CASE STUDY #1

MR. ROBERTSON’S STORY

ADULT WEIGHT MANAGEMENT

NUTRITION CARE PROCESS

GROUP 3

AGUIRRE, DARREN
ROXAS, AIEN BELINDA V.
SORIANO, CASSANDRA
VILLAFLOR, ELIJEAN
 CASE 1: ADULT WEIGHT MANAGEMENT

Case 1 addresses adult weight management in the

context of Mr Robertson, a 65-year-old man whose
family doctor is concerned about his recent weight
gain. Mr Robertson’s diet is high in occasional foods
and exceeds his recommended daily energy intake.
Since retiring six months ago, he has adopted a
sedentary lifestyle.

PATIENT INFORMATION
AGE: 65 years old
WEIGHT: 90 kg
HEIGHT: 175 cm
BMI: 29.4 kg/m^2
PA: Sedentary
DIAGNOSIS AND MEDICAL HISTORY:
-Patient has family history of Type 2 Diabetes.
-Patient has a general examination and discovers blood pressure and weight are higher than
previous times.

OPTIONAL ACTIVITY
STEP 1: NUTRITION ASSESSMENT
>NUTRITION ANALYSIS (MONDAY TO SATURDAY)
Meal Food & Measure Vegetable Fruit Rice Milk Meat Fat Sugar Kcal
Beverage

Breakfast >Toast, 2 slices Rice C: 1 162

white ½
>Butter, 4 tsp 4 180
salted
>Jelly, 3 tsp 1½ 30
strawberr
y
>Egg, 1 egg M: 1 86
boiled
>Juice, 1 cup 1 20
orange
>Coffee, 1 tsp 108
instant
>Milk, ½ tsp W: ½ 85
whole
>Sugar 1 tsp 1 20
 Morning >Coffee, 1 tsp 108
Snack instant
>Milk, ½ cup W: ½ 85
whole
>Sugar 1 tsp 1 20

Midday >Bread, 2 slices Rice C: 1 162

Meal white ½
>Butter, 2 tsp 2 90
salted
>Ham (2), 1 ½ oz H: 1 ½ 183
pre-sliced (40 g)
>Tomato ½ cup ½ 8
(1 med.)

Afternoon >Cookie, 2 cookies 2 1 85

Snack shortbrea
d
>Coffee, 1 tsp 108
instant
>Milk, ½ cup W: ½ 85
whole
>Sugar 1 tsp 1 20

Evening >Steak, 8 oz (240 M: 8 688

Meal fried or g)
chicken,
baked,
skin or
roast
meat
>Butter 4 tsp 4 180
(total
used in
cooking
meat and
mashed
potato)
>Broccoli, ½ cup ½ 8
steamed
>Cauliflow ½ cup ½ 8
er,
steamed
>Potato ½ cup Rice B: 1 150
mashed ½
(1 tsp
butter)

Evening >Mixed 2 oz (60 6 270

Snack nuts (2 g)
handfuls),
salted

TOTAL 1.5 0 A: 0 W: 1.5 LF: 0 18 6.5

SERVING B: 1.5 LF: 0 MF: 9
S C: 3 NF: 0 HF: 1.5

ENERGY 24 0 474 255 957 805 195

KCAL

PROTEIN 1.5 0 18 12 84 0 0

FAT 0 0 0 15 69 90 10

CHO 4.5 0 103.5 18 0 5 32.5

>OTHER OCCASIONAL
>FOODS & NOTES
1 DAY A WEEK
 >MORNING SNACK: Fruit Cake (310 kcal)
>MIDDAY MEAL: Chocolate-coated ice cream (351 kcal)
>AFTERNOON SNACK: 2 small donuts (460 kcal)
>AFTERNOON SNACK: 2 fun-sized chocolate bars (536 kcal)
>EVENING SNACK: 3 ½ oz (100 g) potato chips (500 kcal)
>EVENING SNACK: 7 oz (200 g) potato chips (1000 kcal)

5 DAYS A WEEK
>AFTERNOON SNACK: 2 cans full-strength beer (300 kcal)

>NUTRITION ANALYSIS (OCCASIONAL FOODS AND ALCOHOL)

