This book includes a plain text version that is designed for high accessibility. To use this version please follow this link.
60


Part I Introduction to Nutrition Care in Older Adults


counseling: Strategies (C-2): Goal setting (C-2.2.): Reduce TV time to 1 to 3 h/d and increase physical activity of choice (walk with daughter) to 30 min/d and 150 min/wk. Goals: Increase energy output and prevent further weight gain.


Nutrition Monitoring and Evaluation The fourth step is monitoring and evaluation. In this step, the RDN determines which nutrition indicators will be reviewed on the next encounter with this resi- dent/client. This step is designed to measure the out- comes related to the signs and symptoms of the PES statement. The indicators are what will be measured. Then the criteria are selected to show what estab- lished data will be reviewed to demonstrate the improvement of the signs and symptoms in the resi- dent’s/client’s/group’s care. The following are the nutrition indicators to be monitored for JM:


●


Total energy intake (FH-1.1.1.1): Criteria: Food diary: three meals and two snacks per day for total intake of 1,400 kcal/d


●


Oral fluids (FH-1.2.1.1): Criteria: Food diary: eight to nine (8-oz) beverages per day for a total fluid intake of 2,100 mL/d


●


Type of physical activity (F H-7.3.6): Criteria: Activity log: 30 min/d and 150 min/wk of activity of choice (walks with daughter)


●


TV/screen time (FH-7.3.8): Criteria: Activity log: 1 to 3 hours TV/screen time per day


●


Weight (AD-1.1.2): Criteria: Weight: Stable weight or decreased weight toward a healthier BMI of 23


Note: The lab data for HbA1c are not included in this monitoring and evaluation step for JM because this lab value will not be available when she returns in one month for follow-up nutrition counseling (JM is not scheduled to return to her physician for 6 six- months). Also, HbA1c is not included in the signs and symptoms section of the PES statement, so the value is not relevant to the nutrition diagnosis.


Part 2: Reassessment JM returns to the RDN’s private nutrition clinic for her monthly visit accompanied by her daughter. JM brings her food diaries and activity logs. She states that it was not easy to decrease her TV time because she likes certain programs. However, she has chosen her favor- ites and is trying to limit TV time to three to four hours per day. She found that controlling her portion sizes was also difficult. She has stopped eating meals during TV time, but snacking has been harder to stop. She is still


●


working on this goal. She has been walking with her daughter three days per week. She thinks this is a good start. She is happy with her lifestyle changes so far and plans to continue them. She has started to drink fat-free milk and enjoys eating yogurt and low-fat cheese. She is anxious to learn her new weight. Current weight is 150 lbs/68.1kg. JM did not need to use her asthma med- ications and is doing well with her eating and exercise program. Both she and her daughter are pleased with her success.


The food diaries and activity log are reviewed and discussed with JM and her daughter. The food diaries indicate that JM is consuming three meals and two snacks per day. No other snacking is reported, and she is making better food choices. Activity logs indicate she is spending 30 minutes, three times per week, walking with her daughter. To begin the reassessment documentation, start by listing the current nutrition diagnosis or diagnoses. This will identify the problem(s) that the RDN will be reviewing during this reevaluation time. Then begin collecting monitoring data to assist in the determina- tion of the resolution or continuation of the problem(s). JM’s current nutrition diagnosis is: Excessive energy intake (NI I-1.3) (P) related to intake greater than energy expenditure (E) as evidenced by BMI greater than 25 (overweight) (S).


Nutrition Assessment Food/Nutrition-Related History:


● Food intake (FH-1.2.2): ➤


Meal/snack pattern (FH-1.2.2.3): Three meals per day and two snacks in 1,400 kcal/d meal plan


➤


Amount of food (FH-1.2.2.1): Controlling her portion sizes was difficult. JM is trying to make healthier food choices.


Eating environment (FH-2.1.3): ➤


Location (FH-2.1.3.1): JM eats meals at the kitchen table and has stopped eating meals while watching TV. She tries to avoid snack- ing while watching TV.


➤ ● Eats alone (FH-2.1.3.5): Daily


Physical activity (FH-7.3): Physical activity history (FH-1.3.1): JM completes 30 minutes of physical activity three times per week.


●


TV/screen time (FH-7.3.8): JM limits her TV time to 3 to 4 h/d. She thinks this is a good start. She is happy with her lifestyle changes so far and plans to continue them.


Anthropometric Measurements: ●


Height/length (AD-1.1.1): 62 in (157.4 cm)


