Instructional Planning for Diet Instruction

Diet Rx: Regular Neutropenic/Low Microbial with 2150-2400 kcals, 90-120 g protein
I. General Components of the Therapeutic Diet

A. Dietary Components/Nutrients Controlled and other Dietary Changes:

1) _Calories_________________ 2) _Protein_________________ 3) _Food handling and safety__

B. Key Instructional Points for Implementing Above Changes:

1) Discuss components and restrictions of neutropenic/low microbial diet
2) Discuss importance of increased calorie/protein intake and inadequacy of current regimen
3) Provide recommendations for easy high calorie/protein foods and ways to incorporate more calories/protein into already accepted foods
II. Data Collection / Assessment

A. Diet History:
1. Food/Eating Patterns
a) Typical intake pattern around which to tailor Diet Rx

TDI is 4 health shakes + a few bites of chicken pot pie or cereal with 2% milk____________________________________________________

b) Aspects of typical intake (food or behavior) which impede realization of Diet Rx

4 health shakes provide only 800 calories and 24 g protein, total diet is inadequate in protein and calories; taste aversions, fatigue, early satiety

2. Knowledge and Behavior Re: Diet Rx
a) Previous instruction and level of knowledge on current Diet Rx or other May have had previous MNT during a previous hospitalization; no
neutropenic diet prior as far as RD is aware; level of knowledge somewhat inadequate

b) Cognitive abilities related to instruction (patient or SO) Pt adequate, possibly impeded by fatigue & condition; Husband - adequate

c) Knowledge patient needs to know; knowledge patient wants to know Need to know: neutropenic precautions, inadequacy of current diet in relation
to needs; Want to know: recipes & tips to boost caloric content of currently accepted foods

d) Readiness to learn/staging (precontemplation, contemplation, preparation, action, maintenance); aka Interest/motivation to follow Diet Rx:
Preparation stage: patient and husband appear highly motivated to meet calorie and protein needs, motivated to follow neutropenic precautions


III. Teaching Plan Instructor: Michelle Baker, dietetic student & S.V., R.D. Patient (initials): M.L.J.


A. Learning Goal: Patient and husband will understand importance of adequate intake & neutropenic precautions


B. Key Content Points Specific Objectives Method Activities Tools
(possible discussion topics)
1. a) Patient recall of daily energy and protein needs

b) Verbalization that wt loss is not good for pt health

________________________________________________________________________________________________________________

2. a) Pt lists foods unsafe for consumption at this time

b) Pt verbalizes amount of time food can sit out or
be eaten safely as leftovers

__________________________________________________________________________________________________________________

3. a) Husband lists two additive that can boost intake

b) Pt identifies recipe she would be willing to try

__________________________________________________________________________________________________________________



IV. Evaluation (Describe how patient education would be evaluated, if not implemented)

A) Demonstrated understanding based on specific objectives: Patient and husband successfully met objectives specified above

B) Assessment of interest/motivation and potential compliance: Highly motivated, ready for change, unhappy with weight loss

C) Self-evaluation: Teaching was successful and very rewarding; patient and husband expressed sincere enthusiasm and gratitude for instruction

Myelofibrosis requires increased
protein and energy needs;
adequate intake is important for
health

Neutropenia requires safe food
handling and storage; many foods
are restricted on a neutropenic
diet

Foods should be dense in calories
and protein; protein should be of
high biological value; there are
ways to improve already
accepted foods

One-on-one


One-on-one


One-on-one


Discussion

Discussion

Discussion

None

Handout;
Food list

Handout;
Recipes