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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