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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:

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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

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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

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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)

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

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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

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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

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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.

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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)