OCCASIONAL CHOICES DAYS.WEEK ENERGY CONTENT AVERAGE EXTRA EXCHANGES PER

CONSUMED (KCAL) ENERGY PER DAY SERVINGS

Fruit cake, 1 to 2 pieces 1 310 44.3 2 Rice B, 2 Fat, 1 Sugar

Chocolate-coated ice 1 206 29.4 1 Rice C, 1 ½ Fat, 1 ½

cream Sugar

2 small cinnamon donuts 1 460 65.7 2 Rice C, 2 Fat

2 fun-sized chocolate bars 1 536 76.6 1 Rice C, 2 Fat. 3 ½ Sugar

3 ½ oz (100 g) potato 1 500 71.4 1 ½ Rice B, 3 ½ Fat, 1

chips Sugar

7 oz (200 g) potato chips 1 1000 142.9 2 Rice B, 4 Fats, 2 Sugar

TOTAL DAILY ENERGY 430 KCAL

CONTRIBUTION (KCAL)

● We divide the energy content (kcal) by 7 to get the average extra energy per day

ALCOHOL

OCCASIONAL CHOICES DAYS/WEEK ENERGY CONTENT AVERAGE EXTRA EXCHANGE PER

CONSUMED (KCAL) ENERGY PER DAY SERVINGS

2 cans full-strength beer 5 300 214 5 ½ Fat

(12 fl oz, 375 mL)

TOTAL DAILY ENERGY 214 KCAL

CONTRIBUTION (KCAL)

TOTAL
>ALCOHOL: 214 KCAL
>OCCASIONAL: 430 KCAL
>MEALS: 2710 KCAL
 >ENERGY INTAKE: 3354 KCAL

>PROTEIN: 115.5 g
>FAT: 174 g
>CHO: 158.5 g

>NUTRITION ANALYSIS (SUNDAY)

MEAL FOOD/BE MEASUR VEGETA FRUIT RICE MILK MEAT FAT SUGAR KCAL
VERAGE E BLE
S

Breakfast >Toast, 1 slice RICE C: 54

white 1/2
>Butter, 2 tsp 2 90
salted
>Eggs, 2 eggs M: 2 172
poached
>Sausage 2 oz (60 H: 2 244
links (2 g)
sml),
grilled
>Bacon 2 oz (60 6 270
strips, g)
grilled
(weight
before
cooking)
>Coffee, 1 tsp 108
instant
>Milk, ½ cup W: 1/2 85
whole
>Sugar 1 tsp 1 20

Morning >Coffee, 1 tsp 108

Snack instant
>Milk, ½ cup W: 1/2 85
whole
>Sugar 1 tsp 1 20

Midday >Bread, 2 slices RICE C: 1 162

Meal white 1/2
>Butter, 2 tsp 2 90
salted
>Ham (2), 1 ½ oz H: 1 1/4 163
pre-sliced (40 g)
>Tomato ½ cup 1/2 8
(1 med)

Afternoon >Cookies, 2 cookies RICE B: 1 1 96

Snack cream-
filled
>Coffee, 1 tsp 108
instant
>Milk, ½ cup W: 1/2 85
whole
>Sugar 1 tsp 1 20

Evening >Pasta, 2 cups RICE A: 2 184

Meal cooked
>Beef, 8 oz (240 M: 8 688
ground g)
>Onion ¼ cup ¼ 5
 (ckd, 2 tsp
butter)
>Tomato,
canned 6 fl oz 3 48
>Cheese, (180 g)
cheddar, 1 0z (30 M: 1 86
full fat g)

Evening >Mixed 2 oz (60 9 405

Snack nuts (2 g)
hfls),
salted
>Ice 1 cup RICE C: 2 4 396
cream,
regular (2
scoops)
>Fruit, ½ cup 1 40
canned)

