Aubreyann Veyveris NCP for Elia Hirmez Nutrition Assessment Age, Gender: 31, Female Dietary Intake: PO intake

O intake Entering third trimester of pregnancy Slightly anemic Consumes low kcal diet Restricted diet due to religion- no pork Moderate activity- walks 1 hr a day Anthropometric Measurements o Ht/ Wt before pregnancy: 54/ 162.6 cm and 125#/56.7 kg o BMI before pregnancy: 21.5 kg/m2 (normal) o Wt as of now: 133#/ 60.3 kg Energy, Protein, and Fluid needs o Total Energy= 1567.3-1947.5 kcal/d o Protein= 55.36- 66.7 g/d o Fluid= 1567-1947 ml/d For energy, used Mifflin St. Jeor formula to determine REE using usual body weight then multiplied by activity factor (1.3) and added 300 kcal for pregnancy. For protein used range of 0.8-1.0 g/d plus 10 g for pregnancy For fluid needs, used 1ml/kcal/d

Nutrition Diagnosis Inadequate energy intake related to increased nutrient needs due to pregnancy as evidenced by a weight gain of only 8 lbs for 6 months of pregnancy.

Nutrition Intervention 1. Meal and Snacks o More energy dense foods, more protein, more fruits- ex: whole grain breads and pastas, lean turkey, nuts, chicken, eggs, dairy, protein o Small frequent meals o More iron rich foods- meat, chicken, spinach 2. Supplements a. Iron supplement b. Prenatal vitamin 3. Nutrition counseling

a. Counsel on importance of gaining adequate weight during pregnancy b. Counsel on importance of increasing iron and protein in the diet 4. Coordination of Nutrition Care a. Refer to marriage counselor to discuss body image Goals 1. 2. 3. 4. Increase kcal intake to adequate range Increase protein and iron intake to adequate range Increase weight to appropriate weight for beginning third trimester of pregnancy Begin taking iron supplement and prenatal vitamins right away

Monitoring and Evaluation Follow up session within 3-5 days if still in hospital, if not follow up phone call within 1 wk Re-evaluate iron levels in 2 wk to determine if within normal range Reassess wt in 2 wks to make sure patient is gaining adequate wt

Computer Analysis I used the SuperTracker program from the USDA choosemyplate.gov website. Three Day Food Record Discussion and Chart Total Calories Day 1 1078 Day 2 1475 Day 3 977 Average 1177 Carbohydrates (g) 138 203 119 153 Protein (g) 63 99 60 74 Calcium (mg) 915 912 366 731 Iron (mg) 8 26 8 14 Vit. C (mg) 22 59 107 63 Vit. D (g) 3 0 0 1

According to the nutrient analysis my client is not eating enough calories in order to sustain the health of her and her baby. Her average calorie intake of 1177 a day is lower than the recommended needs for her and her baby. Her average carbohydrate intake is also too low and her protein on most days is also low. She needs to increase her calcium and iron intakes as well due to the fact that they are essential nutrients for the growth and development of the fetus. Most of her vitamin intakes are also low, especially Vitamin C and Vitamin D. Her three day food record shows that she needs to consume more fruits for vitamins and fiber. Her food record shows she is eating vegetables and legumes and whole grains, so many healthful, beneficial foods, however, she needs to be eating more. More iron rich foods such as chicken, beef, and spinach should be added to her diet so she will no longer be at risk for anemia. She also should be limiting her caffeine intake so making sure if she does drink coffee and tea, she chooses only decaf options. While many of her choices are healthy, it would be better if my client consumed more of the foods she eats while also adding more fruits and more whole grains. It is also very important for her to be eating more foods with iron to decrease her risk for anemia and for the blood health of her baby. I would suggest eating more calcium rich foods like milk, yogurt, cheese, and dark

leafy greens. I would also suggest she start taking a prenatal vitamin to supplement many of the nutrients she is missing from her diet.

Client Role For the second counseling session, for my role as Jeanette Hamilton, I will be more compliant and take my health more seriously when talking to the dietitian. I will have realized from my last session that although my job and career are important to me and a top priority in my life, my health is more important because I want to be there for my kids and husband. I will definitely take into consideration everything the dietitian tells me and definitely be willing to change a few things in my life if she suggests that. I will make sure that I understand everything she is telling me and will ask many questions if I have to.