Running head: REALAGE 1

RealAge Health Promotion Paper

Christine Perreault

Ferris State University

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Abstract

The RealAge paper will contain positive or negative results from the RealAge Test questionnaire

and focus on implementing healthy lifestyle changes based on the information gathered from the

client. Two-wellness diagnosis will be established and attainable goals will be implemented.

Barriers will be addressed. Planning and interventions will be outlined based on evidence-based

practice and the client’s progress will be evaluated for effectiveness towards a healthier lifestyle.

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The RealAge Test questionnaire focused on identifying areas of health risks that may be

deleterious to the clients overall health. The collection of information is the first step in the

assessment process. According to White (2012), Standard 1. Assessment, the registered nurse

collects comprehensive data pertinent to the consumer’s health and/or situation (p. 35). Various

factors evaluated during the assessment include client’s history, exercise, diet, and mental health.

Information obtained through this process will help analyze and determine two wellness

diagnosis and reasonable goals for lifestyle changes. Positive and negative results from the

questionnaire will be discussed through the assessment and evaluation of client outcomes. The

client’s readiness to change his behavior will be assessed utilizing the Transtheoretical Model

(TTM) combined with the Self Efficacy and Social Cognitive Theory that plays a central role in

personal change and is the foundation of human motivation and action (Pender, 2015).

Assessment and Analysis

Client’s History

The client chosen for the RealAge paper is a male who has a chronological age of 53.

The completion of the RealAge test revealed a RealAge of 51.2. Family history includes a living

mother at the age of 79 and a father at the age of 85 (Keith, S, personal communication,

September 4, 2015). The client is the youngest of three siblings and works as an independent

construction builder (Keith, S, personal communication, September 4, 2015). He is well rested

after sleeping approximately seven-hours a night (Keith, S, personal communication, September

4, 2015). The client is considered at a healthy weight with low body mass index (BMI) of 23

that falls into the normal range of 18.5 – 24.9 (National Heart, n.d.). My client reveals he might

have had a transient ischemic attack (TIA) at the beginning of August, but he did not seek

immediate medical care for his dizziness, generalized weakness, and a tingling feeling on his left

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side that resolved within 15 minutes from onset. He saw his primary care physician days later,

and lab work showed his cholesterol level was at 353, triglycerides at 332, LDL (low-density

lipoprotein) known as “bad” cholesterol at 119, and his HDL (high-density lipoprotein) known as

“good” cholesterol at 54. He states he started using flax seed and fish oil after he had TIA

symptoms and is scheduled for repeat of fasting lab work in October (Keith, S, personal

communication, September 4, 2015). He is aware that high cholesterol, triglycerides, and an

elevated LDL all contribute to an increase risk for a stroke or heart attack, but he does not want

to take statins. According to the American Heart and Stroke Association (2015), 17.3 million

people die each year worldwide of cardiovascular disease and 33 million people suffer strokes.

His blood pressure is 110/68 and is within normal limits. He suffers from asthma that is

controlled with medications and routinely sees the allergist. He has had some issues with pain

and diarrhea after eating, but he has not had a colonoscopy. According to the Center for Disease

Control and Prevention, screening guidelines for colorectal cancer begins at age 50 and continues

until age 75 (CDC, 2014).

Exercise

The client did not score well on the assessment questions regarding exercise. The client

does not exercise daily, however he believes his job in construction keeps him active and fit

(Keith, S, personal communication, September 4, 2015). His physical activities include

bicycling a few times a week on trails around his house, walking occasionally, and hunting

(Keith, S, personal communication, September 4, 2015). The RealAge health topic suggests that

exercise includes 20-minutes of cardiovascular three times a week and 30-minutes a week of low

intense weight strengthening for muscle toning and bone formation (Roizen, 2015). Regular

exercise maintains independence and can boost energy, as well as help minimize risk of illness

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and disease (Robinson, 2015). Exercise is associated with a 19 percent decreased risk of heart

disease and stroke-related deaths in men (Madell, 2012). The client has been encouraged to

exercise at least three times a week even if it is a brisk walk up and down his road.

