Imagine that you are now working as a nutrition assistant at new The Nutrition Center for outpatients at the local hospital (that was previously introduced). The Nutrition Center is an outpatient nutrition, wellness, and weight loss center offering a comprehensive approach to weight-loss, medical nutrition disease management, and overall wellness. Patients who participate in comprehensive programs require an extensive nutrition assessment in order for the programs strategies to be successful. Understanding a patient’s goals is imperative to the program’s design and it’s success. Goal setting should be both realistic and motivating. A comprehensive nutrition assessment is one part of the entire nutrition care process upon completion of the assessment process the nutrition professional can identify any nutritional problems and design a beneficial intervention. The outpatient setting is an ideal place for long-term nutrition therapy because it offers higher success rates. A patient that was initially assessed has decided to utilize The Nutrition Center’s nutrition and wellness program. Upon joining the comprehensive program, she filled out a questionnaire that included three main health and nutrition related goals.
Client MM’s Three Goals:
• Lose weight (lose 30 pounds in 6 months)
• Improve her cholesterol, blood pressure, and glucose control.
• Improve her energy level, overall mood, and be a positive role model for her three teenage children.
Description of client:
MM is a 40-year-old Hispanic mother of three teenage children who works as a counselor in a job placement bureau.
• Occasionally smokes a cigarette when she is stressed — maybe five per week
• Uses stairs at work, and is tired at night when she gets home
• The children’s birth weight ranged from 9-1/2 to 11 lbs.
• Family history of heart disease, diabetes, cancer
• Blood pressure was 140/92
• Height 165 cm (5’ 5”)
• Weight 93 kg (205 lbs.)
• Glucose test values (GTT) were 300 mg/dl at 1 hour, 248 mg/dl at 2 hours and 195 mg/dl at 3 hours
• Serum cholesterol was 250 mg, HDL 36, LDL 200
• Triglycerides 200 mg/dl.
• Medications: Glucophage, Lexapro, multivitamin
• Eats 2–3 meals per day, and eats goodies at the office
• Irregular bowel movements
• Breakfast: Granola bar and a 12-oz. Diet Coke
• Lunch: Large bowl of cream of broccoli and cheese soup and a sandwich with: luncheon meat turkey (about 3–4 ounces), lettuce, tomato, and 2 Tbsps. of mayonnaise from the cafeteria at work
• Large sweet tea
• Snack : 2 glazed doughnuts in break room
• Snickers Candy bar on the way home
• Dinner: Stouffers Lasagna: about 2 portions
• Small salad with 3 Tbsps. ranch dressing (made from a salad kit)
• 1 piece of Texas Toast
• 2 cans Diet Coke
• Snack: Bowl of chocolate chip ice cream before bed
Imagine that the supervising dietitian has asked you to help in the comprehensive nutrition assessment process of client “MM.” The Nutrition Center has a nutrition assessment protocol that you will follow to organize your information. Your supervisor asks you to keep the client’s goals in mind at all times during the assessment process.
1. Calculate the client’s BMI and include what weight category the BMI result is. Show the BMI calculation/equation.
2. Summarize the client’s current dietary intake (use the calorie/nutrient totals from the Previous Assignment here) by including:
a. Total Calories
b. Total Fat
c. Total Carbohydrates
d. Dietary Fiber
e. Total Protein
3. Calculate the clients EER (estimated energy requirement). Table 7.9 OR Table 7.10 (attached) should be referenced. Please note that calculations are based on weight in kilograms and height in meters. If you propose any alterations to the EER’s original answer (adding or subtracting calories based upon her weight/health goals), then include supporting evidence (references). Include the equation with the patient’s data inserted appropriately and the main mathematical calculation steps.
4. Compare the client’s current estimated calorie intake from #2 with the calorie recommendation in #3 and state the difference (if any).
5. The client mentioned improving her cholesterol, blood pressure, and blood glucose. How do her recent lab values compare to the recommended values? (can include a table/chart)
6. What is one diet or lifestyle change that can be recommended to help improve her cholesterol values?
7. What is one diet or lifestyle change that can be recommended to help improve her blood pressure readings?
8. What is one diet or lifestyle change that can be recommended to help improve her blood glucose (sugar) levels?
9. The patient is scheduled for a follow up appointment in 2 weeks. What nutrition assessment tools and methods do you recommend utilizing during her next visit to measure the patient’s progress? Be sure to think about all nutrition assessment areas and include one from each category. Why did you choose each method?