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Guidelines for Age Group Case Scenarios: Coaching/Counseling Normal Nutrition

(DO NOT CUT AND PASTE INFORMATION YOU HAVE FOUND ON WEBSITES AS YOUR ANSWER.(

Familiarize yourself with the normal nutrition needs of the age groups below. Refer to Motivational Interviewing and Presentation Styles Powerpoints from Orientation Week, and some reference websites are included.

1. This assignment is about normal nutrition, wellness promotion, and prevention.

2. For the age groups on the following pages, using the description and questions indicated, answer the objective questions.

3. For the “advice” questions, respond as though you are speaking with your client, In other words, be literacy friendly, and use real food examples, not macro-and micro-nutrients. Practice asking open-ended questions. You can write a role-play/script if you’d like. Demonstrate your expertise as a coach/counselor, not as a provider of internet accessible information.

4. Write a COMPLETE PES statement, including goals, interventions, monitoring and rationale where indicated. Refer to the PES statement worksheet available on the website in the intern resource center.

Infants and Toddlers

Resources: > on position papers > Life Span > Infancy/Childhood for several AND position papers related to children

|Write a PES Statement |

|These encounters take place in an imaginary WIC office. The office is fully staffed, yet under-utilized. |

|Write a complete PES statement with the above agency as the subject. |

|Refer to the PES statement worksheet. |

|Lack of programming to meet needs related to staff not using time efficiently as evidenced by facility being under-utilized. |

|Nutrition DX (PES): |

|Goal(s) |

|Facility to increase productivity hours |

|Facility to advertize themselves to public |

|Facility to see x-amount of clients per day |

|Intervention(s) |

|Manager to observe workers and see how time can be used more efficiently. |

|Put advertisement for WIC in local news paper and flyers around town. |

|Monitor & Evaluate |

|Evaluate to see if client numbers and productivity hours have increased |

|Rationale |

|I think this would be a good way to make the public aware of the facilities presence in the area. Also, manager should monitor productivity hours to see how |

|they can utilize their time better to see more clients. |

|Case Study 1 Infants and Toddlers |

|Ms. Montenegro comes to you with her 3-month-old son, Jack.  She feels he is ready to begin solid foods, stating he is eating well, but not sleeping through |

|the night.  Jack is 24 1/2" long and weighs 16 pounds.  |

| |

|Plot Jack’s height and weight on the weight chart found on the assignment webpage. What is his percentile for height and weight?  75th percentile |

|How will you engage Ms. M in a conversation about solid-food readiness for Jack? I would tell Ms. M that Jack is at a good weight for his age and that he is|

|getting enough food via formula/breast milk for his age right now. I would talk to her about Jacks feeding schedule and see if there would be better times |

|she could be feeding Jack so that he wouldn’t be waking up hungry during the night. I would also tell Ms. M that babies this age have are not developed |

|enough to have solid foods and that she should first try the new feeding schedule we have planned. I would ask her to come back in a few days so we can |

|discuss if there have been any improvements and then we can go from there. I would advise her not to try solid foods without contacting me or her |

|pediatrician first. |

|What do you want Ms. M to take away from this meeting? Note: Be sure to talk TO Ms. Montenegro, not to a nutrition professional. |

|I want Ms. M to learn that Jack is a good size which indicates he is getting enough food from his formula/breast milk at this time. I want her to understand |

|that him crying in the middle of the night could be for other reasons than hunger, and if he is crying because he is hungry at night, than simply switching |

|his feeding schedule could solve the problem. I also want her to understand that at his age he is just not ready for solid foods and to see a pediatrician if|

|she is really concerned, however I do not advise solid foods at this age. |

|Case Study 2 Infants and Toddlers |

|Ms. Grissom brings her 2 ½ yo daughter Sarah, to you for advice.  Sarah is 36 1/2" tall and weighs 32 pounds.  Sarah appears to be a picky eater. Ms. |

|Grissom wants to be sure that Sarah is growing well. |

| |

|What will you tell Ms. Grissom about her daughter’s eating habits? |

|I would tell Ms. G that her daughter is in between the 75-90th percentile for age to height and she is in the 75-90th percentile for age to weight. I would |

|tell Ms. G that these numbers tell me she is currently on track and growing well, however if she is concerned than I would ask what kinds of foods does Sarah|

|enjoy and what kinds of foods does she not eat? I would want to be sure Sarah is eating a balanced diet and that she isn’t avoiding protein foods and foods |

|with important vitamins and minerals and opting for cheerios and goldfish as toddlers tend to do. |

|Identify four kid-friendly foods or menu items Ms. Grissom might try with Sarah. |

|I would recommend trying to make fruits and vegetables fun by doing things such as “ants on a log” (celery, peanutbutter, and rasins) or making pictures out |

