Designed for the Unique Needs
of Homecare Providers

This site provides homecare clinicians with access to chronic care management models, best practices and downloadable resources for homecare patients.

Heart Failure
Hypertension and Angina
Diabetes

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"The body of knowledge that serves as the rationale for nursing practice determines the areas of specialty to develop as well as the manner in which that knowledge is organized, tested and applied." -Carper, 1978

Diabetes > Nutrition > Plan

Plan

The nutrition plan of care should include measurable specific patient goals that are realistic and obtainable.

Diabetes - Nutrition - Plan
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It needs to include buy-in and understanding on the part of the patient and caregiver(s) and take into consideration culture, ethnicity, tradition, individual preferences and economic circumstances.

Based on deficits found in the assessment, the plan must be comprehensive, patient specific and may be multidisciplinary.

 Characteristics of a good plan
  • Includes a defined time frame
  • Developed with the patient and reflects what the patient wants to achieve
  • Considers patient’s readiness to change 
  • Outlines the support they need to make changes
  • Includes individualized interventions to meet patient’s goals*
    *Under the Implement category you will find tools to help you carry out patient goals.
 Important considerations
  • Target goals for A1c
  • Target goals for blood pressure
  • Target goals for cholesterol (LDL, HDL, Triglycerides).
  • Current recommended standards of clinical care
Diabetes: Monitoring Your Blood Sugar Level for Families (Web Page) - Feb 8th, 2011
A great family resources for parents dealing with children newly diagnosed with diabetes from the FamilyDoctor.org.

Keep Your Teeth and Gums Healthy (Web Page) - Feb 8th, 2011
An easy to read 20 page booklet from NIDDK, updated in 2008. Too much glucose in the blood for a long time can cause diabetes problems.

Four Steps to Control Your Diabetes for Life (pdf) - Feb 3rd, 2011
A 30-page booklet from NDEP, updated in 2006, that explains basic diabetes care and control and includes pages to keep a record of care received and progress toward goals for blood glucose, cholesterol and blood pressure.

Diabetes Self Management Behavior Goals (pdf) - Feb 2nd, 2011
Chart for Patient to Write in Behavior Goals to Better Manage Diabetes

DASH Diet and African American Health (Web Page) - Feb 2nd, 2011
African Americans are especially likely to develop hypertension and complications from high blood pressure. Tips to reduce the chances.

Diabetes - Numbers at a Glance 2010 (Nat. Diabetes Education Program) (Web Page) - Feb 1st, 2011
A two page handout summarising recommended blood glucose and cholesterol numbers. Also indicates currently recommended diabetes screening tests and care, updated for 2010 by NDEP.

How Does Mediterranean Diet Compare with DASH Diet? (Web Page) - Feb 1st, 2011
The Mediterranean diet is rich in fruits, vegetables, nuts/beans/seeds, and heart healthy fats.

DASH Diet Action Plan for Clinicians (Web Page) - Feb 1st, 2011
Practical assistance for clinicians to help patient's eat healthfully and become more physically active.

 


The development of the hypertension and chronic stable angina project was made possible by a grant from the New York State Attorney General on behalf of the Attorneys General of all 50 states, DC and Puerto Rico from litigation settlement funds to benefit the healthcare needs of consumers with high blood pressure and angina. Original funding for the site was provided in part by US Congress and CDC. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC.