Week 4: Discussion Question – Nutrition Counseling – Discussion Response

1. One of Health People 2020 goals is to improve cardiovascular health by prevention early detection and treating patients for heart attacks and strokes (Heart disease and stroke n.d.). Hypertension is one of the most common cardiovascular diseases and a significant risk factor for heart attacks and strokes. In 2013, hypertension was responsible for over 72,000 deaths and 48 billion in health care costs. So controlling hypertension is an important goal from a healthcare and financial management perspective. Controlling hypertension is an essential prevention measure in preventing heart attacks and strokes and reducing advanced cardiovascular disease. One in three people is identified as having hypertension. Obesity and unhealthy food choices are significant components of hypertension, so educating patients on a healthy diet will assist patients with attaining a healthy weight and lowering their blood pressure. These modifiable risk factors will also decrease the patient’s risk of a hypertension-related stroke and or heart attack (Lennon et al., 2017).

An evidence-based analysis conducted in 2015 and published in 2017 recommended medical, nutritional therapy (MNT) with the optimal choice of referring patients to a dietician for individualized education a healthy diet (Lennon et al., 2017). The study also showed strong evidence promoting the DASH diet that stands for dietary approaches for stopping hypertension. Providers must understand that all patients may not have the ability to see a Registered Dietician for various reasons such as lack of insurance, lack of other required resources, and lack of time. As an NP, I will counsel patients and provide written materials using the DASH evidence-based approach. I would counsel patients to reduce sodium, high fat intake in their diet, and increase learner meats, fruits, vegetables, and calcium. Patients would be taught to limit fried and fast foods and rather choose baked foods with smaller carbohydrate portions, i.e., one-half of the vegetable portion. Patients also would be encouraged to try to eat fresh not canned good vegetables and fresh fruit with every meal. A method for portion control that has stuck with me is a protein (meat) the size of your fist, vegetables the size of two fists, and carbohydrate 1/2 the size of your fist or less. Elimination of processed foods and packaged food with high sodium content should also be avoided. Evidence also suggests that for heavy alcohol drinkers, reducing alcohol intake help with blood pressure reduction. Finally increasing physical activity is a must; walking is an easy exercise and the patient can gradually increase the amount as they build up a tolerance to the exercise. Part of the education plan is being sensitive to the patient’s cultural values and knowledge of their current health literacy status. It is vital to provide quality nutrition health education based on established evidence-based guidelines. It is also essential to include the patient in the education process to achieve buy-in and obtain better compliance.

Heart disease and stroke. Heart Disease and Stroke | Healthy People 2020. (n.d.). Retrieved November 19, 2021, from https://www.healthypeople.gov/2020/topics-objectives/topic/heart-disease-and-stroke.

Lennon, S. L., DellaValle, D. M., Rodder, S. G., Prest, M., Sinley, R. C., Hoy, M. K., & Papoutsakis, C. (2017). 2015 Evidence analysis library evidence-based nutrition practice guideline for the management of hypertension in adult

2. The Office of Disease Prevention and Health promotion [ODPHP] (n.d.) in the Healthy People 2030 identified diabetes as a preventable chronic disease. In the United States more than 30 million people are diagnosed with diabetes and is the seventh leading cause of death (ODPHP, n.d.). Healthy people 2030 initiatives goal is to reduce the number of diabetes, complications and deaths as a result (ODPHP, n.d.). Cruz-Cobo and Santi-Cano (2020) identified that the major risk factor for diabetes is a sedentary lifestyle and being overweight. Patient education consists of increased activity level and healthy nutritional habits (Cruz-Cobo & Santi-Cano, 2020). Educational goals persist of knowledge of diabetes and diabetic control, good metabolic control measured by HbA1c, blood sugars between 80-130 mg/dL, triglycerides, cholesterol and body mass index (BMI) within normal range (Cruz-Cobo & Santi-Cano, 2020). Diabetic nutritional education is imperative and takes a team approach with the provider, nurse, and registered dietitian for medical nutritional therapy per Edelman and Kudzma (2018). Medical nutritional therapy is an individualized approach that considers culture, dietary habits, and lifestyle (Edelman & Kudzma, 2018). Meals should be balanced and avoid extremes in the nutritional intake per Malaguit-Boyle (2016). Protein in the diet promotes the maintenance of blood sugars in a normal range (Malaguit-Boyle, 2016). Nutritional education should facilitate a positive dietary practice which incorporates portion control and limiting alcohol intake per Han et al. (2019). Mendes (2016) wrote to improve healthy eating it is suggested to choose fruit instead of cakes, and fruit juice instead of fizzy drinks. It is important that patients understand that starches are carbohydrates that turn into glucose in the body increasing the blood glucose level. As a nurse practitioner I would educate my patients about nutrition starting at the time of diagnosis and reinforce my teaching at every follow up visit.

References

Cruz-Cobo, C., & Santi-Cano, M. (2020). Efficacy of diabetes education in adults with diabetes mellitus type 2 in primary care: a systematic review. Journal of Nursing Scholarship, 52(2), 155-163. https://doi.org/10.1111/jnu.12539

Edelman, C. L., & Kudzma, E. C. (2018). Health promotions: throughout the life span (9th ed.). Mosby Han, C. Y., Zheng, X., Lee, L.F., Chan, C. G. B., Lee, Y. Q., Zailani, N. A., Ng, K., & Bhaskaran, K. (2019). Development of diabetes-related nutritional knowledge questionnaire for individuals with type 2 diabetes mellitus in Singapore. Nutrition & Diabetics, 76(5), 567-573. https://doi.org/10.1111/17470080.12513

Mendes, A. (2016). Importance of nutrition in the care of patients with diabetes. British Journal of Community Nursing, 21(4), 212. https://doi.org/10.12968/bjcn.2016.21.4.212