|of fruit (banana, apple & grape smiley faces). If she isn’t getting much protein, I would suggest hotdogs cut long ways to avoid choking hazard, or “hotdog |

|worms” (take uncooked pasta and raw hotdog, put pasta noodles through cutup raw hotdog chunks and boil on stove). Other kid friendly food ideas include |

|making Mikey Mouse or other shapes out of pancakes that you could fortify with milled flax seed, chia seed, or fruit. Also, simply cutting sandwiches into |

|fun shapes could get Sarah to eat them. |

|What are three suggestions to encourage Sarah to eat more foods? |

|As I said before, making the foods into fun shapes is a great way to get children to eat food that they usually don’t eat. Another idea could be to play a |

|game with the food and the winner gets to eat a piece. For example, tossing grapes into a cup across the table, if you make the “basket” you get to eat the |

|grape! Lastly, another idea could be to sneak the foods into her diet. Making smoothies with fruit juice, fruits, vegetables, and yogurt could be an idea for|

|this. |

Adolescents

Resources:

|Write a PES Statement |

|Write a complete PES statement in which the Problem pertains to assuring adequate nutrition in School Foodservice. |

|Refer to the PES statement worksheet. |

|Food and nutrition knowledge related deficit related to undesirable food choices as evidenced by fried foods selling more than any other foods in school |

|cafeteria. |

|Nutrition DX (PES): |

|Goal(s) |

|To increase the sales of healthier food items in school cafeteria |

|Intervention(s) |

|Educate students on nutrition earlier in the school year to promote a healthy year. |

|Post positive nutrition messages around cafeteria. |

|Put fried foods at an undesirable location (ie. Put chicken nuggets behind baked chicken breasts so that students have to reach past the healthy item to get to|

|the less healthy choice). |

|Monitor & Evaluate |

|Would monitor fried/junk food sales the weeks immediately after nutrition education has taken place and after positive nutrition messages have been posted. |

|I would plan to follow up 1 week after each intervention. I would monitor 1 week after the education took place, 1 week after posting positive nutrition |

|messages, and then 1 week after moving food items around. |

|Rationale |

|The rational behind this is not to send a negative message correlated by these fried foods and weight gain. Rather, the rational is to inspire students to eat |

|more healthfully. If you were to take away the fried foods, students would start to bring their own lunches and sales overall would decrease. By doing so this |

|way, there would hopefully be a subtle decrease in fried food sales and an increase in sales of healthier food items which would indicate students eating more |

|balanced meals. |

|Case Study Adolescents |

|Marco is a 16-year-old high school sophomore. He is 5’9 ½ “tall, weighs 141 #. He likes to eat, gets 6 hours of sleep most nights, and enjoys playing sports,|

|especially varsity wrestling and lacrosse. |

| Marco eats breakfast at home almost every day. He packs a bag lunch three days and buys school lunch 2 days. Lunch is at 11:20 every day.  He likes to get |

|something to eat after school around 3:30 before dinner. Dinners are usually at home. He goes out to eat with friends one or two times on the weekend. |

| Marco has dropped into your office because he wants to be sure he is eating and drinking the right food for energy, growth, and performance. |

| |

| Taking all this information into consideration, especially varsity wrestling and the amount of sleep he gets: |

| |

|How will you assess Marco’s nutritional intake? |

|I would talk to Marco about what kind of meals he eats. He mentioned eating after school every day: is this fast food? Also when he goes out on the weekends, |

|what kinds of foods is he eating? I would assess his nutritional intake based on his BMI of 20.5, and an estimated calorie intake per day based on what he |

|states to eat on a normal day (24 hour recall). |

|What are three pieces of information you will discuss with Marco? |

|Getting more sleep each night, eating enough protein and carbohydrates since he is an athlete, and snack ideas for if he gets hungry throughout the day. |

|What is a one-day menu for Marco, on a day he has a Lacrosse game?   |

|On the day of a Lacrosse game, I want Marco to be consuming protein but especially carbohydrates for energy. Here is a sample 1 day menu: |

|Breakfast: 2 scrambled eggs, whole wheat English muffin with peanut butter, and small piece of fruit. Water or milk to drink. |

|Lunch: turkey sandwich on whole wheat bread with tomato and lettuce, ¼ cup dry roasted almonds, side salad with ranch dressing and vegetables, and yogurt with |

|granola. Water or milk to drink. |

|Pre-game snack: Kashi protein bar, small piece of fruit, water to drink. |

|Dinner: baked chicken breast, steamed broccoli, brown rice, and side salad with dressing. Water or milk to drink. |

Pregnancy and Lactation

 Resources: WIC, > position papers > life span > pregnancy/breastfeeding, La Leche League