TOTAL 3.8 1 A: 2 W: 1.5 LF: 0 24 3

SERVING B: 1 LF: 0 MF: 11
S C: 2 NF: 0 HF: 3.3

ENERGY 13 40 892 255 1353 1347 60

KCAL

PROTEIN 3.8 0 26 12 115 18 0

FAT 0 0 25 15 99 120 0

CHO 11.5 10 207 18 0 115 15

>OTHER OCCASIONAL
>FOODS & NOTES
1 DAY A WEEK
>MORNING SNACK: Fruit Cake (310 kcal)
>MIDDAY MEAL: Chocolate-coated ice cream (351 kcal)
>AFTERNOON SNACK: 2 small donuts (460 kcal)
>AFTERNOON SNACK: 2 fun-sized chocolate bars (536 kcal)
>EVENING SNACK: 3 ½ oz (100 g) potato chips (500 kcal)
>EVENING SNACK: 7 oz (200 g) potato chips (1000 kcal)

5 DAYS A WEEK
>AFTERNOON SNACK: 2 cans full-strength beer (300 kcal)

>NUTRITION ANALYSIS (OCCASIONAL FOODS AND ALCOHOL)

OCCASIONAL CHOICES DAYS.WEEK ENERGY CONTENT AVERAGE EXTRA EXCHANGES PER

CONSUMED (KCAL) ENERGY PER DAY SERVINGS
Fruit cake, 1 to 2 pieces 1 310 44.3 2 Rice B, 2 Fat, 1 Sugar

Chocolate-coated ice 1 206 29.4 1 Rice C, 1 ½ Fat, 1 ½

cream Sugar

2 small cinnamon donuts 1 460 65.7 2 Rice C, 2 Fat

2 fun-sized chocolate bars 1 536 76.6 1 Rice C, 2 Fat. 3 ½ Sugar

3 ½ oz (100 g) potato 1 500 71.4 1 ½ Rice B, 3 ½ Fat, 1

chips Sugar

7 oz (200 g) potato chips 1 1000 142.9 2 Rice B, 4 Fats, 2 Sugar

TOTAL DAILY ENERGY 430 KCAL

CONTRIBUTION (KCAL)

● We divide the energy content (kcal) by 7 to get the average extra energy per day

ALCOHOL

OCCASIONAL CHOICES DAYS/WEEK ENERGY CONTENT AVERAGE EXTRA EXCHANGE PER

CONSUMED (KCAL) ENERGY PER DAY SERVINGS

2 cans full-strength beer 5 300 214 5 ½ Fat

(12 fl oz, 375 mL)

TOTAL DAILY ENERGY 214 KCAL

CONTRIBUTION (KCAL)

TOTAL
>ALCOHOL: 214 KCAL
>OCCASIONAL: 430 KCAL
>MEALS: 3960 KCAL

>ENERGY INTAKE: 4604 KCAL

>PROTEIN: 156.8 g
>FAT: 234 g
>CHO: 261.5 g

CALCULATING MR. ROBERTSON’S TOTAL WEEKLY FOOD GROUP SERVINGS (USING

THE DIET HISTORY)
>Weekday 24-hour diet history
SERVINGS NO. OF VEGETABLE FRUIT RICE MILK MEAT FAT SUGAR
DAYS PER
WEEK

PER DAY 6 1.5 0 A:0 W: 1.5 LF: 0 18 6.5

B: 1.5 LF: 0 MF: 9
C: 3 NF:0 HF: 1.5
DAYS PER 6 9 0 A: 0 W: 9 LF: 0 108 39
WEEK B: 9 LF: 0 MF: 54
C: 18 NF: 0 HF: 9

>Weekend 24-hour diet history

SERVINGS NO. OF VEGETABLE FRUIT RICE MILK MEAT FAT SUGAR
DAYS PER
WEEK

PER DAY 1 3.8 1 A: 2 W: 1.5 LF: 0 24 3

B: 1 LF: 0 MF: 11
C: 2 NF: 0 HF: 3.3

DAYS PER 1 3.8 1 A: 2 W: 1.5 LF: 0 24 3

WEEK B:1 LF: 0 MF: 11
C: 2 NF: 0 HF: 3.3

>Total servings per week (7 days)

