Running head: HOLISTIC HEALTH CARE PLAN 1

Holistic Health Care Plan

Delaware Technical Community College - Stanton Campus

NUR 320-5W1

Megan Couden

April 22, 2019

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Holistic Health Care Plan

A holistic health assessment is a comprehensive client evaluation that takes into

consideration the client’s physical, social, environmental, emotional, spiritual, and intellectual

wellbeing. Using critical thinking, performing a complete head to toe physical assessment, and

maintaining therapeutic, non-judgmental communications, objective and subjective data is

obtained in order to create a quality, effective, plan of care (Dillon, 2016, pp. 1-4). This health

care plan follows the holistic assessment of a 39 year old, Caucasian male who engages in

physical activities through work and sports, and spends a lot of time traveling daily. The focus of

the care plan is on two health problems and one opportunity for health promotion and disease

prevention during the exam.

Health Problem 1: Shortness of breath upon waking

During the health history questionnaire, the client was asked to describe any concerns he

had regarding his sleep patterns and quality of rest. The client described that he periodically

wakes up feeling like he “forgot to breathe” and remains short of breath for approximately 30

minutes after waking. With the client’s subjective statement, combined with the objective

physical assessment of his appearance - having a large stature with a thick neck circumference,

an airway problem with a potential for obstructive sleep apnea is determined. This client has risk

factors consistent with obstructive sleep apnea including male sex, age, higher body mass index,

and upper airway abnormalities related to neck circumference (McNellis & Thomas, 2017). His

preferred sleep position is supine which also contributes to airway obstruction.

Interventions for this client include adopting body position changes during sleep to avoid

lying supine. Lateral or prone positions can prevent gravity from causing the tongue, neck, and
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other physiological structures to obstruct the airway. Encouraging the client to select a pillow

suited for side sleeping or prone positions can enhance comfort and promote client compliance.

With the risk factors present, the American Academy of Family Physicians recommends a

referral to have a sleep study performed at a sleep center (McNellis & Thomas, 2017).

Information for the Christiana Care Sleep Disorders Center will be given to the client as follows:

Christiana Care Sleep Disorders Center

774 Christiana Rd Suite 103, Newark, DE 19713
(302) 623-0650
https://christianacare.org/services/neurosciences/sleepmedicine/.

At this appointment, the client’s respiratory, cardiovascular, and musculoskeletal systems will be

assessed during sleep. Based on the findings, a client-specific treatment plan will be

implemented. Treatments may include the use of a CPAP machine to use positive air pressure

during sleep or wearing a mandibular mouth guard to ensure the airway remains open. The goal

for this client is to be able to have a restful sleep without feeling short of breath upon waking.

Following the implementation of the above methods, interventions can be evaluated in a follow

up appointment assessing sleep outcomes with changes in position during sleep, whether a sleep

study is scheduled or was performed, and if so, what were the findings and treatments prescribed.

Maintaining open communication with the multidisciplinary team and client regarding the sleep

study and findings ensures the most positive outcomes for the client with ongoing evaluations.

Health Problem 2: Dental Caries

The next health problem noted during the holistic health assessment was noted during the

review of systems. The client stated he does not get routine dental checkups, only seeking dental

treatment when problems arise. The client stated his lack of dental health insurance is the reason

for the missed appointments. With the client’s subjective information combined with the visible
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presence of an unrepaired broken molar, this is an identified health problem. The American

Dental Association (ADA) recommends visiting a dentist twice a year to “minimize the risk of

caries and periodontal disease” (2018, p.1). Due to the client’s lack of insurance, education on

recommended interventions include oral home care techniques such as brushing twice a day with

fluoride toothpaste, flossing between teeth, and eating a healthy diet low in sugar. More complex

interventions can also include over-the-counter antimicrobial oral care products that help prevent

periodontal disease, fluoridated mouth rinses, motorized toothbrushes, and interdental devices

such as a water pick that are available for a more complete clean. These recommendations are

available as a handout from the ADA website and can be given to the client as a resource. The

ultimate dental goal for the client is to achieve and maintain optimal dental health remaining free

from dental caries, free from periodontal disease, and have existing problems repaired to prevent

further breakdown and complications. Information for referral to an affordable dental clinic will

also be provided to the client as follows:

Westside Family Health

Newark Dental Office
27 Marrows Road, Newark, DE 19713
(302) 678-4622, option 5
https://www.westsidehealth.org/

Evaluation of the interventions will be assessed at a follow up appointment by questioning

whether the client visited a dentist for routine cleanings and repair of the broken molar. The oral

cavity will then be assessed with a focus on health of the teeth, gums, and tongue as well as the

presence of halitosis. Further re-evaluation and education on the importance of dental health can

be given at that time as needed, considering the relation of good oral hygiene to the optimal

health of the entire body.

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Health Promotion and Disease Prevention:

Prevention of Hypertension and Type 2 Diabetes Mellitus

Following the holistic health exam and physical assessment, risk of cardiovascular

disease and type 2 diabetes mellitus is present based on family history and diet, compounded by

stress levels through work and a large familial responsibility. The goal of health promotion and

disease prevention is to encourage the selection of healthy food choices and to prevent becoming

pre-hypertensive and pre-diabetic. The Centers for Disease Control and Prevention (CDC) states

pre-hypertension is present when the blood pressure falls between 120/80 mmHG and 139/89

mmHg (2014a). To prevent and manage blood pressures, the CDC recommends making lifestyle

changes including a healthy diet low in sodium, total fat, saturated fat, and cholesterol, and high

in fresh fruits and vegetables in addition to being physically active and not smoking (2014b).

