Health Assessment Report: Nursing Assessment of Maria's Case Study

This report presents a health assessment of a 40-year-old nursing student, Maria, who is experiencing weight gain. The assessment includes her health history, physical examination findings, and identified health risks, particularly obesity. The report explores potential health risks like diabetes and hypertension, and emphasizes the importance of cultural considerations in healthcare. It outlines short-term goals for weight management, focusing on dietary changes and lifestyle modifications, including the incorporation of a healthy diet and exercise. Nursing interventions such as dietary adjustments and lifestyle changes are discussed in detail, supported by relevant literature. The report highlights the significance of whole grains, vegetables, reduced sugar intake, and fruits, as well as the benefits of a 30-minute daily cardio exercise routine for weight management. The report concludes with a bibliography of cited sources.

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Running Head: HEALTH ASSESSMENT
Health assessment
Author’s name:
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HEALTH ASSESSMENT
Contents
Additional information from Maria’s physical examination and.................................................................2
Health assessment.......................................................................................................................................2
Real and potential health risks....................................................................................................................3
Real health risk........................................................................................................................................3
Potential health risk.................................................................................................................................3
Why is culture important when conducting a health assessment?.............................................................3
Short term goal for obesity..........................................................................................................................3
Nursing interventions..................................................................................................................................4
Change of diet.........................................................................................................................................4
Lifestyle changes.....................................................................................................................................4
Bibliography................................................................................................................................................5

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HEALTH ASSESSMENT
Additional information from Maria’s physical examination and
Health assessment
From Maria’s health assessment she has disclosed that she is a 40 year old
mother of two, she loves to eat and cook food of Hispanic heritage. She is also a nursing student
and she maintains the household all by herself. The chief complain that brought her to the clinic
is she has noticed she is gaining weight at an alarming rate since she started nursing school. On
physical examination her general appearance looks normal (Carolyn Jarvis, 2016).
Additional informational I would gather from her is her past medical history, her
family history, her obstetric history and her family planning history. I would also enquire about
her lifestyle which includes her eating routine and exercise routine. I would want to know what
she does when not in school and her social life, if she belongs to any social groups or not. I
would also measure her weight, height, blood pressure and blood sugar in order to calculate her
body mass index.

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HEALTH ASSESSMENT
Real and potential health risks
Real health risk
Maria’s real health risk is obesity which will be attributed to her rapid weight gain
and her Body mass index. Obesity can also be linked to her age as a result of estrogen and her
lifestyle which is mainly by food of Hispanic origin.
Potential health risk
Her potential risks include diabetes and hypertension. This will be attributed to her
age, lifestyle, race and weight which predispose her to these two conditions.
Why is culture important when conducting a health
assessment?
Culture is important, because it will tell the health care provider about the lifestyle
of the client. Culture may also contain information about the client’s race and health practices.
Cultures differ in the type food and activities they engage in. Some cultures divide roles
according to the sex of an individual, in most cultures the more strenuous roles are for men and
less strenuous roles are for women.
Short term goal for obesity
In order to reduce the chances of being obese, Maria has to adjust her lifestyle and
diet. She has to include a healthy diet made up of more vegetables, less spices, less sugar, more
fruits and whole grain. Diet can be augmented by exercise. If Maria follows these regulations, in
one month’s time she will be able to reduce her weight on a journey to attaining a healthy
weight, reducing her chances of being obese significantly.

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HEALTH ASSESSMENT
Nursing interventions
In Mari’s case there are two nursing interventions that can be used, that is change
of diet, and lifestyle modifications (O'Reilly, 2014).
Change of diet
Whole grains, vegetables, reducing sugars and fruits should replace her normal diet of
Hispanic heritage which is made up of high calorie foods. This diet will help in reducing her
weight because it contain fats of high biologic value and essential nutrients, and fewer calories;
therefore a small serving makes one fully for longer
Lifestyle changes
She should include an exercise routine of cardio 30 minutes daily, this will help
her burn the extra calories. The diet and exercise augment each other.

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HEALTH ASSESSMENT
Bibliography
Carolyn Jarvis, P. (2016). Evolve Resources for Physical Examination and Health Assessment, 7th Edition.
Elsevier eBook on VitalSource.
O'Reilly, G. A. (2014). Mindfulness based interventions for obesity related eating behaviours:a literature‐ ‐
review. Obesity reviews,, 15(6), 453-461.