International Lactation Consultant Association

|Write a PES Statement |

|Write a complete PES statement about a woman’s ambivalence about breastfeeding. |

|Refer to the PES statement worksheet. |

|Fear of lifestyle change due to breastfeeding related to knowledge deficit about breastfeeding as evidence by expresses ambivalence about breastfeeding. |

|Nutrition DX (PES): |

|Goal(s) |

|Educate woman on benefits of breastfeeding for herself and her child, as well as financially. |

|Intervention(s) |

|The intervention would be the education. Have women take a breastfeeding class at health facility, have one on one education, provide resources and materials |

|for woman to take home and read. Also provide materials and resource for woman if she chooses not to breastfeed. |

|Monitor & Evaluate |

|See if woman attends breastfeeding class and have a follow-up appointment before she has her baby to discuss further. |

|Evaluate effectiveness by whether or not women chooses to breastfeed. |

|Rationale |

|You don’t want to force breastfeeding onto her so it is important to educate her about both breastfeeding and formula feeding for her child. Provide her with |

|all the resources she needs about going either way. Discuss with her why she is ambivalent about breastfeeding and see if you can provide her with any |

|information that may ease her nerves. |

|Case Study Pregnancy and Lactation |

|Naima comes in for a prenatal appointment at 20 weeks.  She is 26 years old; height is 5'4".  Her weight history is as follows: |

|                        Pre-pregnancy: 112# |

|                        8 weeks: 118# |

|                        12 weeks:  120# |

|                        16 weeks:  122# |

|                        20 weeks:  122# |

|  |

|                Plot her weight gain on the weight gain graph  |

| |

|What will you tell Naima about weight gain during pregnancy? |

|Naima’s pre-pregnancy BMI was 19.2 which is on the low end of normal weight for her height. Using the “pre-pregnancy normal weight” growth chart, her weight |

|gain is appropriate and on track up until her week 20 weight. Based off of normal pregnancy weight gain, she should have weighed ~126#’s on this visit. |

|How many calories does Naima need each day? |

|Based off of the Nutrition and Diagnosis-Related Care text, since Naima is still in her second trimester, she should be increasing her caloric intake by 350 |

|calories per day and then increase to 500 calories per day in her third trimester (pg 8). With this equation, Naima should be consuming, in her second |

|trimester, between 1,650-1,880 calories per day. |

|51kg pre pregnancy weight x 25-30kcal/day = 1,300-1,530 calories/day |

|1,300 calories + 350 = 1,650 calories |

|1,530 calories + 350 = 1,880 calories |

|What are three suggestions you will give Naima about meals and snacks? Naima is from India. She is a Lacto-ovo-vegetarian with sensitivity to peanuts. |

|I would suggest Naima pay careful attention to how much protein she is getting in each day. With her being a lacto-ovo vegetarian with a peanut sensitivity, it|

|would be important to educate her on complimentary proteins and teach her different ways to ensure she is consuming enough protein. Another suggestion I would |

|have for Naima about meals and snacks would be to eat throughout the day. She should have about 6 small meals a day to ensure she is getting enough energy into|

|her body since it is so in demand. Lastly, another suggestion I would have for Naima about meals and snacks would be to make sure her snacks are rich in |

|protein. This could include yogurt, scrambled eggs, nuts (other than peanuts), and even protein bars if she wants. |

| |

|Naima is not sure about breastfeeding.  Supporting whatever decision she makes, |

|What would you tell her about breast-feeding? |

|I would tell her that breast milk is that the breast milk secreted from days 1-4 is called Colostrum and contains immunological factors that you simply cannot |

|get from formula. I would also tell her that breast milk is better digested and absorbed by the baby when compared to formula. I would also mention that |

|breastfeeding saves a lot of money while also benefiting the baby. |

|What nutrition advice would you give her for when she is breastfeeding? |

|I would tell Naima that while breastfeeding she needs to continue to eat more calories than she was pre-pregnancy. I would tell her that her body is working to|

|create and deliver the milk to the baby and therefore she needs to continue to eat a diet rich in protein and about 330 calories/day increase from her |

|pre-pregnancy regimen. Based off of her consuming 1,300-1,530 calories/day pre-pregnancy, this would mean she would now consume ~1,630-1,860 calories/day. |

Elderly

Resources:   National Policy and Resource Center on Nutrition and Aging, > position papers > life span > older adults,   AARP,   Administration on Aging

     

|Write a PES Statement |

|Write a complete PES statement about ways to prevent malnutrition among older adults. |

|Refer to the PES statement worksheet. |

|Inadequate oral intake related to decreased ability to consume sufficient energy as evidenced by BMI ................
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