TOTAL PER 12.8 1 A: 2 W: 10.5 LF: 0 132 42
WEEK B: 10 LF: 0 MF: 65
C: 20 NF: 0 HF: 12.3

AVERAGE 1.8 0.1 A: 0.3 W: 1.5 LF: 0 18.9 6

PER DAY B: 1.4 LF: 0 MF: 9.3
(total per C: 2.9 NF:0 HF: 1.8
week / 7)

CALCULATING MR. ROBERTSON’S AVERAGE DAILY FOOD SERVINGS (AVERAGE

DAILY ENERGY INTAKE)

VEGETABLE FRUIT RICE MILK MEAT FAT SUGAR OTHER

OCCAS.
FOODS

SERVINGS 1.8 0.1 A: 0.3 W: 1.5 LF: 0 18.9 6

PER DAY B:1.4 LF: 0 MF: 9.3
C: 2.9 NF: 0 HF: 1.8

ENERGY, 16 40 A: 92 W:170 LF: 41 45 20

KCAL/SERVI B: 100 LF; 125 MF: 86
NG C: 108 NF: 80 HF: 122

AVERAGE 28.8 4 A: 27.6 W: 255 LF: 0 850.5 120 644

KCAL/DAY B: 140 LF: 0 MF: 799.8 (ALCOHOL =
C: 313.2 NF: 0 HF; 219.6 214)

(OCCAS. =
430)

214 + 430 =
644 KCAL

TOTAL
KCAL/DAY
3402.5
or 3400
kcal
A. FOOD / NUTRITION-RELATED HISTORY (FH)
Knowledge/ Beliefs/ Attitudes (FH-4)
Food/Nutrient Intake:
Energy Intake: Intake is about 3400 kcal/day
Amount of Food: He will have to follow the estimated servings based on the guideline
recommendations.
Bioactive Substance Intake: 2 cans of full-strength beer, 5 days per week
Micronutrients Intakes: Nutrients of concern are vitamins A, D, calcium and fiber.
Food Intake: 3 meals and 3 snacks a day
AM Meal and Snack: Toast, Butter, Jam, Egg, Juice, Coffee with milk and sugar.
Lunch Meal and Snack: Sandwich, Cookies Cream Filled, Coffee with milk and sugar
PM Meal and Snack: Meat, Potatoes, Gravy, Vegetable, Nuts
Weekend: Toast, Bacon, Eggs, Butter, Coffee, Spaghetti Bolognese, Fruit, Ice Cream
Occasional Foods: Beer, Fruit Cake, Chocolate, Donuts, Chips
Intake of vegetables, fiber, and dairy are low.

Areas of Knowledge: Cut back on sweets, unclear if he understands energy-balance or

about occasional foods.

Beliefs/Attitudes:
Conflicts: Really enjoys retirement and spends a lot of time with family and friends.
Readiness: Contemplation Phase: wants to change but doesn’t know where to start.
Emotion: Worried about health risks but enjoying the life he has.
Social Network: Support from wife and friends.

Physical Activity and Functions:

Changed from moderate to sedentary because of retirement in the last 6 months.

Nutrition Education: None

Eating Environment: Most consumed with friends and family in social settings.

B. ANTHROPOMETRIC MEASUREMENTS (AD)

Height/Length: 5 ft 9 in
Current Weight: 198 lbs
 Current BMI: 29.4 kg/m^2
Previous (6 months) Weight: 172 lbs
Previous (6 months) BMI: 25.5
26 lb weight gain in 6 months; 1 lb/ week

C. NUTRITION-FOCUSED PHYSICAL FINDINGS (PD)

Appearance: Clothes are too tight
Body Language: Open Communication
Blood Pressure: 130/85 mmHg

D. CLIENT HISTORY (CH)

Age: 65 years old
Gender: Male
P: Hypertension (wants to avoid anti-hypertensive medication)
F: Type 2 diabetes on his mother’s side and cardiovascular disease on his father’s side.

