DNP-810 Topic 5 DQ 1: Health issues in a clinical setting can be influenced by nutrition. Identify a health issue that has been positively influenced by nutrition in your clinic. How does nutrition improve health? How can the doctoral-prepared nurse apply this information in practice? Explain. Support your rationale with a minimum of two scholarly sources.

DNP-810 Topic 5 DQ 1: Health issues in a clinical setting can be influenced by nutrition. Identify a health issue that has been positively influenced by nutrition in your clinic. How does nutrition improve health? How can the doctoral-prepared nurse apply this information in practice? Explain. Support your rationale with a minimum of two scholarly sources.

Nutrition has significantly impacted hypertension in patients at our healthcare facility. Patients diagnosed with hypertension in the clinic are referred to the clinical nutritionist who educates them about the DASH diet, which effectively lowers hypertension. The DASH diet encourages a high consumption of fruits, vegetables, and whole grains and moderate amounts of low-fat dairy products, lean meat, nuts, seeds, dry beans, fats, and oils. Patients are advised to have low consumption of red meat, salt, cholesterol and saturated fat, sweets, and sweetened drinks (Koehler & Drenowatz, 2019). The DASH diet has significantly reduced the number of patients with pre-hypertension who advance to stages 1 and 2 hypertension. Furthermore, it has helped maintain patients’ blood pressure below 140/90 and promoted weight loss, lowering the incidence of hypertension complications and comorbidities.

          Nutrition plays a major role in health and development. Good nutrition is associated with strong immunity and a low risk of malnutrition and non-communicable diseases (NCDs) (Shahid & Bishop, 2019). Malnutrition occurs in two forms, undernutrition (due to inadequate intake of nutrients) and overweight (excessive caloric intake). Individuals who observe healthy nutritional practices have a low risk of developing NCDs like hypertension, diabetes, heart disease, and some cancers.

          The DNP-nurse can utilize this information in practice by educating patients and their families about healthy dietary practices to promote good nutrition. The nurse can assess patients with malnutrition and offer nutritional counseling on the nutrients they should increase or reduce in their diet to attain healthy nutrition (Koehler & Drenowatz, 2019). Besides, the nurse can apply the information in managing patients with lifestyle diseases by educating them on dietary habits they need to adopt to promote weight loss and achieve optimal blood pressure and blood glucose levels.

References

Koehler, K., & Drenowatz, C. (2019). Integrated Role of Nutrition and Physical Activity for Lifelong Health. Nutrients, 11(7), 1437. https://doi.org/10.3390/nu11071437

Shahid, S. M., & Bishop, K. S. (2019). Comprehensive Approaches to Improving Nutrition: Future Prospects. Nutrients, 11(8), 1760. https://doi.org/10.3390/nu11081760

Thank you for your post. I agree with you that nutrition plays a major role in health and development. The global rise of diet related diseases and the double burden of obesity and malnutrition means that it is imperative more than ever that all healthcare professionals can provide at least basic evidence-based nutrition advice. Improving an individual’s diet requires more than just information provision, it requires consistent and long-term support to change and maintain new behaviors. The Doctoral-prepared nurse acknowledges that nutrition plays a crucial role in health and agree that providing nutrition advice is part of their role. However, providing sufficiently detailed nutrition advice that is relevant to a patient’s health goals, useful for the patient, and that results in measurable changes, is not common in practice settings. Nutrition recommendations need to be implemented at an individual level, but social and environmental factors can make it difficult for an individual to make the changes required to achieve these recommendations. Improving an individual’s diet requires more than just information provision; typically, several strategies, such as social support and goal setting, are needed to change and maintain dietary behaviors (Coutinho et al. 2017).

Reference

Coutinho SR, Halset EH, Gasbakk S et al. (2017) Compensatory mechanisms activated with intermittent energy restriction: a randomized control trial. Clinical Nutrition. https://doi.org/10.1016/ j.clnu.2017.04.002.

. I agree that hypertension is an important health issue at our healthcare facility. Complications associated with morbidity and death have a significant impact on a patient’s quality of life and survival. As you point out, changes in diet are often discussed with patients and can significantly improve blood pressure regulation. Therefore, examining current evidence will help patients, their doctors and dieticians make decisions. 

DNP-prepared nurses possess the breadth and depth of knowledge to answer these questions and lead translational research efforts launched to improve care. Many DNP-prepared nurses are frequently overseeing and implementing quality improvement initiatives in hospitals. We can advocate dietary restriction as a behavioral way of life change to prevent and treat hypertension. Nurses prepared by the DNP-prepared nurses make a significant contribution to developing and implementing the science that shapes nursing practice (Trautman et al., 2018).

Reference Trautman, D., Idzik, S., Hammersla, M., & Rosseter, R. (2018). Advancing scholarship through translational Research: The role of Phd and DNP prepared nurses. OJIN: The Online Journal of Issues in Nursing, 23(2). https://doi.org/10.3912/ojin.vol23no02man02 

Your post was insightful. Maintaining a DASH diet and increasing the intake of individual nutrients such as very low sodium and potassium and lifestyle modification such as weight loss significantly reduces blood pressure and the incidence of cardio-metabolic diseases. Besides hypertension, Song et al. (2021) note that the DASH diet can significantly reduce the risk of type 2 diabetes and metabolic syndrome. The researchers state that dietary factors are the main contributors to the incidences of these chronic diseases. The study further found that China has the highest diet-related CVD mortality globally. The study indicated that the high mortality is linked to high sodium intake and inadequate intake of whole grains and fruits.

