Counseling NCP: Jeanette Hamilton

Date: 10/22/13

Recorder: Jessica Salgado

Nutrition Assessment Age, Gender: 55, female Intake: PO Symptoms: Chest pains Diagnosis: Angina Family History: Father: hypertension, myocardial infraction: age 51 Lifestyle: Sedentary, low physical activity and high stress job Eats high fat and calorie diet regularly Drinks 2 to 3 severing of alcohol a day Anthropometrics o Ht/Wt: 58/ 172.7cm and 180#/ 81.6kg o BMI= 81.6kg/1.727m2=27.4kg/m2 (Overweight) o eEIBW= 140#/63.5kg, %IBW=140/180=128% (Obese) o Adjusted BW= (180-140)x.25+140=150#/68kg Energy, Protein Fluid Needs o Energy= 1700-2040kcal/d o Protein= 54.4-68g/d o Fluids= 1700-2040ml/d Based on BW of 49.0kg o For energy, used Adjusted body weight and used 25-30kcals/kg per day o For protein, used non-stressed factors of 0.8-1.0 g/kg per day o For fluid needs, used 1ml/kcal per day Lab Test o Total Cholesterol= 285mg/dL, High o Triglycerides=300mg/dL, High Nutrition Diagnosis Excessive energy intake R/T food and nutrition related knowledge deficit concerning energy intake AEB high BMI, %IBW, Adjusted BW, intake of high caloric density or large portions of foods/beverages and intake of energy in excess of estimated energy needs. Nutrition Intervention 1. Meals and Snacks Plan a. Calorie modification to 2040kcal/d or less than current, i.e. eat more salad, lean meats, fruits, low fat options. b. Eat small frequent meals with less fat and more fiber, limit cholesterol to 200mg and saturated fat to 20g. c. Limit eating out to restaurants to 1-2 X a week d. Limit alcohol consumption to 5oz glass a day or none at all if possible 2. Nutrition Education a. Educate pt on the importance of a lower fat diet for pt with Angina b. Education pt on healthy food options when eating out and at home and importance of sleeping 7-8hr a night 3. Coordination Care Plan

a. Refer pt to an exercise physiologist to determine if pt can exercise with angina and make an exercise plan for pt at least three times a week. b. Refer pt to community program for emotional support ex. overeaters anonymous c. Refer pt to a stress management classs, i.e. Meditation or yoga classes Goals 1. 2. 3. 4. 5. 6. Decrease caloric & fat intake/ Increase fiber and eat small frequent meals immediately Set up an exercise plan with exercise physiologist within 1-2 weeks Lose 1-2# a week until reaching Adjusted BW or IBW Decease and control stress levels immediately Limit consumption of alcohol immediately Decrease total cholesterol and triglycerides to normal within 3 to 4 months

Monitoring and Evaluation Follow up phone call within a week and schedule next session to see pt progress Monitor and re-evaluate cholesterol and triglycerides in 3-4 months Have pt keep a food record for a week to see if pt has decrease kcals, total fat, sat. fat & total cholesterol Keep a weight log for a month see if pt is losing wt weekly Keep a log for chest pain episodes see if stress or exercise techniques work for pt

Jessica Salgado Nutrition 510 Counseling Session II Three Day Food Record Discussion and Chart Fat (g) DAY 1 DAY 2 DAY 3 Average 291.2 g 237.8 g 277.0 g 268.6 g Sat. Fat (g) Carbohydrates (g) 120.2g 977.2 g 70.2 g 618.9 g 87.0 g 770.9 g 92.7 g 789.0 g Sodium (mg) 7131 mg 7281 mg 9050 mg 7820 mg Cholesterol Calories (mg) (kcals) 265 mg 7490 kcals 773 mg 5676 kcals 783 mg 6678 kcals 607 mg 6615 kcals

For my clients three day food record nutrient analysis I used fatsecret.com because this website had all the food items from the restaurants my client eats out to regularly, like Apple Bees, Starbucks, and Outback Steak House. Even though all my clients nutrients were all high, the ones that concerned me the most were Saturated fat, total fat, cholesterol and sodium which were all extremely high for her health condition. Other nutrients that were also really high were carbohydrates and calories. Since my client lab vales show that her total cholesterol of 285mg/dL, its alarming that my client eat large quantities of cholesterol per day. In her food record she averaged 607 mg of cholesterol more than double of the RDI, which is no more than 300 mg of cholesterol per day. My client since she has factors of heart disease should use the American Heart Association (AHA) recommendation of less than 200 mg of cholesterol per day. Some of the foods that were high in cholesterol were Starbucks caramel Frappuccino, chocolate ice cream, fried chicken, glazed ribs, burgers, backed goods, fried eggs, and pork chops my client ate. Another nutrient that concerned me was total saturated fat, she averaged 92.7 g per day and regular saturated fat RDI are no more than 20 g per day. And according to AHA the

recommendation based on a 2000 calorie diet saturated fat should only make up 7% of calories, which is around 16g of saturated, my clients intake of saturated fat is six times as much of AHA recommendation and around 5 times as much as the regular RDI. Some of the foods in her three day food record that concerned me were the ribs, chocolate ice cream, desserts, Jack Daniel burgers, potato chips, and meatballs from subway. Her total sodium intake was also extremely high at an average of 7820mg, when the RDI is 2400 mg per day. Some of the foods my client regularly eat that are high sodium are potato chips, crispy chicken BLT, glazed ribs, mash potatoes, potato salad, burger, blueberry muffin, pork chops, hash browns and fried eggs. Total grams of fat are also another nutrient that concerning since she average 268 g of total fat, she should be consuming no more than 65g of fat per day which means she has to cut back on high fat foods like the caramel Frappuccino, burgers, pork chops, fried chicken, fried eggs, hash browns, potato chips and most of the food she consumes extremely high in total fats. She should eat more fruits and vegetables in her daily diet so that higher fiber foods replace the high fat foods. The last two nutrients that were also considerably high that my client can improve on is carbohydrates and total calories consumption, her average for these two nutrients were 789 g and 6615 kcals. I believe my client can cut down her amount and portions of food she consumes every day her total calories will decease significantly. This means eating more small frequent meals throughout the day instead of eating large meals like she shows in her food record. My client should also limit her consumption of simple carbs and eat more high fiber foods. Some of the foods high in carbohydrates my client should limit are caramel Frappuccino, soda, wine, the large portion meals from restaurants, mash potatoes, potato chips and most of the foods choices on her three day food record.

Jessica Salgado Nutrition 510 October 22, 2013 Discussion: Client Role For my counseling session playing an older Native American women, Ms. Nadia Whitehorse, I tend to act similar to how I acted in my interviewing session. But this time I will act a little bit more interested and act more cooperative so I can improve my health so I can live longer and see my family for more years to come. I will listen carefully to what my dietitian has to say in regards to my health and will act calm for most of the time she is counseling me. I will not use too much direct eye contact or expressive language. And as she asks me questions I will try answer them to the best of my abilities. During my counseling session I will also use facial expressions and body language to express my interest in getting better. I will try to make her see my point of view if I dont agree with all her ideas but I will be very respectful in regards to all her counseling suggestions. I will try to keep my mind open to her suggestions as long as they are beneficial not just for my wellbeing but also for my family. I will also be very thankful and appreciative at the end of my counseling session if she helps me improve my health as well as my families.