COMPUTATION:
NDAP METHOD
PATIENT: Mr. Robertson
AGE: 65 YEARS OLD
HEIGHT: 5 ft 9 in = 175 cm
WEIGHT: 90 kg = 198 lbs

DBW (Desirable Body Weight)

5 ft = 112 lbs
9 inches = 36 lbs
112 + 36 = 148 lbs or 67.13/ 67 kg

BMI (Body Mass Index)

= 90 kg / 3.06
= 29.4 (overweight according to WHO guidelines; pre-obese according to Asia-Pacific
guidelines)

ACTIVITY 1.9
SUMMARIZING NUTRITION ASSESSMENT
I. Revisit the information you gathered for Step 1 Nutrition Assessment. Identify and
discuss the nutrition-care indicators relevant to the case.

FOOD/NUTRITION-RELATED HISTORY (FH)

FOOD AND NUTRIENT INTAKE (FH-1)

ENERGY INTAKE (1.1)

Energy Intake (1.1.1)
> Total Energy Intake: 3,400 Kcal

FOOD AND BEVERAGE INTAKE (1.2)

Fluid/ Beverage Intake (1.2.1)

Qty. / Amt. Fluid / Beverage Frequency

250 mL (8 fl. oz.) Orange Juice 6x / week

- Water During the day

Food Intake (1.2.2)

Starchy Foods

Qty. / Amt. Food Frequency

2 slices Bread, white Whole week

½ cup Potato, mashed 6 days / week

5 cups Pasta, cooked 1 day / week

Fruits

Qty. / Amt. Food Frequency

250 mL ( 8 fl. oz.) Orange, juice 6 days / week

½ cup Canned Fruit 1 day / week

Vegetables / Low Starch

 Qty. / Amt. Food Frequency

1 med size ( ½ cup) Tomato Whole week

1 cup Cauliflower & Broccoli 6 days / week

1 large size (150 g) Onion 1 day / week

Dairy / Alternatives

Qty. / Amt. Food Frequency

½ cup Whole Milk 3x, 7 days / week

2 scoops (1 cup) Ice cream, regular fat 1 day / week

Meat / Substitutes

Qty. / Amt. Food Frequency

2 pcs Egg, poached Whole week

2 slices (40 g) Ham Whole Week

240 g (8 0z.) Steak, fried (or roast 6 days / week

chicken/meat)

60 g (2 oz.) Sausage 1 day / week

2 small links (60 g / 2 oz.) Bacon 1 day / week

(from 600 g) Beef, ground, cooked 1 day / week

Fats / Oils

Qty. / Amt. Food Frequency

2 tsp Butter Whole week

2 handfuls (60 g / ~2 oz.) Mixed Nuts, salted Whole week

Sweets / Alternative Carbohydrates

Qty. / Amt. Food Frequency

1 tsp Sugar (in coffee) Whole week

3 tsp (per slice of bread) Strawberry. jelly 6 days / week

Mixed Foods

Qty. / Amt. Food Frequency

 1-2 pcs Shortbread and 1 day / week
Cream-filled Cookies

2 scoops (1 cup) Ice Cream, reg. fat 1 day / week

Occasional Foods

Qty. / Amt. Food Frequency

2 pcs, small size Cinnamon Donuts 1 day / week

2 pcs, fun size Chocolate Bar 1 day / week

200 g Potato Chips, large 1 day / week

100 g Potato Chips, small 1 day / week

BIOACTIVE SUBSTANCE INTAKE (1.4)

Alcohol Intake (1.4.1)

> 2 cans ( 275 mL / 12 fl. oz.) Full-strength Beer; 5x / day

Caffeine Intake (1.4.3)

> ½ cup (125 mL / 4 fl. oz.) Brewed Coffee, 3x for 7 days / week

FOOD AND NUTRIENT ADMINISTRATION (FH-2)

Diet Order (2.1.1) The patient needs to lessen consumption of fatty food, and
Modified Diet incorporate fruits and more vegetables to their diet.

Diet Experience (2.1.2) None

Dines out with friends on specific days, and at home with family
Eating Environment (2.1.3)
(grandchildren, wife)

MEDICATION AND HERBAL SUPPLEMENT USE (FH-3)

MEDICATION AND HERBAL SUPPLEMENTS (3.1)

No prescriptions given by the attending physician, however any more increase in blood pressure may
require anti-hypertensive medication.
KNOWLEDGE/BELIEFS/ATTITUDES (FH-4)

Food and Nutrition Knowledge (4.1) - Minimal;

- Refers to home-cooked meals by his wife as
“good basic meals”

Beliefs and Attitude (4.2)
- Concerned about recent weight gain, indicated
by his clothes no longer fitting him comfortably
- Prior to retirement, did not watch what he eats
- Desire to change diet but does not know where
to begin
- Says he really enjoys retirement, food is an
integral part of time with friends and
grandchildren.

