9.4: Implement Nutritional Strategies to Impact Hematological Wellness
By the end of this section, you should be able to:
- 9.3.1 Assess the client for readiness to learn.
- 9.3.2 Teach nutritional strategies to optimize hematological wellness.
Holistic Nursing Assessment of the Client
Assessing clients for nutritional influences on hematologic wellness must encompass the client and their support circle. The nurse should consider the different realms the client may be impacted by in their nutritional choices (Figure 9.4). For example, adolescents, who may be adequately knowledgeable about nutrient-rich food sources, may choose less-healthy options at school due to peer influence. The nurse should help clients visualize potentially challenging situations. Visualization of the situation—and how to respond to the situation—can empower clients to improve their attitude and practice of healthy eating and is part of a holistic approach to fostering hematologic wellness (Wiafe et al., 2023).
Age-Specific Considerations
For infants, school-aged children, and adolescents, determining where children spend their time and with whom is an important step in developing a holistic approach to nutritional interventions. The modern family is diverse, and often consists of multigenerational members and different households influencing each other’s health practices. Gaining the confidence of the family unit’s influencer(s) requires a nurse’s thoughtful approach and cultural sensitivity (Barnes et al., 2020). For infants, family traditions regarding the addition of solid food and cow’s milk to the diet can contradict current evidence-based recommendations and can result in nutritional anemias. Discussing menstruation may be taboo for some female adolescents and thus result in undisclosed menorrhagia and secondary iron-deficient anemia. Older adults are often uncomfortable discussing oral health issues and economic burdens that may have led to late recognition of malnutrition. The nurse is in a unique situation to holistically assess clients and their families utilizing active listening and therapeutic communication strategies.
Client Teaching
As the teaching session begins, the nurse should ask the client to describe what they already know about the health concern and should be prepared to adjust their educational plan. If the client reports having nutrient-deficient anemia but does not understand what anemia is, the educational plan should start with an overview of the function of red blood cells and how they are produced in the body. Most clients will struggle with adherence to a nutritional plan (meal plan) if they do not understand why the modification is necessary. This is a component of determining the client’s health literacy . Other variables of health literacy to consider include:
- Language spoken and read
- Cultural considerations regarding who should be present for the educational session
- The learning style of the client and their significant other as applicable
- External constraints (time, state of health)
Learning Modalities
Taking advantage of technology and existing reputable resources can be a time saver for both the nurse and the client. Reputable references may be available electronically and/or in writing. Determining access to a computer or internet service is vital if relying on an electronic modality for content. Additionally, consideration of the material in the client’s primary language cannot be overlooked. Potential options include:
- One-on-one teaching
- Group or family teaching
- Demonstration—including food preparation and shopping
- Printed materials
- Videos, podcasts, applications for smart phones
- Community resources
A list of client education resources is included at the end of this chapter.
Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up to Case Study Parts A and B.
Grant starts discharge education with Ms. Foster by sharing his intended goal and time frame for completion. Ms. Foster’s daughter offers to retrieve the car to expedite discharge. Grant suggests that she stay for the education and participate in identifying potential barriers to the plan. Ms. Foster reports that her anemia should be resolved since she received a blood transfusion. Grant explains to Ms. Foster that the lifespan of transfused red blood cells is approximately 60 days and that she will need to start oral iron replacement therapy as soon as possible to restore her hematologic wellness. He then modifies his educational plan to include an overview of red blood cell production, signs and symptoms of anemia, and the expected time for recovery of symptoms.
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Family presence
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Medical diagnosis
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Family medical history
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Hearing or vision changes
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Cognitive function
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Preferred spoken language
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Level of alertness