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Outline for today (1/20) 12:30pm-3:15pm. Sign-In/Handouts Questions about Interviewing/Counseling? Turn in Dairy Council Counseling Skills Module Test Score Nutrition Assessment PowerPoint, Handouts

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Outline for today 1 20 12 30pm 3 15pm
Outline for today (1/20)12:30pm-3:15pm

  • Sign-In/Handouts

  • Questions about Interviewing/Counseling?

  • Turn in Dairy Council Counseling Skills Module Test Score

  • Nutrition Assessment PowerPoint, Handouts

  • For Tuesday (Older Adults, 51+): Read over the California Food Guide Chapter 14 (Go to: http://www.cafoodguide.ca.gov and click on CFG Table of Contents and it will bring you to all the chapters: click on Chapter 14)

  • Read Nutrition & You Pages 469-487


Nutrition assessment

NutritionAssessment

(Gaining further nutrition information after an initial Nutrition Screening)

Source: Student manual P.4-7


Components of nutrition assessment
Components of Nutrition Assessment

  • Anthropometric data

  • Biochemical

  • Clinical

  • Dietary

  • Note: Sometimes data can fit into more than one category.


Components of nutrition assessment1
Components of Nutrition Assessment

  • Anthropometric data:

  • Physical Measurements: height or length, weight, BMI, head or arm circumference, or skinfold measurement. (This data is most valuable if it is measured over time)

  • Example: Jenna is 5’4.”


Components of nutrition assessment2
Components of Nutrition Assessment

  • Biochemical data:

  • Lab work: analysis of blood, urine, and other body tissues.

  • Example: Jim’s recent blood test shows that his cholesterol is 200 mg/dL.


Components of nutrition assessment3
Components of Nutrition Assessment

  • Clinical data:

  • Includes a complete physical examination and a medical and psychosocial history.

  • Example: Jay smoked for 10 years and quit 1 month ago.


Components of nutrition assessment4
Components of Nutrition Assessment

  • Dietary data:

  • Includes foods and quantities eaten, eating habits, accessibility of food, and cultural and socioeconomic factors that affect selection of food.

  • Example: Bob drinks 3 cans of Coke a day.


Case study 1
Case Study #1

Selena is a 19 year old pregnant woman

This is her first pregnancy. She is 15 weeks pregnant.

Before she became pregnant her BMI was 27.0

Her Hct is 31.6%

She is currently living in a homeless shelter.

Her 24 hour recall listed the following foods:…………

Source: California WIC Training Manual


Case study 2
Case Study #2

Sarah Jones is 28 y.o.

She is breastfeeding her 2 month-old son.

She is 5 feet, 6 inches tall

She weighs 130 pounds.

She smokes 10 cigarettes/day.

Her hemoglobin is 10.8 gm/dl.

Her 24 diet recall listed the following foods…….

Source: California WIC Training Manual


Case study 3
Case Study #3

John is 6 feet tall, weighs 200 pounds.

His recent blood test shows his cholesterol is 240, LDL is 103, TG is 220, FBG is 102.

He smoked for 20 years and finally has stopped 3 months ago. He walks in the park 30 minutes every morning. Currently, he is sharing a apartment with his cousin. His food frequency show that his consumption of certain foods…….



3 types of dietary assessments
3 Types of Dietary Assessments

  • 24 hour recall/diet history

  • Food record/diary

  • Food frequency questionnaire


Dietary assessment
Dietary Assessment

Source: WIC Training Manual


Dietary assessment1
Dietary Assessment

Source: WIC Training Manual


Dietary assessment2
Dietary Assessment

Source: WIC Training Manual


3 types of dietary assessments1
3 Types of Dietary Assessments

  • 24 hour recall/diet history

  • Food record/diary

  • Food frequency questionnaire


Dietary assessment3
Dietary Assessment

Source: WIC Training Manual


24 hour recall
24 hour recall

  • Welcome and explain purpose

  • Use food models

  • Try to use open-ended questions and avoid leading questions at the beginning of the session

  • Start with yesterday in the am, or start backwards

  • Avoid giving comments/approval or disapproval with facial expressions


24 hour recall1
24 hour recall

  • Ask what foods/drinks/condiments are consumed

  • Can ask daily activities to help patient remember what foods were related with activities

  • Mixed foods-break them apart

  • Rephrase questions if needed

  • Allow silence

  • Ask if patient understands the question


24 hour recall2
24 hour recall

Information should include:

  • Specifics of food (e.g. low fat/1%/whole milk,

    fresh/frozen/canned etc)

  • How food is prepared (home/restaurant)

  • Portion size (estimate #, size, volume)


