Nutrition Counseling : A Journey

1. Nutrition Counseling: A Journey Colleen Poling

2. The Client at the time of session one: • Demographics: • Age: 52 YO • Race: White • Material Status: Single • Sex: Female • Education: Master’s degree • Location: Albany Ohio • Household:93 YO mother living at home.

3. The Client at the time of session one: • Significant Data: • Meds: Lipitor, Verapamil, Diovan, Calcium/Vit D supplements, Immitis, Excedrin, • Frame size: Medium • Waist: 39 inches, Hips: 46 inches, Wrist Circumference: 6.5 inches • Family history-HTN, High Cholesterol, Cancer, Osteoporosis, Arthritis. • History of HTN, Elevated cholesterol and osteoporosis.

4. The Client at the time of session one: • Diet History: • Has good appetite • Does the cooking • Eats out 10 time a week • Initial Assessment of food recall: • Only one serving of milk • Only one serving of fruit • Low on vegetables • High in sweets, sodium saturated fat and cholesterol

5. The Client at the time of session one: • Dietary intake in relationship to lifestyle, medical and physiological problems: • States she has elevated cholesterol, diet high in saturated fat and cholesterol could contribute. • States she has hypertension, diet high in sodium could contribute. • States she has Osteoporosis, diet low in Ca could contribute

6. The Client at the time of session one: • Etiology and conditions to be assessed: • Poor diet control • Inadequate exercise

7. The Client at the time of session one: • Initial nutrition diagnoses: • Excessive energy intake as related to poor diet control as evidenced by body mass index. (NI-1.5) • Physical inactivity as related to no exercise regime as evidenced by body mass index. (NB-2.1) • Overweight/obesity as related to inadequate exercise as evidenced by IBW%. (NC-3.3)

8. Evaluation Nutrition Plan of Care: Initial dietary recommendations: Diet pattern: DASH Dietary recommendations in relation to nutrition diagnosis: 1800kcal DASH eating plan Emphasis on potassium, magnesium and calcium rich foods. Dietary recommendations in relation to DRIs: Increase Vitamin D Increase K, Mg and Ca

9. Evaluation Nutrition Plan of Care: Initial Nutrition plan: DASH eating plan Third: Modified to more specific focus on Mg, K and Calcium rich foods, to advance her understanding of the DASH eating plan. Fourth: Modified to concerns with combination food and meal planning with elderly mother.

15. Evaluation Nutrition Plan of Care: Impacts of materials: The education on DASH might have been overwhelming at first, since she had no nutrition background. The cookbook education might have been drawn-out and redundant for her. How would I change materials: I would have made a different eating guide for the DASH eating plan. I would now have allowed more time for education on DASH. Would I use fewer?: I would focus more on her understanding, and use constant evaluation throughout the education. Was the health literacy accurate for client?: Yes

16. Evaluation Nutrition Plan of Care: Dietary Changes over time: Decreased calories: while increasing carbohydrates, increasing protein, and decreasing total fat. (Just like what we aimed for) Decreased sodium and dietary cholesterol Increased K, Mg, Ca, Vitamin D and Fiber (just like what we aimed for)

17. Evaluation Nutrition Plan of Care: Final Food log assessment vs. Inital:

18. Evaluation Nutrition Plan of Care: Final Food log assessment vs. Inital:

19. Final Eval of Client Progress Dietary changes: Decreased calories: while increasing carbohydrates, increasing protein, and decreasing total fat. (Just like what we aimed for) Decreased sodium and dietary cholesterol Increased K, Mg, Ca, Vitamin D and Fiber (just like what we aimed for)

20. Final Eval of Client Progress Lifestyle changes: Increased physical activity from no times per week to two times per week for 20 min each.

21. Final Eval of Client Progress Anthropometric changes: Waist circumference increase by 4 inches (39 to 43inches) Hips circumference increase by 1 inch (46 to 47 inches) Weight change: +0.01% (198-200 pounds)

22. Final Eval of Client Progress Change in nutrition diagnosis: I would still emphasis the DASH eating plan, increasing physical activity, portion control and meal planning.

23. Future Nutritional needs • She needs a continuous accountability partner to help keep her on track. • She needs more practice with portion control. • She needs further education and practice with the DASH eating plan. • Maybe a more in depth explanation on physiological changes associated with the DASH eating plan.

24. Overall Summary of My effectiveness What did I learn about myself as a counselor: I became more confident in my knowledge as a future dietitian. With some work on my weaknesses, I discovered I have the potential to become a great nutrition counselor. I feel more prepared to answer nutrition-related questions off the top of my head What did I learn about educational preparations: The preparations are what make you a good counselor, because it shows exactly what you will be presenting to the client. They are vital Recommendations to future counselors: The process does not happen in one day (it is a journey!), and that it takes time and effort to make things happen and change. Four sessions may not be enough, so don’t worry if things don’t work out the way you hoped. Be prepared to set some time aside for your client, they deserve your full attention.

25. THANK YOU!