Download Kelsey Fenton NTR 401 Assignment # 3 12/9/11 Outline of

Kelsey Fenton
NTR 401
Assignment # 3
12/9/11
Outline of counseling session
In the initial visit, I spoke with Shelby about her lifestyle choices, such as physical
activity level, smoking, eating habits and alcohol consumption. Additionally I
questioned her about any food preferences and food aversions. She contested to the
fact that she avoids most fried foods as they upset her stomach, and she experiences
severe abdominal cramps when she consumes starchy foods. Shelby also dislikes
vegetables and rarely eats them. Shelby prefers to eat fruits and they are healthy
and she likes many of them. She also enjoys fish and admits that this is usually her
main source of protein. She frequently eats out, about 3-4 times a week, and
generally eats twice a day, and usually does not eat breakfast. She doesn’t cook
much as she usually eats alone, and doesn’t like to cook for herself. She’s willing to
learn more about cooking, and is interested in finding some fast, healthy recipes for
delicious food she can prepare at home. Shelby rarely drinks alcohol, as this will
often upset her stomach. She does not smoke cigarettes, and exercises 3-4 times a
week for 1 hour, most of which is cardio. She is a full time student and works 25
hours a week at a convenience store. She does not receive financial support from
her family, and is living on a tight budget. She does not partake in any
extracurricular activities, and enjoys spending free time with friends.
Shelby Lubbers
21 years old, female
Height: 5’ 5
Weight: 105 lbs
BMI: 18.5
Food Synopsis
Below is a list of foods suggested for Shelby based off her preferences and aversions.
It’s important that Shelby read the ingredients of anything that is pre-packaged or
frozen, as these items can sometimes contain gluten.
Fruits and Vegetables
Try eating 5-9 servings of these a day. They are gluten free. Frozen fruits and
vegetable sold without added ingredients are also gluten free. Try eating broccoli
(steamed) with cheese sauce for dipping. Spinach salad is another great way to get
your greens, throw in your favorite fruits, toppings, cheeses, croutons, and dressings
to spice it up a little. Green beans are very nutritional, and contain carbohydrates,
which serve as energy. Try sautéing them in some butter with a little garlic for
flavoring.
Cereal
Look for gluten free cereals, these can be found in your local co-op or health food
stores. Gluten Free Oats are also another alternative
Pasta
Avoid Couscous as this contains wheat. Most rice is gluten free, but be careful with
the seasoning agents as many of these could have traces of gluten.
Look for gluten free pasta, and read the ingredients of sauces, some of which may
contain gluten.
Dairy
Butter, cottage cheese and sour creams don’t contain gluten. Some milk is made
with malt should be avoided. Ordinary Milk is fine. Be cautious of blue cheese and
other aged cheeses.
Meat/Poultry/Fish
Try and purchase these items fresh that are free of seasonings, and are left plain.
Read the ingredients on frozen varieties, as sometimes traces of gluten can be
included. Eggs are high in protein and gluten free, try eating these for breakfast,
with some type of fruit. Be cautious of processed, luncheon meats, as some of these
have gluten ingredients Salmon, tuna, cod, and halibut are all delicious cuts of fish,
and all free of gluten. Try baking these and seasoning them with little pepper, lemon,
or garlic for taste
Frozen Foods
Ice cream is usually okay; just beware of cookie chunks, gram crackers, and starches
that may be added in the mix. Most fruit bars and popsicles are okay, just be sure to
check the ingredients for gluten traces. Many frozen dinners with sauces have
gluten ingredients, avoid these
Beverages
Coffees, tea, sodas, and milk, are all gluten free
Avoid beer and liquor as they contain gluten. There are gluten free beers, which are
available at your local co-op. Rice liquor, and wine may be good alternatives for
ordinary liquor.
Brochures for celiac disease (web generated) these links have good information
available in brochures for patients with celiac disease.
Http://www.purdue.edu/hhs/hk/documents/honors499/Spring%202008/Celiac_
Disease2.pdf
http://www.celiaccentral.org/SiteData/docs/NFCA%20WOMEN/019c0a188ed589
2f/NFCA%20WOMENS%20HEALTH.pdf
Http://www.celiaccentral.org/education/Women-s-Health/ClinicianResources/440/
NCP
Assessment:
Signs and Symptoms- Bloating, Abdominal cramping, diarrhea, gas, and constipation
High level of celiac antibodies present in the blood.
Diagnosis
PES statement
Inadequate carbohydrate intake related to impaired glucose tolerance and energy
malabsorption as evidenced by weight loss, abdominal pain, bloating, delayed
gastric emptying and high levels of anti-endomysium and anti-tissue
transglutaminase.
Intervention
Avoid foods containing barley, Bulgar, Durum, Farina, Graham flour, Rye, Semolina,
Spelt, Triticale, and Wheat.
To increase carbohydrate intake, encourage foods that are a good source of
carbohydrates and gluten free, such as vegetables, wild rice, and gluten free pasta,
which she could pair with her favorite protein, fish.
Provide information and resources about healthy recipes that are gluten free and
time efficient.
Encourage her to eat a well balanced breakfast, a meal rich in carbohydrates and
protein, like eggs with a slice of gluten free toast and a glass of orange juice.
