smoker, smoking a pack a day for the last 30 years, with no intention to
quit. Her parents lead a primarily sedentary lifestyle and follow a diet that does not include many
fruits or vegetables, while high in carbohydrates and proteins. The client attributes many of her
lifestyle choices to her parents habits and states that she has been working to identify these
unhealthy behaviors and adopt healthier choices over the last couple years.
Transtheoretical Model
The Transtheoretical Model was created following the results of a study conducted by
Prochaska and DiClemente (2005) regarding smoking cessation, which focuses on an
individuals motivation and readiness to change in ceasing unhealthy habits and/or adopting
healthier habits. The authors concluded readiness to change is identified in five distinct stages,
with the first being precontemplation, in which the individual is not considering any change in
current lifestyle within the next six months. The second stage is contemplation, in which the

CLIENT RISK REDUCTION: ENHANCED SELF-CARE

individual is weighing the benefits of change and the detriments of maintaining current lifestyle
choices and is considering making the change within the next six months. The third stage of this
model is preparation, in which the individual is bordering on making the decision to either cease
an existing unhealthy habit or adopt a healthier habit and begins planning a strategy for how to
carry out this decision within the next month. The fourth stage is action; in this stage the
individual implements the decided strategy and carries out this decision for the next six months.
The final stage of the Transtheoretical Model is maintenance, in which the individual is
continuing the plan of change and plans to continue for an indefinite period (Mayville and
Huerta, 2013).
Based on the identification of areas in her life that she feels need to be changed and her
desire to have those areas changed, the client is best placed within the second stage of the
Transtheoretical Model, or the contemplation stage. Because she does not have a plan or strategy
currently set in place to make the changes she desires, she has not yet moved into the third stage
of preparation.
Diagnosis
Nursing Diagnosis
The clients current lifestyle, which is high in stress, low in healthy exercise habits, and
limited in healthy eating habits is compounded with her uncertainty about her current health
status, due to infrequent visits to her primary care physician. The client has a family history with
high occurrences of hypertension and high cholesterol with dietary habits that contribute to the
progression of these diagnosed disorders. Given that the client is aware of these health risks and
does not frequently partake in health strategies to prevent these disorders, the nursing diagnosis
chosen is Ineffective Health Maintenance (Taylor, Lillis, LeMone, & Lynne, 2011, p. 252-253).
Wellness Diagnosis
The client has expressed an interest in adopting healthier lifestyle habits, as well as
ceasing unhealthy lifestyle habits. She has already taken steps to improve some unhealthy

CLIENT RISK REDUCTION: ENHANCED SELF-CARE

behaviors in her life, but also acknowledges areas that she feels could be improved, such as
infrequently visiting her primary care physician for health maintenance check-ups and a
tendency to eat a diet low in fiber and high in protein that is compounded with a family history
of hypertension and high cholesterol. Given the clients readiness for change, the chosen
wellness diagnosis is Readiness for Enhanced Self-Health Management, as the client expresses
desire for increased control of health practice (Ladwig and Ackley, 2014, p.168).
Planning
The RealAge test was used to identify areas for improvement in the clients daily life, as
well as areas where she has already established healthy lifestyle habits. The client answered
questions provided by the test regarding past and current health status, familial risk factors, and
daily habits. The RealAge test then delivers an estimated age based on the clients responses to
the question. The age given to the client by the RealAge test is 25 years and 1 month, thus
identifying her as one year and four months younger than her actual age of 26 years and five
months. The results of the RealAge test (refer to Appendix A) additionally identified areas in
which the client has already established healthy lifestyle habits, including maintenance of a
healthy waistline, avoidance of sunburns, limiting exposure to smoke, and healthy sleeping
patterns. Areas of concern identified by the RealAge test include lack of knowledge regarding
her blood pressure and cholesterol levels, as well as her limited contact with her doctor (RealAge
test, 2010).
To verify the validity of the RealAge test, the results of a study conducted by Hobbs and
Fowler (2014) were examined. This study found that the RealAge score is a valid measure of
mortality risk in its user population (para. 4, p. e86385). Considering these findings, the results
of the RealAge test will be considered valid for the purpose of this risk assessment. Therefore,
given the identified areas of the RealAge test and areas of concern noted during the interview
process with the client, the plan for health promoting strategies will focus on the clients need to

CLIENT RISK REDUCTION: ENHANCED SELF-CARE

10

follow activities that will help in preventing hypertension and high cholesterol (Hobbs and
Fowler, 2014).
Intervention
The first intervention proposed for the client will be the adoption of Dietary Approaches
to Stop Hypertension (DASH), which consists of a diet rich in fruit, vegetables, low in fat, red
meat, and added sugar and has been found to lower systolic and diastolic blood pressures as
well as low-density lipoprotein (LDL) cholesterol (Dudek, 2014, p. 538). It is thought that
multiple factors of this diet work together to produce a reduction in blood pressure and LDL
levels, with the unique characteristic being that sodium levels and caloric intake were not limited
to produce effective results (Dudek, 2014). As the client is still young and healthy and has not yet
been diagnosed with hypertension or high cholesterol, but does have a family risk for these
factors, adoption of this diet could be largely beneficial in preventing a diagnosis of hypertension
or high cholesterol from occurring.
The next intervention recommended for the client is increased frequency of visits to her
primary health care provider. According to the American Heart Association ([AHA],2014),
blood pressure is one of the most important screenings because high blood pressure usually has
no symptoms so it cant be detected without being measured (para. 7). This statement by the
AHA is further supported by a study conducted by Schmid, Damush, Plue, Subramanian, Bakas,
and Williams (2009), which found that an essential component to the management of blood
pressure is frequent and clear communication with ones health care provider.
The final recommendation for the client is to continue including jogging in her exercise
routine and to increase her current frequency of jogging from one to two days per week to three
to four days per week, maintaining the 30 minute minimum duration. The client states that she
has weekends open and two days during the week in which her class times are shorter; it is
proposed that the client use these shortened class days and open weekends to get in 30 minutes

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11

of moderate to vigorous jogging. According to Mayville and Huerta (2013), cardiovascular


exercise in conjunction with strength training exercise have been found to lower systolic and
diastolic blood pressure levels in addition to a lower resting heart rate and lower body fat.
Evaluation
The risk reduction strategy, which was written in collaboration with the client, was
presented to her for review. The client states approval for plan and feels that the goals are
additionally attainable, realistic, and fit well within her time constraints. She does not feel that
the plan needs any adjustments and states that she looks forward to implementing the health
promoting strategies within the upcoming weeks. As the ultimate results are measurable (i.e.
blood pressure), the client states that she will begin visiting her primary care physician with more
frequency in order to verify the efficacy of the plan. Verification of the plans efficacy will
include a lowered blood pressure and an increased frequency of meals that follow the DASH
diet.

CLIENT RISK REDUCTION: ENHANCED SELF-CARE


Appendix A

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Philadelphia, PA: Lipincott Williams & Wilkins.
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Hobbs, W. R., & Fowler, J. H. (2014, January 17). Prediction of mortality using on-line, selfreported health data: Empirical test of the realage score. PLOS One, 9(1).
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