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74  |  Page 75  |  Page 76  |  Page 77  |  Page 78  |  Page 79  |  Page 80  |  Page 81  |  Page 82  |  Page 83  |  Page 84  |  Page 85  |  Page 86  |  Page 87  |  Page 88  |  Page 89  |  Page 90  |  Page 91  |  Page 92  |  Page 93  |  Page 94  |  Page 95  |  Page 96  |  Page 97  |  Page 98  |  Page 99  |  Page 100  |  Page 101  |  Page 102  |  Page 103  |  Page 104  |  Page 105  |  Page 106  |  Page 107  |  Page 108  |  Page 109  |  Page 110  |  Page 111  |  Page 112  |  Page 113  |  Page 114  |  Page 115  |  Page 116  |  Page 117  |  Page 118  |  Page 119  |  Page 120  |  Page 121  |  Page 122  |  Page 123  |  Page 124  |  Page 125  |  Page 126  |  Page 127  |  Page 128  |  Page 129  |  Page 130  |  Page 131  |  Page 132  |  Page 133  |  Page 134  |  Page 135  |  Page 136  |  Page 137  |  Page 138  |  Page 139  |  Page 140  |  Page 141  |  Page 142  |  Page 143  |  Page 144  |  Page 145  |  Page 146  |  Page 147  |  Page 148  |  Page 149  |  Page 150  |  Page 151  |  Page 152  |  Page 153  |  Page 154  |  Page 155  |  Page 156  |  Page 157  |  Page 158  |  Page 159  |  Page 160  |  Page 161  |  Page 162  |  Page 163  |  Page 164  |  Page 165  |  Page 166  |  Page 167  |  Page 168  |  Page 169  |  Page 170  |  Page 171  |  Page 172  |  Page 173  |  Page 174  |  Page 175  |  Page 176  |  Page 177  |  Page 178  |  Page 179  |  Page 180  |  Page 181  |  Page 182  |  Page 183  |  Page 184  |  Page 185  |  Page 186  |  Page 187  |  Page 188  |  Page 189  |  Page 190  |  Page 191  |  Page 192  |  Page 193  |  Page 194  |  Page 195  |  Page 196  |  Page 197  |  Page 198  |  Page 199  |  Page 200  |  Page 201  |  Page 202  |  Page 203  |  Page 204  |  Page 205  |  Page 206  |  Page 207  |  Page 208  |  Page 209  |  Page 210  |  Page 211  |  Page 212  |  Page 213  |  Page 214  |  Page 215  |  Page 216  |  Page 217  |  Page 218  |  Page 219  |  Page 220  |  Page 221  |  Page 222  |  Page 223  |  Page 224  |  Page 225  |  Page 226  |  Page 227  |  Page 228  |  Page 229  |  Page 230  |  Page 231  |  Page 232  |  Page 233  |  Page 234  |  Page 235  |  Page 236  |  Page 237  |  Page 238  |  Page 239  |  Page 240  |  Page 241  |  Page 242  |  Page 243  |  Page 244  |  Page 245  |  Page 246  |  Page 247  |  Page 248  |  Page 249  |  Page 250  |  Page 251  |  Page 252  |  Page 253  |  Page 254  |  Page 255  |  Page 256  |  Page 257  |  Page 258  |  Page 259  |  Page 260  |  Page 261  |  Page 262  |  Page 263  |  Page 264  |  Page 265  |  Page 266  |  Page 267  |  Page 268  |  Page 269  |  Page 270  |  Page 271  |  Page 272  |  Page 273  |  Page 274  |  Page 275  |  Page 276  |  Page 277  |  Page 278  |  Page 279  |  Page 280  |  Page 281  |  Page 282  |  Page 283  |  Page 284  |  Page 285  |  Page 286  |  Page 287  |  Page 288  |  Page 289  |  Page 290  |  Page 291  |  Page 292  |  Page 293  |  Page 294  |  Page 295  |  Page 296  |  Page 297  |  Page 298  |  Page 299  |  Page 300  |  Page 301  |  Page 302  |  Page 303  |  Page 304  |  Page 305  |  Page 306  |  Page 307  |  Page 308  |  Page 309  |  Page 310  |  Page 311  |  Page 312  |  Page 313  |  Page 314  |  Page 315  |  Page 316  |  Page 317  |  Page 318  |  Page 319  |  Page 320  |  Page 321  |  Page 322  |  Page 323  |  Page 324  |  Page 325  |  Page 326  |  Page 327  |  Page 328  |  Page 329  |  Page 330  |  Page 331  |  Page 332  |  Page 333  |  Page 334  |  Page 335  |  Page 336  |  Page 337  |  Page 338  |  Page 339  |  Page 340  |  Page 341  |  Page 342  |  Page 343  |  Page 344  |  Page 345  |  Page 346  |  Page 347  |  Page 348  |  Page 349  |  Page 350  |  Page 351  |  Page 352  |  Page 353  |  Page 354  |  Page 355  |  Page 356  |  Page 357  |  Page 358  |  Page 359  |  Page 360  |  Page 361  |  Page 362  |  Page 363  |  Page 364  |  Page 365  |  Page 366  |  Page 367  |  Page 368  |  Page 369  |  Page 370  |  Page 371  |  Page 372  |  Page 373  |  Page 374  |  Page 375  |  Page 376  |  Page 377  |  Page 378  |  Page 379  |  Page 380  |  Page 381  |  Page 382  |  Page 383  |  Page 384  |  Page 385  |  Page 386  |  Page 387  |  Page 388  |  Page 389  |  Page 390  |  Page 391  |  Page 392  |  Page 393  |  Page 394  |  Page 395  |  Page 396  |  Page 397  |  Page 398  |  Page 399  |  Page 400  |  Page 401  |  Page 402  |  Page 403  |  Page 404  |  Page 405  |  Page 406  |  Page 407  |  Page 408  |  Page 409  |  Page 410  |  Page 411  |  Page 412  |  Page 413  |  Page 414  |  Page 415