Diet

The RealAge assessment revealed my client does not eat a healthy diet. His BMI reveals

his weight and height ratio is within normal range. He understands that eating a balanced diet

low in fat and rich in fruit and vegetables reduces his chances of stroke and heart attack. The

client eats a lot of processed sugar items such as cake, cookies, and donuts, but did not know

these items can elevate bad cholesterol levels caused by trans fats. Eating trans fat raises the

level of LDL in the blood and increases risk of developing heart disease, which is the leading

cause of death in men and women in the United States (U.S Food, 2015). He rarely eats fresh

fruit; instead, he eats fruit snacks and believes this qualifies as a fruit. He seldom eats cooked

vegetables, but he has an occasional green salad with dinner. His few healthy habits include

broiling or grilling food, eating fish at least twice a month, eating venison, and consuming milk

every day. Recommendation would be to include eating fruit in place of processed sweets,

increasing vegetable consumption, and continuing eating lean meats such as fish, turkey,

chicken, and venison.

Mental Health

My client’s mental status is healthy. He is happily married. He feels grateful he has a lot

of work and is making money. He lives within his means of income and is debt free allowing

him to not worry about money. Overall 78.5% of studies showed the likelihood of having a

mental health problem are higher among people who have debt, compared with people without

debt, (Richardson, 2013). He has a Type B personality and does not stress over issues. He does

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not easily get upset but tends to keep his feelings to himself and minimally engages in

confrontational matters. He has a great family support system and has a healthy relationship

with many friends. Good relationships are associated with enhanced happiness, quality of life,

resilience, cognitive capacity, and perhaps even wisdom (Walsh, 2011). He is active with the

Marine Corp league and with his church. The mental assessment of the client developing mental

or stress issues later in life is very low and requires no interventions at this time.

Wellness Diagnosis

The first wellness diagnosis selected for this client is Risk for ineffective cerebral tissue

perfusion (Ralph, 2014). This wellness diagnosis is in relationship to patient having a transient

ischemic attack (TIA). His second wellness diagnosis is Activity intolerance related to lack of

motivation in relation to not regularly exercising (Nurse, 2015). My client’s diet, elevated

cholesterol and triglycerides, and lack of a consistent exercise regimen all contribute to a higher

risk for TIA’s and stroke. Both of the wellness diagnoses will parallel each other towards the

planning, interventions, and evaluation, because of my client having a TIA. Expected outcomes

would be participating in diagnostic tests and lab work, reducing his risks factors by

implementing an exercise regimen of 30-minutes of walking three times a week, and eating more

fruits and vegetables.

Planning and Intervention

My client’s overall health is good; however, he experienced a transient ischemic attack

(TIA) and is concerned about having another one. The RealAge assessment was an important

tool to show that there is a need for change and that he needs to take responsibility for healthier

choices especially in prevention of heart attacks and strokes. The core determinant of the client

is his lack of knowledge in making healthy choices to help reduce the risk in having another

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TIA/stroke. According to Pender (2015), the basic components of the Self Efficacy and Social

Cognitive Theory include knowledge and benefits of reducing risks, the belief that one has the

ability to change a habit, outcome expectation about changing behavior, personal goals, and

strategies for achieving the goals. Creating goals for this client would consist of keeping a log of

eating a healthy balanced diet with fruits and vegetables every day while limiting sugary snacks,

and increasing cardiovascular exercise by implementing an exercise plan of walking one mile

three times a week. Evidence-based practice supports the idea of self-monitoring in behavior

change and that it has a strong theoretical foundation towards meeting the client’s goal and self-

reinforcement of the client’s progress (Burke, 2011).

According to the Transtheoretical Model (TTM), individuals’ progress through five

stages towards adopting and maintaining behavior changes (Pender, 2014). In the first stage,

precontemplation, an individual is thinking of adopting a particular change in behavior, and

second stage, contemplation, the individual is serious of changing behavior in six months. My

client has progressed through the first two stages and is in the third stage of planning because his

TIA scared him, and he intends to make changes regarding unhealthy behaviors. In the planning

stage, my client will schedule for a repeat of a lipid panel in October to see if taking flaxseed and

fish oil reduced his cholesterol and triglyceride levels. The client will schedule an appointment

for diagnostic testing such as Ankle Brachial Index (ABI’s) that measures the severity of

peripheral arterial disease (PAD), Noninvasive vascular assessment (NIVA) of the carotids and

the abdominal aorta, EKG, and a blood test to check a C-reactive protein. He will be provided

material resources explaining stroke symptoms, diet, exercise, and when to seek medical help for

TIA symptoms.

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The client is willing to eat vegetables for dinner as well as fruit in place of sweets and is

encouraged to write on a calendar of his consumption of vegetables and fruit for four weeks.

The barrier to his consumption of vegetables is that his wife does not like vegetables; therefore,

she seldom cooks them. Implementing a plan would include his wife with education on

importance of eating vegetables. Adults should consume 1.5–2.0 cup equivalents of fruit and 2–

3 cups of vegetables daily (Moore, 2015).

