ÐÏࡱá>þÿ DFþÿÿÿCÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿì¥Á'` ð¿ÌbjbjVwVw *.44¶ ÿÿÿÿÿÿ¤ÈÈÈÈÈÈÈÜ884l4ܯT¬¬¬¬¬‡‡‡.000000$!hk#–Tȇ‡‡‡‡TÈȬ¬Ûiééé‡èȬȬ.é‡.ééV¦@ÈÈþ¬  °hÜÔ"4Îo‚æ ÚT0¯ò $ñÄ$þþ$ÈÈ采‡TTµ4‡‡‡¯‡‡‡‡ÜÜÜ$ ÜÜÜÜÜÜÈÈÈÈÈÈÿÿÿÿ  ADIME Nutrition Documentation Form Section: Thursday Name: Jonny Wymore Nutrition Note: Case Study 9 Date: 4/08/2013 Time: 0800 A: Nutrition Assessment (Assessment info related to Nutrition Dx) Client Hx Name: Jack Nelson Age: 48 Male Causasion Pt Hx: Hypertension 1y Family Hx: Father had CAD Nutrition-Focused Physical Findings Obese Chronic and consistent indigestion over the past yearAnthropometrics Ht: 5’ 9” Wt: 215 lbs BMI: 31.7 kg/m2Food/Nutrition-Related Hx & Comparative Standards Gained 35lbs in the last 5 years Food intake: increased food intake over the past year related to stress Medicine: Atenolol 50mg/d, Aspirin 325mg/d, daily multivitamin, Ibuprofen 500mg 2x/d for the last month Energy intake: 4,360caloriesBiochemical, Medical Tests & Procedures CHOL 200 mg/dL (H) HDL-C 20 mg/dL (L) LDL 165 mg/dL (H) TG 178 mg/dL (H)  D: Nutrition Diagnosis (PES statement) 1) Food and nutrition-related knowledge deficit of GERD-specific diet, related to habitual consumption of foods which increase gastric acidity and lower GES pressure, as evidenced by dietary recall containing high fat foods, soda, and alcohol. 2) Obesity related to excessive energy intake of 150% of daily caloric needs, as evidenced by 24-hour recall of 4,360 calories compared to his needed 2,900. I: Nutrition Intervention Prescription: PES #1 Goal: Increase nutrition-related knowledge to decrease a) foods that increase gastric acidity, and b) lower GES pressure. Intervention: Restrict foods that increase gastric acidity and lower GES pressure, including soda, alcohol, caffeine, and high fat foods. PES #2 Goal: Weight loss Intervention: Prescribe a 2,500 calorie diet, and provide nutrition education on new GERD diet as well as making healthful dietary choices using the TLC eating plan. TLC diet: <7% sat fat, <200 mg/d cholesterol, increased physical activity to 30 minutes 3 d/wk, 10-25 g/d viscous (soluble) fiber, 2 g/d of plant stanols/sterols. Patient should consume the refer to the following: (Vegetables: 3-5 serv/d (without added fat, sauce or salt) (Fruits: 2-4 serv/d (Dairy products: 2-3 serv/d (fat free or low fat milk, yogurt, cottage cheese &cheese) (Eggs: <2 egg yolks/wk (use egg whites or egg substitutes) (Meat/poultry/fish: <5 oz/d (Fats/oils: unsaturated oils, seeds and nuts ___________________________________________________________ M & E: Monitoring and Evaluation 1) Monitor dietary patterns using a FFQ in 6 weeks 2) Monitor weight status. Long term weight loss goal of 10% of body weight, or approximately 21 pounds. 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