PHYSICAL ACTIVITY AND FUNCTION (FH-7)

● Physical Activity History
-Changed from moderate to low active physical activity level on retirement six months
ago.

ANTHROPOMETRIC MEASUREMENTS (AD)

Height: 5ft 9in (175 cm)

Weight: 90 kg (198 lbs)

Frame Size: Large

Weight Change: Gain: 12 kg (26 lbs), 6 mos.

Body Mass Index: 29 kg/m²

Growth Pattern Indices/ N/A

Percentile Ranks:

Body Compartment Waist-Hip Ratio: 1.0

Estimates: Skinfold: -

BIOCHEMICAL DATA, MEDICAL TESTS AND PROCEDURES (BD):

● NOT AVAILABLE
NUTRITION-FOCUSED PHYSICAL FINDINGS (PD)
 Overall Appearance: Overweight, Active

Body Language: Open Communication

Cardiovascular-Pulmonary: Blood Pressure: High-Normal

Pulmonary: -

Extremities, muscles, and bones: Normal

Digestive System (mouth and Normal

rectum):

Head and Eyes: Normal

Nerves and Cognition: Normal

Skin: Normal

Vital Signs: Blood pressure: 130/85 mmHg

Pulse Rate: -
Respiration Rate: -

CLIENT HISTORY (CH)

Current and past information relating to personal, medical, family and social history

PERSONAL HISTORY (CH-1)

● AGE :65
● GENDER: Male

PATIENT/CLIENT/FAMILY MEDICAL/HEALTH HISTORY (CH-2)

● Patient/client OR family nutrition-oriented medical/healthy history
-P Patient: hypertension, aiming to avoid commencing anti-hypertensive medication
-F Family: reported a family history of type 2 diabetes on mother’s side and
cardiovascular disease on father’s side
● Social History
-Living/housing situation
-Lives with wife
-Domestic issues
-Wife does cooking and shopping
 -Occupation
-Retired for six months

COMPARATIVE STANDARDS (CS)

Comparative Standards allow the dietitian to record both the estimated energy needs and the
method used to estimate the energy needs.
II. Return to your calculations and determine Mr. Robertson’s estimated requirements for
weight maintenance.

ENERGY NEEDS (CS-1)

Total energy estimated needs in 24 hours: 2300 kcal (9623 KJ)
COMPUTATION:
BMR = (9.99 x W) + (6.25 x H) - (4.92 x A) + 5
= (9.99 x 90 kg) + (6.25 x 175) - (4.92 x 65) + 5
= 899.1 + 1093.75 - 319.8 + 5
= 1678.05 or 1650 kcal
TER = BMR x PAL
= 1650 x 1.40
= 2310 or 2300 kcal (9623 KJ)
Method for estimating total energy needs: Mifflin-St Jeor Equation with Sedentary
Activity (1.40 activity factor)

MACRONUTRIENT NEEDS (CS-2)

Total protein estimated needs in 24 hours: 85 g/day (rounded up from 86 g)
COMPUTATION:
2300 kcal x 0.15
= 345
= 345 / 4 kcal/g
=86.25 or 86 g
= 85 g
Method for estimating total protein needs: 0.2 to 1.0 g protein/kg of adjusted body

WEIGHT AND GROWTH RECOMMENDATION (CS-5)

Ideal/reference body weight (IBW): Midpoint of BMI body weight range = 150 lbs (68
 kg)
COMPUTATION:
(5 ft x 12 in) + 9 in = 69
= 69 x 0.0254
= 1.7526 m
= (1.7526 m)^2
= 3.072 x 22
= 67.57 or 68 kg
= 68 kg x 2.205 lbs = 150 lbs
Recommended body mass index (BMI): 126 to 168 lbs (57 to 76 kg)
COMPUTATION:
Lower end of weight range (kg) = 18.5 x (1.7526 m) ^2 = 56.83 or 57 kg
Upper end of weight range (kg) = 24.9 x (1.7526 m)^2 = 76.49 or 76 kg
57 kg x 2.205 lbs = 126 lbs
76 kg x 2.205 lbs = 168 lbs