The client makes no promises of walking up and down his road three times a week, but

will record his performance on a calendar sheets provided to him. He understands the importance

of exercising; however, he continues to feel he is active enough with working as a construction

builder on his work sites. He rarely watches television and in his leisure time works in his shop

making furniture or other constructional projects. The barrier to exercising is his perception that

he does not have to get his heart rate up in terms of walking or running, and feels he is exercising

by keeping physically busy with his job.

Evaluation

Evaluation is “the process of determining the progress toward attainment of expected

outcomes, including the effectiveness of care” (White, 2012, p. 105). The client repeated a lipid

panel in October after being on flaxseed and fish oil for about two months. His cholesterol level

went from 353 to 223, his triglycerides went from 332 to 67, and LDL went down to 102, and his

HDL was still at 54. His diagnostic tests revealed normal ABI’s, the NIVA of his bilateral

carotids showed less than 40% of stenosis in the arteries, EKG showed normal sinus rhythm, no

abdominal aortic aneurysm, and his C-reactive protein was within normal limits.

My client was instructed to keep a calendar log for one month, starting at the end of

October, and record his consumption of eating fruits and vegetables while reducing his

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consumption of sweet snacks, and record his exercise of walking three times a week (see

Appendix A). Evidence shows that increasing fruits and vegetables reduces the chances of

having a TIA/stroke by 32 % (Brooks, 2014). Evidence also suggests that regular physical

activity reduces the incidence and the mortality associated with having a TIA/stroke between 20

and 30% (Gallanagh, 2011). The results of October showed that the client had fruits and

vegetables five times during the week and reduced his sugary snack consumption; however, he

did fail in walking a mile three times a week (Appendix A). In the month of November my

client was asked to repeat the same process as in October (see Appendix B). The client’s log

indicated that he walked a mile three times a week. He did not have fruits or vegetables every

day, but he did reduce his consumption of sugary snacks (Appendix B). He was given a stroke

education book from my work and educated on symptoms such as facial drooping, arm

weakness, speech difficulty, and when to call 911. The RealAge assessment addressed certain

issues and behaviors that opened the eyes of the client regarding his health. According to the

Self-Efficacy and Social Cognitive Theory, clients expect that their efforts will produce

favorable change and believe that obstacles are surmountable (Pender, 2015). The client is

accepting responsibility for lifestyle changes and feels the goals set were easily attainable to

achieve and will ensure a positive outcome towards maintaining a healthier lifestyle.

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References

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Black, B.P. (2014). Professional nursing: Concepts and challenges (7th ed.) Maryland Heights,

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Brooks, M. (8 May 2014). More evidence fruit and vegetables cut stroke risk. Medscape.

Retrieved from http://www.medscape.com/viewarticle/824877

Burke, L. E., Wang, J., & Sevick, M. A. (January 2011). Self-monitoring in weight loss: A

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CDC. (2014). Colorectal cancer. Centers for Disease Control and Prevention. Retrieved from:

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Gallanagh, S., Quinn, T. J., Alexander, J., & Walters, M. R. (2011). Physical activity in the

prevention and treatment of stroke. International Scholarly Research Notices, 2011, 1-

10. doi:10.5402/2011/953818

Madell, R. (10 April 2012). Exercise and heart disease statistics. Healthline. Retrieved from

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Moore, L.V. & Thompson, F. E. (10 July 2015). Adults meeting fruit and vegetable intake

recommendations-United States, 2013. Morbidity and Mortality Weekly Report.

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National Heart, Lung, and Blood Institute (NIH). (n.d.). Calculate your body mass index.

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Nurse Theory (2015). Activity intolerance-nursing care plan. Retrieved from

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Ralph S. S. & Taylor, C. M. (2014). Risk for ineffective cerebral tissue perfusion. Sparks &

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Richardson, T., Elliott, P., & Roberts, R. (December 2013). The relationship between personal

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Journal Clinical Psychology Review, 33 (8), 1148-1162. doi:10.1016/j.cpr.2013.08.009

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get fit and stay fit as you grow older. Retrieved from

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Roizen, M., & Oz, M. (2015). Minimum exercise, maximum health: Your shortcut to wellness.

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U.S. Food and Drug Administration. (16 June 2015). Trans fat. Retrieved from

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Walsh, R. (2011). Lifestyle and mental health. American Psychologist. Retrieved from

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White, K.M. & O’Sullivan, A. (2012). The essential guide to nursing practice. Washington

D.C: Author

Appendix A

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Appendix B

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