Download Document

NUTRITION COUNSELING
UNIT 3
Stacey Day, MS, RD
Kaplan Instructor
COUNSELING
THE ASSESSMENT PROCESS
Medical hx, biochemical parameters, and clinical
exam.
 Anthropometrics and fitness evaluation.
 Food intake, preferences, allergies, and needs.
 Psychosocial factors, family influences,
development skills, motivation, and readiness.
 Lifestyle and health risk appraisal.
 Personal and preferred learning style.

Name three of the 6 characteristics of the screening
process.
6 CHARACTERISTICS OF THE
SCREENING PROCESS
May be completed in
any setting.
 Facilitates completion
of early intervention
goals.

Includes the collection
of relevant data on
risk factors.
 Includes the
interpretation of data
for intervention and
treatment.
 Determines the need
for an in-depth
nutrition assessment.
 Is cost-effective.

Where are nutrition screenings administered?
Let’s review the nutrition screening process.
Please turn to page 300/ Appendix 7C
WHERE DO YOU OBTAIN THE
MEDICAL HISTORY FOR A PATIENT?

Inpatient?

Outpatient
WHERE DO YOU OBTAIN THE
MEDICAL HISTORY FOR A PATIENT?

Inpatient

Typically in the
medical chart.

Outpatient
Call the primary care
doctor’s office to
retrieve it.
 Send your nutrition
assessment notes after
each consultation to
the doctor’s office.
 Why is it important to
retrieve from the
doctor’s office versus
only the patient?

MEDICATION USAGE
Record all Rx and
OTC meds.
 Identify any possible
food-drug interaction
 Counsel client on
timing of meals, food
selections, or
supplementation.


Ask specifically about
vitamins, minerals,
and herbal
supplements.
MEDICATION USAGE
Record all Rx and
OTC meds.
 Identify any possible
food-drug interaction
 Counsel client on
timing of meals, food
selections, or
supplementation.


Ask specifically about
vitamins, minerals,
and herbal
supplements.
WHAT ARE SOME BIOCHEMICAL
PARAMETERS YOU WOULD ASSESS?
PERFORMING A CLINICAL
EXAMINATION

Trained professional only can detect:
Loss of somatic fat and protein stores.
 Micronutrient deficiencies in a client’s hair, skin,
eyes and mouth areas.

These findings may also be due to non-nutritional reasons
 Must support clinical signs with other parameters.


What are various types of anthropometric
measurements?
ANTHROPOMETRIC: WEIGHT
Most commonly performed type is weight to
height ratio, IBW.
 %IBW = Actual Weight/IBW
 BMI = wt in kg/ht in m2.
 BMI:

Underweight: < 18.5
 Normal/healthy 20.0 – 24.9
 Overweight 25.0 – 29.9


Obesity Classification:
Obesity Class I 30.0 – 34.9
 Obesity Class II 35.0 – 39.9
 Obesity Class II ≥ 40

ANTHROPOMETRIC: CIRCUMFERENCE
MEASUREMENTS AND SKIN-FOLD
THICKNESS
Somatic protein reserves: MAMC (mid-arm
muscle circumference) = upper arm
circumference and triceps skin-fold
measurements.
 Most common: WHR (waist:hip) = waist at
smallest circumference and hips at the largest

WHR > 1.0 in men
 WHR > 0.8 in women
 Measures android obesity

ANDROID VS. GYNECOID
DIETARY INTAKE AND NUTRITION
NEEDS

What are some limitations of receiving accurate
dietary intake?

What are the 3 common methods used to collect
dietary intake data?
3 COMMON METHODS USED TO
COLLECT DIETARY INTAKE DATA
24 Hour Recall
 Food Records
 Food Frequency
Questionnaire

QUANTITATIVE ASSESSMENT OF
DIETARY INTAKE
Computerized
nutrient analysis
software
 The American
Diabetes/Dietetic
Associations’
Exchanges for Meal
Planning
 A food composition
handbook

ENERGY
Harris-Benedict
Equation is most
common.
 Indirect Calorimetry
 Multiply activity
factor for total energy
needs.

PROTEIN

Healthy adults =
0.8 g/kg body weight
For unhealthy
individuals, protein
needs to be assessed
for disease state,
degree of stress,
unusual losses, and
visceral protein
status.
VITAMINS AND MINERALS
Do they meet the DRI
requirements?
 Are there missing food
groups?
 Are there digestive
impairment?

FLUID
General
recommendation is
1cc/kcal
 Or it could be stated,
6-8 glasses of
fluid/day.
 Workers and athletes
should drink 2 quarts
additionally and
replace each pound of
weight loss with 1 pint
of fluid.