Pre-diabetes is present when A1C levels are between 5.7 and 6.5, fasting blood sugar is between

100 and 125, and oral blood glucose tolerance is between 140 and 199 (American Diabetes

Association, 2016). Through Healthy People 2020, as outlined in the Guidelines and Key

Recommendations, “strong evidence shows that healthy eating patterns are associated with a

reduced risk of cardiovascular disease” and “moderate evidence indicates that healthy eating

patterns also are associated with a reduced risk of type 2 diabetes” (Dietary Guidelines 2015-

2020, n.d., para. 3). Interventions for this client include monitoring the blood glucose levels and

blood pressure, encouraging the client to obtain periodic blood pressures at home or at

neighborhood pharmacies and participating grocery stores, having the client keep track of his

blood pressures and blood glucose levels in a log book, and creating a healthy meal plan that

follows the key recommendations including vegetables, fruits, whole grains, low-fat dairy,

proteins including seafood, lean meats and poultry, eggs, legumes, nuts, seeds, and soy products.
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The meal plan should limit saturated and trans-fats, added sugars, sodium, and alcohol (Dietary

Guidelines 2015-2020, n.d.). Due to the fact that this client spends a lot of time travelling, it is

beneficial to include healthy choices available from fast food restaurants that are easily

accessible for a worker on the go. The Healthline website provides an easily accessible list that

can be shared with the client to use as a resource with optimal choices from places including

McDonald’s, Wendy’s, Subway, Chik-fil-a, Ruby Tuesdays, the Cheesecake Factory, and also a

general rule of thumb which can be used when selecting menu options at almost any place

(Bjarnadottir, 2015). For further dietary guidance and support, a referral can be made for the

client to see a nutritionist at the following:

Nutrition Center at STAR Health

540 S College Ave, Newark, DE 19713
(302) 831-3195
https://sites.udel.edu/bhan/the-nutrition-clinic-at-ud-health/

The client can also be referred to a primary care physician for follow-up care at:

Total Care Physicians

Glasgow Medical Center
2600 Glasgow Avenue, Suite 124
Newark, DE 19702
Phone: (302) 836-4200
Fax: (302) 836-8431
https://www.totalcarephysicians.com/

Evaluation of the client’s diet and food choices can be made at a follow up appointment by

having the client keep a food journal to bring to the appointment for a week of meals or a copy of

a weekly grocery shopping list and restaurant receipts showing purchases made for a subjective

health assessment. Checking blood pressure and blood sugar levels at the follow-up appointment

and evaluating blood sugars and blood pressures taken and logged by the client can objectively
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assess the client’s status. Interdisciplinary communication with the nutritionist will also be

beneficial for optimal client health outcomes and continuity of care.

Evaluation/Reflection

At the beginning of the holistic health assessment, there were no specific concerns

initiating the client’s visit. However, through subjective and objective observations and

questioning, discoveries were made that merit further assessment and intervention. Creating a

care plan that is realistic for the client and includes useful tools and referrals, helps educate the

client on how to address current conditions and enable him to seek options that will have the

greatest potential for success in reaching his optimal level of health and prevent future problems.

Establishing a trusting relationship will encourage the client to follow through with interventions

and lifestyle changes at home as well as coming back to future follow up appointments.

With this assessment, I learned that there are lots of opportunities to educate and identify

areas for improvement in a person’s health and wellness. From helping a client identify a

deviation from the norm as with the shortness of breath following sleep, to making nutritional

choices which can help prevent hereditary diseases, a comprehensive nursing assessment can

initiate nursing diagnoses, implement interventions, and monitor and evaluate outcomes to help

maintain a client’s condition and quality of life. With a great assessment comes the nurse’s

power and ability to evoke change.

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References

American Dental Association. (2018, August 3). Home oral care. Retrieved from

https://www.ada.org/~/media/ADA/Science%20and%20Research/Files/HomeOralCare_

Web_Final_July2018.pdf?la=en

American Diabetes Association. (2016, November 21). Diagnosing diabetes and learning about

prediabetes. Retrieved from http://www.diabetes.org/diabetes-basics/diagnosis/

Bjarnadottir, A. ( 2015, July 7). 10 "fast food" restaurants that serve healthy foods. Retrieved

from the Healthline website: https://www.healthline.com/nutrition/10-healthy-fast-food-

restaurants

Centers for Disease Control and Prevention. (2014a, July 7). Conditions that increase risk for

high blood pressure. Retrieved from https://www.cdc.gov/bloodpressure/conditions.htm

Centers for Disease Control and Prevention. (2014b, July 7). Controlling blood pressure.

Retrieved from https://www.cdc.gov/bloodpressure/control.htm

Centers for Disease Control and Prevention. (2017). Family health history for adults. Retrieved

from https://mycourses.dtcc.edu/d2l/le/content/18855/viewContent/306792/View

Dietary guidelines 2015-2020. (n.d.). Retrieved April 22, 2019, from the Office of Disease

Prevention and Health Promotion website:

https://health.gov/dietaryguidelines/2015/guidelines/chapter-1/the-science-behind-

healthy-eating-patterns/#eating-patterns-health
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Dillon, P. M. (2016). Nursing health assessment: The foundation of clinical practice. (3rd ed.).

Philadelphia, PA: F.A. Davis Company.

McNellis, R.J. & Thomas, S. (2017, July 15). Screening for obstructive sleep apnea in adults.

American Family Physician, 96(2), 123-124. Retrieved from

https://www.aafp.org/afp/2017/0715/p123.html?cmpid=em_AFP_20170714