1. JenniferDerasmo
ADIME
NUTR 431
ASESSMENT:
Age: 10
Gender:Female
Role in family: Daughter
Occupation: Student
Eyes and Ears: Clear
Area and level ofknowledge/skill: Clienthaslimitedknowledge onthe relationshipof the correcttypes
of foods tointake;Clienthaslimitedknowledge of typesof fats&types/quantitiesinfoods due to
parentspreparingmeals andbeingachild
Vitaminintake: Multivitamindaily
Dietingattempts: Pt has neverdietedbefore
Caregiver/companion:Pt liveswithbothof herparentswho prepare hermeals
Type of food/meals:Highsaturatedfattyfoods,highamountsof highsugaryfoodswithlarge portions
Total Caffeine intake:6 oz.coffee with¼ cupof cream with2 sugars per24 hour recall
Physical activity history: Her elementaryschool discontinuedphysical educationandcurrentlyno
physical activityonherown
Other sedentaryactivity time:Playsvideogamesandreads inplace of physical activity
Height/weight/BMI:Ht. 57”, weight115#/, 52.2 kg./;BMI: 24.9%
Weightchange:gained10# overpast several years
Growth pattern indices:Ptis inthe 97th
percentileforherage
Vital Signs:Bloodpressure 123/80
Overall appearance: Somewhattiredandirritable
Patient/Chiefcomplaint:Feelingtired andparentsare concernedwithhercessationof breathingforat
least10 secondsperepisode
Cardiovascular: Regularrate and rhythm, heartbeatsnormal
Endocrine/metabolism(M):Motherand grandmotherhasType 2 DM (motherpossible gestational
diabetes)
Total energyestimatedneeds:~900-1200 kcals
Methodfor estimatingneeds: Harris-Benedictformulawithsedentaryactivitylevels
Recommendedbodyweight:97th percentile tolessthanthe 85th percentile
Total fat estimatedneeds: maximumof 44 g/d (25%-35% total kcals)

2. DIAGNOSIS/PESSTATEMENTS:
 Obese,pediatricrelated to excessive energyintakeand lackof physical activity asevidenced by
BMI of 24.9% (˃95 percentile) and 24 hourrecall.
 Excessive oral food/beverage intake related to caloricallydensefoodsandbeveragessuchas
friedfoods,fatty/processedmeats,sugarysodasandjuicesandwhole milk asevidenced by 24
hour recall.
 Physical inactivity related to sedentarylifestyleasevidenced by self-reportedvideogame use
and physical activityclassdiscontinuedatschool.
 Poornutritionqualityof life related to sleepdisturbances asevidenced by feelingtiredand
irritable daily anddifficultyconcentratinginschool.
 Excessive energyintake related to unchangeddietaryintakeasevidenced by >10lb steady
increase overpastseveral years.
 Excessive caffeineintake related to coffee dailyforachild as evidenced by 24 hour recall of 6 oz.
coffee with¼ cupof creamand 2 tsp of sugar
NUTRITION INTERVENTION:
 Nutritionprescription:Using a low-calorie energyintake(900to 1,200kcal per day) as part of a
clinicallysupervised,multi-componentweight-lossprogramisassociatedwithbothshort-term
and longer-termreduction.(EAL) (45-65% of kcal from CHO,25-35% from fatand 10-30% from
protein). Getlabvaluesdone forA1C,lipidpanel,B/P,FBG.
 Food and/or Nutrient Delivery:
o Energy modifieddiet:To reduce energyintake 900kcal to 1,200kcal perday-focuson
incorporatingmore fruitsandvegetables, low-fatdairyproducts, whole-grainbreads
and cereals,nuts, seeds,fishandleanmeats.
 NutritionEducation (Content)
o Nutritionrelationshipto health/disease: describe relationshipof
overweight/obesity &dietaryfatintake,highsodiumintake withotherpotential risk
factors forhealth.
o Recommendedmodifications:
 Reduce energy&dietaryfatintake as notedinthe nutritionprescription.
 Teach portionsizesforeachfoodgroup withpatientandfamilymembers.

3.  Teach meal prepping,foodswapping, mealplanningandhow toread foodlabels
withpatientandfamilymembers.
 Meal planwill be appropriate forenergyandfatintake.
 Educate the importance of including fiberintothe dietincluding fruitsand
vegetables andwhole grains toincrease toabout26/g perday withpatientand
familymembers.
 Refertoan exercise physiologisttoincorporate anexercise programgearedforthe
pt.
 Limitsodiumintake tolessthan2000 mg/day
 Short-term goal:Helpprepare twodays’worthof snacksfor the weekwithfamily
on the weekend. Limitvideogame use totwice a weekforthirtyminutes.
 Long-termgoal: Be able toselecthealthieroptionsatthe grocerystore bybeing
able to take knowledgelearnedfromfoodlabel education. Incorporate atleastsixty
minutesof exerciseforfour daysa week.
 Educate pt’s parentsabouthow to increase activitylevelswithgames,dancing,
outside playing,andhealthier,lowercalorie snacksandbeverages.
o Skill development:
 Short-term goal:Bringa healthy prepared snacktoschool 3 daysa week for2
weeksthatincludesfiber.Clientwill replace friedfoodswithbakedfoods 3times
perweekfor2 weeks.
 Long-termgoal: Clientwilldemonstrate understandingof portionsizesandfat
contentof foodsby choosingcorrectportionsfromall foodgroupsfor all meals. Use
foodlabelstomake healthierchoices.
 NutritionCounseling:
o Motivational interviewing:Client’sparents describedreasonsfordesiredgwt.loss;
outlinedprosandconsof currenteatinghabits.Requestsspecificguidance onhealthy
eatingnow.Goal:Increase dietreadiness.
o Goal Setting: Short term goal:Go fora bike ride twice aweekfor30 mins.Long-term
goal:Get at least60 minutesof relatedendurance exercise 4-5daysa week.
 Collaborationwith other providers:
o Referclienttoan exercise physiologisttoreceiveexerciseprescription andrefertoa
Psychiatristtohelppromote abetterwell-being.
Monitoringand Evaluation:
 Energy Intake: Criteria:Reduce energyintaketo 900-1200 kcals/day.Continue tomonitor
weight- gradual weightlossof nomore than 1 poundperweekisthe goal until the BMI-for-age
percentile dropsto< 85th
.
 Total Fat: Criteria:Reduce fatintake to <20% of total kcals(44 g perday) and saturatedfat
intake to< 7% of total kcals(15 g).

4.  Physical Activity: Criteria:Initiate exercise plan of atleast60 minutesadaymost daysof the
week tooptimize correctweightlosswithpreventionof diseases asdirectedbyexercise
physiologist.Continue tomonitorthisplanistakingplace.
 Caffeine:Criteria:Eliminatecoffeeconsumption completely.
 Daily Stress Level:Criteria:Payattentionto PT’semotional state anddailystresslevel.
 Other: Maintainoptimal metabolicoutcomeswithinthree monthsfollowinginitiationof dietary
and behavioral modifications
 Lab Values:Continue tomonitorA1C,lipidpanel,B/P,FBG.