24 hour recall3
24 hour recall

  • Review recall

  • Ask if typical

  • Check if there are any contradictions

  • Thank patient/client

  • Make plans for education/counseling topics


Timefood/drinks/condiments (portion size)

8:30am 1 apple

1 piece toast with 1 tsp butter

2 cups of orange juice

11:00am 1 sandwich:

2 pieces bread

1 tsp mayo

½ cup lettuce & tomatoes

2oz ham

12 oz diet coke


TimeFood/drinks/condiments/portion

3pm 1 cup milk (2%)

2 small apples

½ cup cereal (Frosted flakes)

4-6 crackers (saltine)

7pm casserole:

1 cup pasta

2 oz chicken

½ cup carrots

½ cup pinto beans

1-2 Tbsp creamy sauce


Miscommunications
Miscommunications!

Operator: Hello, may I help you?

Student: Yes, I would like more information on Theatre Art.

Operator: Sorry, there is no one by the name of Therdore Art.

Student: No, I want more information on Theatre Art.

Operator: I told you, there is no Theodore Art here.


Student: No, I mean Theatre “t-h-e-a-t-r-e”

Operator: No, that’s not how you spell Theodore.


24 hour recall4
24-Hour Recall

Look Over Melanie’s PowerPoint (if you need more information on conducting a good 24-hour recall)


3 types of dietary assessments2
3 Types of Dietary Assessments

  • 24 hour recall/diet history

  • Food record/diary

  • Food frequency questionnaire


Dietary assessment4
Dietary Assessment

Source: WIC Training Manual


Food record diary
Food Record/Diary

  • Patient/client writes down everything they eat/drink for as many days as needed (one to seven days)

  • The more days, usually the more accurate

  • Used for individuals

  • Used more in an outpatient setting


3 types of dietary assessments3
3 Types of Dietary Assessments

  • 24 hour recall/diet history

  • Food record/diary

  • Food frequency questionnaire


Dietary assessment5
Dietary Assessment

Source: WIC Training Manual


Food frequency questionnaire
Food Frequency Questionnaire

  • Used more often in out-patient settings

  • Used in large studies (e.g. school studies)



Elijah!!


Nutrition screening
Nutrition Screening

  • Process of recognizing the presence of factors known to be associated with nutrition problems for the purpose of identifying individuals who are at nutritional risk

  • Easy and quick to complete

  • Determines need for Nutrition Assessment

  • Examples

Student Manual Pg. 7


Factors which affect food choices
Factors which affect food choices

  • Taste

  • Texture

  • Appetite

  • Ethnicity/culture

  • Cost

  • Availability

  • Medical Factors

  • Advertising

  • Convenience

  • Emotion

  • Nutrition/health value

Source: WIC Training Manual


Stages of change
Stages of Change

  • Pre-contemplation

  • Contemplation

  • Preparation

  • Action

  • Maintainance


  • Pre-contemplation:

    • Patient is in denial or not aware of the problem

    • “Why eat healthy? We will all die anyway.”


  • Contemplation:

    • Patient is thinking about it, started to see the problem, think of pros and cons

    • “Should I start eating healthy? My doctor said if I eat better, my diabetes will be better.”


  • Preparation:

    • Patient is ready for action

    • “I think I am ready to try to eat healthier and take control of my diabetes. Let me schedule a time to see the dietitian.”


  • Action

    • Patient is actually doing it for 3-6 months Yeah!

    • “ I have skipped drinking regular soda everyday.”


  • Maintenance:

    • Patient has made change for at least 6 months and trying to maintain the action.

    • “I have been skipping my regular soda for 6 months.


  • Relapse:

    • Patient has gone back to the old behavior.

    • “Oops, I had a can of soda in the past 3 days while having fun in Disneyland.”


Goal setting contract
Goal setting/Contract

Name:

During the next _____________, I plan to do the following:

1._______________________________

2._______________________________

If successful, I will reward myself _______

with the following:_______________

Signed:______________ Date:________

Signed:______________ Date:________


Stages of change1
Stages of Change???

  • Joan has been moderately exercising 5 times a week for the past 7 months.


Stages of change2
Stages of Change???

  • David has been checking his blood sugars 4 times a day for the past 5 months.


Stages of change3
Stages of Change???

  • Greg stopped drinking soda for 1 year, but the past week went to 3 parties and drank 8 cups of soda.


Stages of change4
Stages of Change???

  • Darlene was not sure if she wanted to participate in the WIC program, but today she attended her first nutrition class at WIC.


Stages of change5
Stages of Change???

  • Sabrina knows she needs to lose weight, but she isn’t sure if she wants to start a new meal plan now since her birthday is in 2 months.


Stages of change6
Stages of Change???

  • Shelly does not think she has a problem with alcohol.


Stages of change7
Stages of Change???

