Download Nutritional Teaching Plan Form - Trinity Valley Community College

TRINITY VALLEY COMMUNITY COLLEGE
ASSOCIATE DEGREE NURSING
NUTRITIONAL TEACHING PLAN - LEVEL III
Student Name: ________________________________
Patient’s Initials: ____Age: _____ Sex: _______
Course: _________________
Date of Contact: ________________
Focused Diet Plan _________________________________________
PART I -- Selection of Patient: To be completed and submitted to clinical instructor by
clinical week 2. (4 points)
Why was this patient selected?
What health issue(s) does your patient
have?
Abnormal data for patient (if available)
Lab:
BMI:
Weight/Height
If not available what would you wish
to have to evaluate the patient issue?
Desired outcome:
By the end of this project the patient will :
Nutritional focus:
Type of diet to be taught to this patient:
(ex low fat). Give Rationale for the diet.
Teaching GOAL(S): initial
Short term goal:
Long term goal:
Instructor approval:
Letter for patient
Signature form for patient completed
Date:
Signature
Date signed
Date
Instructor signature
PART II: To be submitted to clinical instructor by clinical week 5 (12.5 points)
Nutritional Assessment
Part A - Nutritional assessment completed :
Date:
Instructor signature:
a. What information did you find affected the
patients eating habits?
b. List eating patterns that would help the
patient meet the objectives.
c. List habits that would hinder the patient
meeting objectives.
d. What emotional, environmental, social, and
physical states influence their eating habits?
Part B - Home assessment competed
Three day diary completed:
Computer analysis is included
Analysis of Three Day Diary
a.
What foods groups dominate current intake?
b.
What food groups are absent or insufficient in
diary?
c.
List examples of intake that are detrimental
to the patient’s nutritional intake.
d.
List examples from 3 day diary that promote
healthy eating.
e.
Discuss shopping, preparation, or portion
control that impacts current eating patterns.
(both pro & con)
f.
What environmental or social factors
influenced patient’s dietary intake during the
three days?
Date:
Instructor Signature
Date:
Instructor Signature
Date:
Instructor Signature
Pathophysiology
a. Describe the pathophysiology for the patient’s
identified problems. (include pertinent
medications).
b. Compare and Contrast the patient data and
textbook
c. Discuss how the patient’s dietary habits impact
the pathophysiology.
d. Discuss the patient’s understanding or lack of
regarding how food impacts their
pathophysiology.
List references were used for this project? ( One
internet, one lay journal and two professional
references)
Development of patient problem and goals: (revised after analysis if needed)
PROBLEM:
SHORT TERM GOAL:
LONG TERM GOAL :
a. State how the problem addresses nutritional
teaching needs (not medical diagnosis)
b. Explain how the goals listed are Realistic,
Measurable and time limited.
By the end of teaching, the patient will:
Assessment of Learning
a. Identify the patient’s Education level
b. Discuss the patient’s preferred method of
learning (reading verbal, demonstration etc.)
c. Present comments made by the patient to
support a readiness to learn or lack of.
d. List any identified barriers to learning
e. Subjective comments: (What has patient said
about process?)
PART III: Submit to the clinical instructor clinical week 9 (13.5 points)
Teaching - Plan and Implementation
Method of Teaching
a. What teaching strategies were utilized?
b. What learning aids were used?
c. Discuss how these teaching strategies and
learning aids were selected.
Student’s Proposed Individualized 2 Day Meal Plan with Computer Analysis for the Patient
a. Discuss how this plan reflects patient’s
preferences and life choices.
b. Discuss how this meal plan promotes health
and “goal achievement” for this patient.
TEACHING PLAN
Specific Content Taught
Interventions (Content to be
Taught)
Scientific rationale for
intervention: (Referenced)
List specific (food content) suggestions you recommend to modify their current eating habits to increase
health promotion.
Suggestions include food groups, types of foods, modification of three day diary, strengthening health
promoting habits, food preparation, frequency of meals, snacking, times of food intake, etc.
a.
b.
c.
d.
e.
Specific Content Taught
Interventions (Content to be
Taught)
Scientific rationale for
intervention: (Referenced)
f.
g.
h.
i. Medications related to diet
j. Activity recommendations
k. Collaborative
resources/referrals
MAY INCLUDE ADDITIONAL INTERVENTIONS AS NEEDED FOR INDIVIDUALLIZED PLAN
Evaluation of Teaching
a. Identify patient responses to teaching.
b. Which teaching tool(s) was (were) most
effective and why?
c. Was STG met at the end of the teaching?
Discuss supporting data.
d. Was LTG met?
e. Discuss how you could revise the teaching plan
for a better outcome?
N/ADN/Sophomore/Fall/2161/Nutritional Care Plan Revision 2013
Revised 7/13