PSYCHOSOCIAL FACTORS
AFFECTING FOOD INTAKE
Social influence
 Food availability issues
 Cultural and religious background
 Stress and emotions
 Developmental skills
 Motivation and Readiness

COUNSELING SKILLS FOR
BEHAVIOR CHANGES
NONVERBAL ACTIVE LISTENING
SKILLS
Eye contact
 Tone of voice
 Body language
 Practice Activity

VERBAL ACTIVE LISTENING
Key to developing rapport and empathy.
 Creates an accepting environment
 Silence or minimal response


Nod of head, “um-um”


Message heard, no judgment
Reflective responses

Summarize content or clients feelings

Shows understanding, encourages elaboration, confirms
clarity
REFLECTIVE RESPONSES
Summarizes what the client said or target the
feelings expressed.
 3 purposes

Help the client to continue talking
 Clarify
 Communicate a willingness to help.

WHAT ARE THE 4 TYPES OF VERBAL
LEADING SKILLS?
4 TYPES OF VERBAL LEADING
SKILLS
Questions
 Influencing Responses
 Advice
 Giving Information

QUESTIONS
Used to gather information
 Open Questions
 Closed Questions
 Why Questions

OPEN QUESTIONS
The question does not place parameters on a
client and it does not merely ask “yes” or “no”
 “What” or “How”
 “Tell me more”
 “Can you be more specific?”
 What are examples of these?

CLOSED QUESTIONS
Usually answered with “yes” or “no” or in a word
or two.
 Do not encourage exploration and can lead to a
dead-end
 Try to ask open questions as much as possible.

WHY QUESTIONS
May place clients on the defensive side.
 Answers often provide little information to
counselors.

ADVICE



Provides clients with thoughts or behaviors that
they haven’t tried yet to help solve their problem.
Make sure problem is fully explored prior to
advice.
What are some examples?
INFORMATION
Break up the information
 Allow clients time to review it
 Make sure it is pertinent.

DEVELOPING BEHAVIOR CHANGE
STRATEGIES
STEP 1: GOAL IDENTIFICATION
Flipside of problem
 Achievable goals are positive, specific, and under
the goal setter’s control.
 Small steps = achievable = empowerment
 Focus on positive goals and avoid negative goals
and terminology
 Distinguish goals from results

Lower cholesterol is result
 Goal is to avoid saturated foods
 Goal is to increase physical activity

STEP 2: GOAL IMPORTANCE
ASSESSMENT
Defines the motivation
 Must be important to the client.

STEP 3: GOAL ROADBLOCK
ANALYSIS

Four obstacles that impede goal acheivement

Lack of knowledge


Lack of skills


Doesn’t understand the “how to”
Inability to take a risk


Doesn’t know the “what”
Fear associated with goal achievement
Lack of support

Look beyond traditional support structure
CASE STUDY #1

A 79 year old female named A.S. is present due to gastritis. She reports she has
been taking Tums after every meal for a very long time and has been increasing the
amount she has been taking from 2 Tums to 6 Tums after meals. She reports she
can hardly eat anything, but is gaining weight. She reports when she was 40 she
weighed 128 lbs, at 60 weighed 145 lbs and at 79 is currently weighing 175 lbs and is
only 5’1”. She reports is disgusted with her weight, but does not have the energy she
used to and cannot cook as well with her arthritis, so basically uses the microwave
for most things. She reports she is on a fixed income and cannot afford most healthy
foods and cannot take any more pills than what she currently is on. (Billion, W.
(2006). Clinical Nutrition Case Studies. Wadsworth Cengage 4th edition.)

What is gastritis?

What stage of change do you believe she is in?

What is her BMI? What is her ideal body weight?

What about her Tums intake?

Are you concerned with her weight gain and why would she be gaining weight?

What diet information would you provide her with?

What goals would you establish with her?
CASE STUDY #2

A 17 year old female named J. F. is present for Chron’s disease and weight loss. Pt
reports usually when she has a flare up cannot eat much because of the pain, so has
lost 10 lbs within 3 weeks and the doctor is concerned she is not eating the right
amount of foods to prevent these painful occurrences from happening. Pt reports
within the past 6 months has been in the emergency room at least once a month from
these flare ups. Pt usually eats 3 meals a day and for lunch will have either the
school’s cafeteria meal or else will run across to a fast food place with her friends and
will drink Diet Soda throughout the day. Pt is in track and cannot do anything when
these hit her. She is not taking any medications except for multivitamins and has
seen nutritionists in the past and so does not think we will be providing her with
anything that is helpful.

Height: 5’4” Weight: 110 lbs Weight history: 120 lbs (3 weeks ago)

What is Chron’s disease?

What stage of change do you believe she is in?

What is her BMI? What is her ideal body weight?

Are you concerned with her weight loss?

What would be her goals?