Moreover, proper nutrition, specifically a diet rich in vitamin D, is pivotal in growth and muscle development. Vitamin D plays a monumental role in regulating the amount of calcium and phosphate in the body. The mentioned nutrients ensure that the bones, teeth, and muscles are healthy and strong. A diet deficient in vitamin D may lead to bone deformities such as rickets in children and osteomalacia in adults (Song et al., 2021). Due to the critical role of vitamin D in promoting health, the government advises individuals to take daily vitamin d supplements, especially during winter. Sources of vitamin d include omega-3 fatty acids, red meat, liver, and fortified foods such as breakfast cereals.

The DNP can utilize the information to develop policies to ensure mechanisms are in place to prevent diet-related diseases. According to the study by Evans, China has the highest diet-related deaths worldwide. Consequently, the information about the correlation between nutrition and diseases will help the nurse ensure that preventive measures are in place to curb the menace. Additionally, the information will enable the nurse to provide safe and evidence-based nursing. Koehler et al. (2019) note that properly trained nurses ensure that treatment costs are reduced threefold. DPN is knowledgeable and well equipped; thus he/she is to educate and guide patients and their families on how to utilize nutrition to manage and prevent some diseases (Koehler et al., 2019)

References

Song, Y., Lobene, A. J., Wang, Y., & Hill Gallant, K. M. (2021). The DASH Diet and Cardio-metabolic Health and Chronic Kidney Disease: A Narrative Review of the Evidence in East Asian Countries. Nutrients, 13(3), 984. https://doi.org/10.3390/nu13030984

Koehler, K., & Drenowatz, C. (2019). Integrated Role of Nutrition and Physical Activity for Lifelong Health. Nutrients, 11(7), 1437. https://doi.org/10.3390/nu11071437

Topic 5 DQ 1

identify a health issue that has been positively influenced by nutrition in your clinic.

The health issue mostly seen in adults and children is chronic kidney disease (CKD) impacted by protein-calorie malnutrition (PCM). Although they have different pathogenesis, protein-calorie (energy) malnutrition is caused by a deficiency of energy, protein, and micronutrients. Signs and symptoms of PCM include being underweight compared to the expected healthy weight or muscle wasting seen in certain disease conditions such as HIV/AIDS. Protein calorie malnutrition (PCM) is also common in older people as seen in aggressive weight loss programs or patients with CKD (Mathur, et al., 2022).

During recent research by Mathur, et al., 2022 in a large community cohort with CKD, studies have characterized the relationship between severe protein-calorie malnutrition and the appearance of metabolic syndrome (MS) in adulthood. With each rise in serum bicarbonate levels, the hazard ratios adjusted for age, sex, race, GFR rate, serum albumin, hemoglobin, diabetes, and cardiovascular comorbidities were noted as an outcome of protein-calorie malnutrition (Mathur, et al., 2022).

Experimental animal and human studies conducted by Mathur, et al., 2022 show that chronic kidney disease (CKD) is very high among geriatric patients with a risk of adverse effects such as metabolic acidosis associated with protein catabolism and bone loss. Research studies by Mathur, et al., 2022 sought to quantify the independent association of metabolic acidosis with adverse muscle, bone, and functional outcomes in patients with non-dialysis-dependent patients with stage 3–5 CKD who had low estimated glomerular filtration (GFR) and serum bicarbonate values. The presence and severity of metabolic acidosis were significant and independent risk factors for failure to thrive, protein-calorie malnutrition, and falls with a possible fracture (Mathur, et al., 2022).

The second type of protein-calorie malnutrition is edematous malnutrition known as Kwashiorkor and Marasmus. They are two clinical syndromes observed in severe acute malnutrition in young children primarily found in developing countries. Marasmus comprises of depletion of antioxidants, vitamins, and minerals. While Kwashiorkor is a severe and uncontrolled oxidative stress associated with the depletion of gut anaerobes and proliferation of aerotolerant gut pathogens (Pham, et al., 2021).

How does nutrition improve health?

Nutrition improves health positively because, urgent correction of plasma glutathione depletion, alongside supply of specific essential amino acids, particularly methionine and cysteine, early suppression of gut Proteobacteria including K. pneumoniae, and the use of probiotics to restore the human gut anaerobic and mature microbiota open new avenues to develop more targeted and effective treatments modalities. We can use this knowledge to healthily educate our patients and their family that increasing the intake of protein-containing foods, using milk-based formulas, antioxidants, vitamins, minerals, and daily multivitamins are the treatment of choice for replacement therapy (Mathur, et al., 2022).

How can the doctoral-prepared nurse apply this information in practice?

The doctoral-prepared nurse applies this information in practice by using Anthropometry methods to monitor blood pressure, weekly weight, and laboratory test levels such as plasma levels of glucose, triglyceride, and HDL. It was determined that the prevalence of non-communicable diseases such as protein-calorie malnutrition shows a direct and significant association between the burden of metabolic syndrome on body mass index, waist/height index, Dyslipidemia, CKD, and blood pressure. Identification of the specific pathogenic organisms and treatment with antibiotics could also save many children with kwashiorkor and marasmus (Pham, et al., 2021).

Reference

Mathur, V., Reaven, N. L., Funk, S. E., Whitlock, R., Ferguson, T. W., Collister, D., & Tangri, N. (2022). Association of metabolic acidosis with fractures, falls, protein-calorie malnutrition and failure to thrive in patients with chronic kidney disease. Clinical Kidney Journal. V15 (7), p1379-1386, 8p. Retrieved from DOI: 10.1093/ckj/sfac065

Pham, T. P., Alou, M. T., Golden, M. H., Million, M., & Raoult, D. (2021). Difference between kwashiorkor and marasmus: Comparative meta-analysis of pathogenic characteristics and implications for treatment. Microbial pathogenesis. V150, pp. 104702. DOI:

10.1016/j.micpath.2020.104702