Provide resources and education on label reading
Stress the importance of reviewing the ingredients on labels of foods and
supplements to avoid sources of gluten, which may be present in some of these.
Education on food cross contamination
Inform Shelby about the cautions of eating out, explaining cross contamination, and
how she needs to make sure she is eating food that is prepared gluten free.
Monitoring and Evaluation
Antibody levels
Gluten free dietary pattern
Potential exposure to cross contamination
Review the changes in client status (gastrointestinal, immune, neurological and
physiological status) as well as her social status (social and medical support, stress
level)
Monitor symptoms such as bloating, gas constipation and diarrhea, bacterial
overgrowth
24 hr recall
Breakfast
Apple slices 1 cup
Oatmeal, instant, 1 cup
Fat free milk, 1 cup
Lunch
Wild and brown rice, 1 cup
Chicken baked (3 oz)
Dinner
Salmon, baked (3 oz) seasoned with lemon juice and garlic salt
Mashed potatoes (1 cup)
Margarine (1 tbsp)
Ice cream (1 medium scoop)
Total Estimated Calorie Intake: 1300 kcal
Recommended Calorie intake: 1800 kcal
*Gathered from mypyramid.gov
NCP
Assessment
Weight loss of 6 lbs. higher levels of celiac antibodies present in the blood. Patient
looks weak and frail, complains of increased abdominal pain, gas and constipation.
She declares she is unable to eat the suggested foods, and is experiencing severe
lethargy
Diagnosis
Inadequate nutrient intake related to food aversions and nutrition/food knowledge
deficit as evidenced by continued weight loss, and a BMI of 17.6, indicating
malnourishment
Intervention
Recommend taking a daily multivitamin, as she is deficient in essential nutrients,
vitamins, and minerals based off of caloric intake. Stress the importance of staying
away from foods that contain gluten, such as oatmeal. Suggest she switch to gluten
free oatmeal, which provides much of the same vitamins and minerals in ordinary
oatmeal.
Examine what foods she would be open to trying, give her a list of vegetables that
she may not be familiar with and encourage her to try them. Explain 1 serving of
most vegetables is equal to 15 grams of Carbohydrates.
Recommend liquid protein and carbohydrate rich beverages, which will supply her
with calories she needs to meet her 1800 kcal needs.
Reduce exercise to light/moderate physical activity twice a week until patient has
reached a healthy weight.
Consult with physician about prescribing medications that control intestinal
inflammation, such as steroids.
Monitoring and Evaluation
Monitor weight loss, symptoms such as gas, constipation, and abdominal cramping.
Monitor compliance with gluten-free diet, review any changes in medical status
(gastrointestinal, immune, neurological, and psychological)
Additionally, follow up on patient’s intake of steroids; collect information about any
changes in medical status
What I learned…
As the RD in this experiment, I feel I provided a lot of choices and good information
about gluten free dieting. I also explained the importance of complying with a gluten
free diet as this will help eliminate some of the gastrointestinal discomfort she
frequently experiences while eating certain foods. I also felt like I carried out the
Nutrition Care Process very well, and developed realistic goals, which I felt the
patient was capable of obtaining. I developed good rapport between the patient, and
me and listened to her desires, as well as her concerns. I tried to implement changes
within her diet based upon preferences she listed. I also tried to encourage that she
experiment with new foods to eliminate some of the food aversions she has towards
vegetables. I feel that listened well, and conveyed respect throughout our initial visit
I expressed empathy for her discomforts with gluten intolerances, and developed
strategies and suggested foods that would be good alternatives. I made an accurate
diagnosis based off the signs/symptoms and data I collected in the initial visit, and
developed good intervention strategies, which I believed, would resolve the
problem. Though my client still struggles with consuming enough calories to satisfy
her energy needs, she is in the action phase of implementing some of the changes
and strategies we’ve developed and discussed. I believe she is ready, willing and
capable to do this, she just needs to explore her choices more, and find foods, which
she can tolerate and serve as alternative sources of energy. In summary, I found this
experience to be very realistic and exciting. It allowed me to practice and apply
many of the skills I’ve acquired throughout my educational career. It gave me a
sense of accomplishment and reward that I’ve been yearning for.
As the client, I was a tough case to resolve because of a debilitating illness that
drastically affected my appetite, resulting in a reduced food intake. I couldn’t
partake in the recommended diet because I couldn’t eat. I’m sure had I been healthy
and with an appetite, the dash diet would have worked well. I know this diet is
designed for people who struggle with hypertension, though I’m not one of these
people, I believe it’s important to moderate and limit salt intake as it can only
benefit your health. While I did not partake as the client in this experiment, I can
appreciate the fact that this diet would be ideal for many individuals living in this
country today. I also acknowledge the resources and information given by the RD
who displays competent knowledge about this subject matter. In summary, I feel
that this diet change is a great experience, and can give us insight about what
situations we may come across in our professional careers as Registered Dietitians.
Works Cited
Evidenced Based Nutrition Practice Guideline on Celiac Disease. 23rd June 2009.
American Dietetics Association.
http://www.adaevidencelibrary.com/topic.cfm?cat=3677
Gluten Intolerance. 2010. Giforkids.
http://www.giforkids.com/?a=utrition&celiac%20Disease%20Gluten%20Intoleran
ce