STEP 2: NUTRITION DIAGNOSIS

Activity 1.10
CREATING AN INITIAL LIST OF NUTRITION DIAGNOSIS

INITIAL LIST OF NUTRITION ADDITIONAL DATA RANK ORDER OF

POTENTIAL ASSESSMENT DATA NEEDED TO IMPORTANCE
NUTRITION USED TO CONFIRM CONFIRM
DIAGNOSIS THAT THIS
DIAGNOSIS EXISTS

Onset of Has a history of High intake of fatty 1

cardiovascular cardiovascular foods
disease disease from
father’s side

Obesity Does not exercise, Patient consumes 3

sedentary lifestyle 1,050 kcal in excess
daily

Stage 1 High salt intake as Blood pressure is 4

Hypertension seen in diet recall 130/85 mmHg

Onset of diabetes Family history of High intake of 2

type 2 diabetes sweet/starchy foods
ACTIVITY 1.11
DEVELOPING PES STATEMENTS
I. Create appropriate Nutrition Diagnosis Statements using standardized language.
PROBLEM #1

P Problem Excessive Energy Intake

E Etiology Related to: Increased snack and drink consumption while socializing
and a limited knowledge of energy-dense foods and beverages.

S Signs and As evidenced by: Current average intake is 3200 kcal/day (13389
Symptoms KJ/day) compared to estimated energy requirements of
approximately 2150 kcal/day (8996 KJ/day) with at least 598 kcal/day
(2502 KJ/day) from occasional foods and weight gain 4lbs (2 kg) per
month over the past six months.

PROBLEM #2

P Problem Overweight/Obesity

E Etiology Related to: Frequent Intake of energy-dense foods and reduced

activity since retirement.

S Signs and As evidenced by: BMI 29.4 kg/m^2

Symptoms

PROBLEM #3

P Problem Physical Inactivity

E Etiology Related to: Retirement six months ago and lack of awareness of the
significance of recent changes in activity relative to energy
expenditure.

S Signs and As evidenced by: Less than 30 minutes of moderate activity on most
Symptoms days compared to previous moderate activity level before retirement.
PROBLEM #4

P Problem Undesirable Food Choices

E Etiology Related to: No previous need to restrict calories, increase in social

activities during retirement.

S Signs and As evidenced by: Low intake of vegetables, fruits and dairy and five
Symptoms to seven servings of occasional foods daily, including energy-dense
occasional foods, when compared to the dietary guidelines.

PROBLEM #5

P Problem Not ready for diet/lifestyle change

E Etiology Related to: Still adjusting of retirement lifestyle

S Signs and As evidenced by: Statement that he is “considering” making some

Symptoms changes in heating habits.

STEP 3: NUTRITION INTERVENTION

ACTIVITY 1.12
I. Create a Nutrition Prescription that identifies optimal diet and lifestyle recommendations.
Provide patient-specific recommendations for energy, nutrients, specific foods and
physical-activity levels based on current national guidelines.

II. Describe the goals of medical nutrition therapy (individual- and family- focused) that
underpin Nutrition Intervention.

ACTIVITY 1.13
CREATING AN INITIAL LIST OF NUTRITION INTERVENTIONS

ACTIVITY 1.14
RE-EVALUATING THE INITIAL NUTRITION DIAGNOSIS AND NUTRITION INTERVENTION

ACTIVITY 1.15
FORMULATING SPECIFIC BEHAVIORAL-CHANGE TARGETS

STEP 4: NUTRITION MONITORING AND EVALUATION

ACTIVITY 1.16
CREATING A PLAN FOR NUTRITION MONITORING AND EVALUATION

ACTIVITY 1.17
NUTRITION PROGRESS NOTE
ACTIVITY 1.18
CLOSING VIDEO