Last 4 digits of PSU ID:5777

Nutrition 453-PES Homework (14 pt) Spring 2016

See class handouts and lecture notes for examples and guidance.
Mr. Sparrow is a 45 year-old African-American male with a medical history of hypertension,
hypercholesterolemia, and diabetes mellitus (type II). His physician has requested that he meet
with you, the dietitian, for dietary counseling. The goal of dietary counseling is to assist Mr.
Sparrow in improving his lab values through diet changes.
Anthropometrics:
Ht: 60 Wt: 270 lb. gradual 30 pound weight gain over past few years
Labs:
Total cholesterol = 255 mg/dL
Fasting triglycerides = 350 mg/dL

BMI: 36.7

HDL = 30 mg/dL LDL = 185 mg/dL

Fasting blood glucose = 130 mg/dL

Client History:
Patient is a manager in a fast food restaurant. His wife is a law enforcement officer with a
rotating schedule. The couple has no children. Patient states the family rarely prepares their
own meals, maybe 1-2 days per week we cook at home. Mr. Sparrow often skips breakfast due
to his schedule at the restaurant. Patient stated because of convenience he consumes most
meals at the restaurant where he works. His favorite pastime activity is watching sports on
television with his friends. Often these televised games turn into big events with lots of chicken
wings and pizza. Mr. Sparrow states he often feels tired and unmotivated to perform any
physical activity, especially after being on his feet at the restaurant.
Food/Nutrition History:
Patient does not cook or prepare his own meals. His wife often does the cooking 1-2 days per
week when her schedule allows. Mr. Sparrow states he eats when he is at work. His diet consists
of fast/convenient foods (burgers, fries, sodas). Patient stated he does not eat his meals at the
same time every day but when I have time, if I think of it. It is usually late in the day. Mr.
Sparrow stated when he does consume breakfast (approximately 2-3 days per week) he will go
through the drive through at his favorite coffee/donut shop or pick up an egg sandwich at the
closest convenience store. He purchases snacks for his home such as snack cakes, potato chips,
and occasionally beer.
Mr. Sparrow completed a 24-hour food record before his appointment, as instructed. The 24-hour
food record showed he is consuming ~3200 kcal, with most of his foods being high in
carbohydrate (CHO representing ~55% of kcal with ~20% from added sugars) and fat (fat
representing ~38% of kcal with ~15% of total kcal from saturated fatty acids). However, you
notice his portion sizes are described inaccurately and with some discrepancies. After the initial
consultation, you estimate that he needs to be consuming ~3000 kcal/day just to maintain his
current weight. You send him home with instructions to complete a more detailed 7-day food
record; you also provide a booklet with illustrations of appropriate food portions.

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Last 4 digits of PSU ID:5777

1. List one nutritional problem that was addressed during this session. (P)
Excessive fat intake (NI-5.5.1)
2. What aspects of his lifestyle have contributed to this problem? (E)
Mr. Sparrow eats the majority of his meals at the restaurant in which he works, and he
only eats a home cooked meal about 1-2 times per week. He also eats a lot of
fast/convenience, foods, such as burgers, fries and chicken wings. For snack he eats a
lot of snack cakes, chips and other high fat foods.
(E) Frequent consumption of high fat fast/convenience foods (burgers, fries etc.)
3. What laboratory or anthropometric value(s) (or other information, above)
provide(s) evidence of this problem? (S)
Total CHOL: 225 mg/dL (normal: <180 mg/dL) , LDL: 185 mg/dL (reference value: ,100
mg/dL), Fasting TG: 350 mg/dL (reference value: <150 mg/dL), BMI: 36.7 (reference
value: <24.9) with a gradual 30 lb weight gain over the past few years, 38% of energy
intake from fat (reference value: 20-35%)
(S) Total CHOL level of 255 mg/dL and 38% of energy intake from fat
4. Write one PES statement (using your answers from 1, 2, & 3 above) and one
intervention statement (including both the RD and patient portions) that you would
include in his chart after your first visit with Mr. Sparrow. You can either use the
interventions noted in the paragraphs above to shape your PES and intervention
statements, or develop your own. Regardless, be sure that your intervention targets
the E of your PES statement, use relevant eNCPT within your statements and make
sure that the patient portion of your intervention statement is a WRAP.
Excessive fat intake (NI-5.5.1) related to frequent consumption of high fat
fast/convenience foods (burgers, fries, etc.) as evidenced by a total CHOL level of 255
mg/dL and 38% of energy intake from fat.
a. RD intervention: The RD will provide nutrition counseling to set behavioral
goals to decrease caloric intake by ~250 kcals below Mr. Sparrows 3000
energy maintenance requirement, by reducing the consumption of high/fat
convenience foods.
b. Patient Goals: To decrease Mr. Sparrows consumption of high fat/convenience
foods, Mr. Sparrow will bring a lunch from home at least 1-2x/wk in place of
the restaurant meals he has been consuming. The lunch will consist of lean
meat on whole wheat bread, at least one fruit and vegetable, and a low fat
yogurt.

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Last 4 digits of PSU ID:5777

At the two-week follow up appointment, Mr. Sparrow arrives late and was only able to complete
3 days of his 7-day food record. He states he has had no time to do this and couldnt possibly be
expected to spend this much time recording what he eats. He has tried to make some changes
during the past two weeks, but is frustrated because his weight has not gone down. He tells you
that he has started consuming more sweetened iced tea and frappuccino at the restaurant, since
soda contributed so many of his calories last time he saw you. He also has been consuming more
chicken nuggets and fish sandwiches instead of burgers, as he heard from some patrons of the
restaurant that chicken and fish were better for you. After reviewing his food records, you
estimate his intake to be ~3200-3500 kcal.
5. List one problem that you identified during this session. (P)
(P) Excessive carbohydrate intake (NI-5.8.1)
6. What about his lifestyle may be contributing to this problem? (E)
It has been reported that Mr. Sparrows feels overwhelmed and frustrated with the
changes that have been made to his diet. He is also receiving false nutrition
information from some of the patrons at his restaurant. He recently started consuming
more sweetened ice teas and frappucions at the restaurant in place of the soda that he
has been consuming.
(E) Frequent consumption of high sugar beverages, such as sweetened ice tea and
frappucinos
7. What signs and symptoms provide evidence of this problem? (S)
Mr. Sparrow is still consuming too many calories (3200-3500), and consequently he
has not seen any changes in his weight over the past two weeks.
(S) Total energy intake of 3200-3500 kcal, compared to his 3000 energy maintenance
requirement, and no weight change over a two week period
8. Write one PES statement (using your answers from 5, 6, & 7 above) and one
intervention statement that you would include in Mr. Sparrows chart after your
second visit with him. Use relevant eNCPT within your statement; be sure that
the patient portion of your intervention statement is a WRAP.
Excessive carbohydrate intake (NI-5.8.1) related to frequent consumption of high
sugar beverages as evidenced by a total energy intake of 3200-3500 kcals, and no
weight change over a two week period.
a. RD intervention: The RD will provide nutrition counseling to set and adjust the
behavioral goals to decrease caloric intake by ~250 kcals below Mr. Sparrows
energy maintenance requirement, by reducing the consumption of high sugar
beverages.

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Last 4 digits of PSU ID:5777

b. Patient Goals: To decrease Mr. Sparrows consumption of high sugar
beverages, Mr. Sparrow will make his iced tea with half unsweetened and half
sweetened tea, as well as, reduce the pumps of liquid sugar in his frappaccinos by
half, at least 3-4x/wk.

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