Jane is new to WIC. She is very shy. She said she had received some brochures on breastfeeding. She knows breastfeeding is a healthy choice for her infant. She is still considering if breastfeeding is the best option for her family situation.


Stages of change8
Stages of Change???

Peter smokes 1 pack of cigarettes everyday. His whole family has encouraged him to quit smoking, but he doesn’t see smoking as a problem to his health or family at all.


Stages of change9
Stages of Change???

Sylvia has seen the dietitian a few times and has just started to increase her calcium intake by drinking 2 cups of milk everyday. 1 cup in the morning and 1 cup before bedtime.


Stages of change10
Stages of Change???

BJ has been increasing his physical activity by riding his bike 30 minutes everyday. And he has been doing it for 4 months.


Stages of change11
Stages of Change???

After much consideration, Donald has just signed up for a diabetes class to try to learn more about how to take care of his diabetes.


Nutrition screening1
Nutrition Screening

  • Process of recognizing the presence of factors known to be associated with nutrition problems for the purpose of identifying individuals who are at nutritional risk

  • Easy and quick to complete

  • Determines need for Nutrition Assessment

  • Examples

Student Manual Pg. 7


Factors which affect food choices1
Factors which affect food choices

  • Taste

  • Texture

  • Appetite

  • Ethnicity/culture

  • Cost

  • Availability

  • Medical Factors

  • Advertising

  • Convenience

  • Emotion

  • Nutrition/health value

Source: WIC Training Manual


Stages of change12
Stages of Change

  • Pre-contemplation

  • Contemplation

  • Preparation

  • Action

  • Maintainance


  • Pre-contemplation:

    • Patient is in denial or not aware of the problem

    • “Why eat healthy? We will all die anyway.”


  • Contemplation:

    • Patient is thinking about it, started to see the problem, think of pros and cons

    • “Should I start eating healthy? My doctor said if I eat better, my diabetes will be better.”


  • Preparation:

    • Patient is ready for action

    • “I think I am ready to try to eat healthier and take control of my diabetes. Let me schedule a time to see the dietitian.”


  • Action

    • Patient is actually doing it for 3-6 months Yeah!

    • “ I have skipped drinking regular soda everyday.”


  • Maintenance:

    • Patient has made change for at least 6 months and trying to maintain the action.

    • “I have been skipping my regular soda for 6 months.


  • Relapse:

    • Patient has gone back to the old behavior.

    • “Oops, I had a can of soda in the past 3 days while having fun in Disneyland.”


Goal setting contract1
Goal setting/Contract

Name:

During the next _____________, I plan to do the following:

1._______________________________

2._______________________________

If successful, I will reward myself _______

with the following:_______________

Signed:______________ Date:________

Signed:______________ Date:________


Stages of change13
Stages of Change???

  • Joan has been moderately exercising 5 times a week for the past 7 months.


Stages of change14
Stages of Change???

  • David has been checking his blood sugars 4 times a day for the past 5 months.


Stages of change15
Stages of Change???

  • Greg stopped drinking soda for 1 year, but the past week went to 3 parties and drank 8 cups of soda.


Stages of change16
Stages of Change???

  • Darlene was not sure if she wanted to participate in the WIC program, but today she attended her first nutrition class at WIC.


Stages of change17
Stages of Change???

  • Sabrina knows she needs to lose weight, but she isn’t sure if she wants to start a new meal plan now since her birthday is in 2 months.


Stages of change18
Stages of Change???

  • Shelly does not think she has a problem with alcohol.


Stages of change19
Stages of Change???

Jane is new to WIC. She is very shy. She said she had received some brochures on breastfeeding. She knows breastfeeding is a healthy choice for her infant. She is still considering if breastfeeding is the best option for her family situation.


Stages of change20
Stages of Change???

Peter smokes 1 pack of cigarettes everyday. His whole family has encouraged him to quit smoking, but he doesn’t see smoking as a problem to his health or family at all.


Stages of change21
Stages of Change???

Sylvia has seen the dietitian a few times and has just started to increase her calcium intake by drinking 2 cups of milk everyday. 1 cup in the morning and 1 cup before bedtime.


Stages of change22
Stages of Change???

BJ has been increasing his physical activity by riding his bike 30 minutes everyday. And he has been doing it for 4 months.


Stages of change23
Stages of Change???

After much consideration, Donald has just signed up for a diabetes class to try to learn more about how to take care of his diabetes.


Another nutrition assessment measure
Another Nutrition Assessment Measure…

  • The SOAP note

    • Used for individuals

    • Used in in-patient settings


Soap note documentation
SOAP Note Documentation

  • Subjective

    • Information from talking with client

  • Objective

    • Facts, physical findings, labs, anthropometrics, facts about background, history, environment, problems

  • Assessment

    • Interpretation of nutritional status, needs or problems based on data from S and O, calorie or nutrient needs

  • Plan

    • Treatment, education, Follow-up plans

Student Manual Pg. 10


More on the soap note
More on the SOAP Note

  • S: Subjective Data

  • client’s thoughts and feelings,

  • client’s complaints, history, “quotable” significant information, description of his/her problems, statement of needs,

  • information obtained by talking with client or client’s family.

  • O: Objective data

  • facts, findings that can be verified, observations,

  • physical findings, signs and symptoms,

  • anthropometric data,

  • laboratory or biochemical data,

  • factual information regarding background, history, environment, progress or problems.

Student Manual Pg. 10


More on the soap note1
More on the SOAP Note

  • A: Assessment

  • interpretation of client’s nutritional status, needs or problems based on data given under S and O,

  • estimate of client’s calorie, protein and other nutrient needs.

  • P: Plans

  • plans of action for the problem identified, including:

  • Dx (diagnosis): Plans to obtain more information about.

  • Rx (treatment): Plans for client care/services, problem management.

  • Ed (education): Plans to counsel/educate the client.

  • F/U (follow-up): Schedule of return visits; referrals to other agencies, services and/or R.D.

Student Manual Pg. 10


Sample of progress notes in soap format
SAMPLE OF PROGRESS NOTES IN SOAP FORMAT

NUTRITION SERVICE

  • 6-3-02, 1200

  • Problem I: Excess Body Weight

  • S: Diet history shows usual intake of 3,000 kcal/day with high intake of sweetened soft drinks. No c/o, 1,500 kcal diet.

  • O: Ht. 5 ft, 2 in. Wt. 160# (bed scale), IBW 110-120#. Diet Rx-1500 kcals.

  • A: Prescribed diet is acceptable to client. Needs ed. on wt. reduction diet.

  • P: Dx: Weigh weekly.

  • Ed: 1. Reviewed concept of exchange lists with elimination of sweetened foods.

  • 2. Gave client exchange list booklet with 1500 kcal meal plan to study.

  • 3. F/U next week.

  • Rx: Maintain flow sheet of client’s weekly weights to be kept in chart.

    Mary Smith, R.D.

Student Manual Pg. 11


Soap notes
SOAP notes

S: Chol:256, HDL:45, LDL: 110

Pt likes fried foods. Diet recall show high

fat intake.

O: Pt exercises 3 times/week. Fasting Blood Glucose (FBG):100, Ht: 5’2” Current weight: 130, Pt is overweight.

Recommend a 1800 kcal diet.

Pt’s goal: exercise more.

A: f/up pt in 4-6 weeks. Refer pt to see social worker for applying Food Stamps. Meds: Lipitor, Aspirin. “Currently unemployed”

P: Give pt a brochure on hypercholesterolemia.

Pt it receptive to diet counseling.



Soap notes1
SOAP notes

1/21/2010 1200

S: Pt likes fried foods. Pt exercises 3 times/week. “Currently unemployed”

O: Ht: 5’2” Current weight: 130, Fasting Blood Glucose (FBG):100, Chol:256, HDL:45, LDL: 110

A: Recommend a 1800 kcal diet. Diet recall show high fat intake. Pt is overweight. Pt it receptive to diet counseling.

Pt’s goal: exercise more.

P: Give pt a brochure on hypercholesterolemia.

Refer pt to see social worker for applying Food Stamps.

f/up w/ pt in 4-6 weeks.

Jill Tarver, MS, RD


Assignment i 2 soap progress notes
ASSIGNMENT I-2 - SOAP PROGRESS NOTES

  • DIRECTIONS: Observing all the guidelines, write a SOAP progress note for the given client under Problem #2.

  • Problem #2: Inadequate Growth.

  • P.J. is a 24-month old girl seen at the clinic for the first time today. According to her birth record, she was born at 40 weeks gestation, weighing 6 lbs (slightly above the 10th percentile), and her length was at the 10th percentile.

  • Her mother brought P.J.’s growth record, which showed that both her weight and length progressively dropped percentiles since birth, and the latest measurement at 18 months reads well below the 5th percentile for both weight and length. Today, her weight is 19½ lbs. (Well below the 5th percentile), and her height is also below the 5th percentile.

  • Her mother noted that P.J. has been a very picky eater but loves Kool-Aid. The mother complained that her baby daughter is sick a lot.

Student Manual Pg. 12


  • For Tuesday (Older Adults, 51+): Read over the California Food Guide Chapter 14 (Go to: http://www.cafoodguide.ca.gov and click on CFG Table of Contents and it will bring you to all the chapters: click on Chapter 14)

  • Read Nutrition & You Pages 469-487



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