Name: Stephanie Heinlein

Assignment: Follow-up Meeting with Tonya

Step 1: Review her previous goal.

Initial Goal: I will drink water with dinner M-F for the next two weeks.
Reward: Place $1 in a jar for each time I meet my goal and save for a new
dress.
Monitoring: Calendar method
This intervention plan would save 150 kcals per day or 750 kcals per week.

Step 2: Review data from her current visit

New assessment data:

A: Self-report of physical activity is still 5 times per week for 30 minutes.

Wt: 177 lbs; IBW; 98% UBW Wt changes: down 3 lbs in past 2 weeks
Intake:
Kcal needs 2400; Intake=3000
Pro needs 65 g; Intake 100 g
155 grams fat; 47% kcals from fat
300 g cho; 40% kcals from cho
Food group intake:
Excessive 10 serv grains (8 rec) and 700 extra kcals from sugars (limit
to 360)
Adequate: 3 serv dairy, 6 serv meat, 7 serv oils
Low: serv fruit (2 rec),1 serv veg (3 rec)

Other concerns: Tonya works in a fast food restaurant after school, must cook
for siblings when she returns home, receives money for fast food dinners,
selects pizza and French fries instead of school lunch, and has mindless eating.

Step 3: Review her goal monitoring calendar below. She has placed an X in
the box on the days she drank water for dinner.

Week Sunday Monday Tuesday Wednesday Thursday Friday Saturday

1 x x x x x
2 x x x x x x x

Step 4: You ask Tonya to rate the following characteristics on a scale of 1-

10. Below are her ratings.

Follow-up on previous goal to assess the following on a scale of 1-10:

Readiness to continue to change this behavior __10___
Adherence to the goal _10____
Confidence in making change ___10__
Importance __10___
Name: Stephanie Heinlein

Tonya tells you how happy she is with her weight loss and ability to carry out
this specific goal. She has also started to drink diet soda at work several times
per week. She states that is it does not taste too bad. She prefers water. She
has reduced her intake from 6 sugar-sweetened beverages to 4 per day. Tonya
would like to advance the goal for SSBs and reduce her intake of SSBs by 1
more per day. She would also like to write a new goal to reduce the number of
servings of French fries she consumes from 2 to 1 small order per day. She
rates her motivation as a 9/10 for this new goal.

Step 5: In the Module 6 assignment, you wrote three diagnoses for Tonya.
List them below. If you need to make improvements in your PES
statements based on the instructors feedback, please do so.

D1: Undesirable food choices (NB 1.7) r/t limited access to recommended
foods and poor cooking skills AEB estimated intake inconsistent with DRI
standards (CHO: 517.5g, recommended CHO: 130g; added sugar 28% of total
kcals, recommended added sugar <25% of total kcals; serving of fruit,
recommended 2 cups of fruit; French fries only source of vegetables,
recommended 2.5 cups of vegetables; 15.5 teaspoons of oil, recommended less
than 6 teaspoons of oil); and self-reported limited access to food consistent
with the guidelines (mother buys groceries, patient works at fast food
restaurant).

D2: Excessive energy intake (NI 1.3) r/t limited access to healthful food
choices at home and part-time job (eating in fast food restaurants 6 days per
week, unlimited sodas at work), excessive soda intake, unsupported attitudes
about food and nutrition from family AEB BMI of 27.4 (91st percentile), weight
gain of 50 pounds in last 6 months, and estimated intake of 3727.5 kcals
intake versus recommended 2000 kcals needs.

D3: Physical inactivity (NB 1.7) r/t lack of role models, time constraints, and
unsupported attitudes about physical activity from family/peers AEB BMI of
27.4 (91st percentile), and self-reported infrequent physical activity (mostly sits
during school gym class, and 10 hours/day sedentary), and self-reported
limited time for physical activity because of school and part-time job.

Step 6: Tonya has improved her intake slightly. Discuss the changes in
each diagnosis (resolved, better but not resolved, same, or worse).

Diagnosis: Progress made on D1/D2. No change in D3 and no new diagnoses.

D1: Undesirable food choices (NB 1.7) r/t limited access to recommended
foods and poor cooking skills AEB estimated intake inconsistent with DRI
standards (CHO: 300g/10 servings [better, but not resolved], recommended
CHO: 130g/8 servings; added sugar 23% of total kcals/700 extra kcals
Name: Stephanie Heinlein
[better, but not resolved] from sugars (<360 kcals recommended), fat
intake 47% of total kcals (23-35% recommended) [worse-increased from
33.2%]; serving of fruit [no change], recommended 2 cups of fruit; French
fries only source of vegetables [no change], recommended 3 cups of vegetables;
7 servings of oil [better, but not resolved], recommended less than 6
teaspoons of oil; and self-reported limited access to food consistent with the
guidelines (mother buys groceries, patient works at fast food restaurant)[no
change].

D2: Excessive energy intake (NI 1.3) r/t limited access to healthful food
choices at home and part-time job (no change)(eating in fast food restaurants
6 days per week, unlimited sodas at work), excessive soda intake (4 SSB/day)
[better, but not resolved], unsupported attitudes about food and nutrition
from family [no change] AEB BMI of 26.9 (90th percentile) (better, but not
resolved), weight gain of 47 pounds in last 6 months (better, but not
resolved), and estimated intake of 3000 kcals intake versus recommended
2400 kcals needs (better, but not resolved).

D3: Physical inactivity (NB 1.7) r/t lack of role models[no change], time
constraints [no change], and unsupported attitudes about physical activity
from family/peers [no change] AEB BMI of 26.9 (90th percentile) and self-
reported infrequent physical activity (mostly sits during school gym class [no
change], and 10 hours/day sedentary), and self-reported limited time for
physical activity because of school and part-time job [no change].

Step 7: Rewrite one diagnosis statement based on the new assessment

data.

D2: Excessive energy intake (NI 1.3) r/t limited access to healthful food
choices at home and part-time job (eating in fast food restaurants 6 days per
week, unlimited sodas at work), excessive soda intake (4 SSB/day),
unsupported attitudes about food and nutrition from family AEB BMI of 26.9
(90th percentile), weight gain of 47 pounds in last 6 months, and estimated
intake of 3000 kcals intake versus recommended 2400 kcals needs.

Step 8: Tonya writes two goals. Evaluate the goals. Highlight your answer.

Goal 1: I will drink water at work and dinner (M-F) for the next two
weeks.

Is it stated in a positive way? YES NO

Is it reasonable? YES NO
Is it under the clients control? YES NO
Could the client measure success? YES NO
Is there a time frame? YES NO
Name: Stephanie Heinlein
Does it solve a problem? YES NO

Goal 2: I will eat only one small order of French fries per day (M-F).

Is it stated in a positive way? YES NO

Is it reasonable? YES NO
Is it under the clients control? YES NO
Could the client measure success? YES NO
Is there a time frame? YES NO
Does it solve a problem? YES NO

Step 9: Help her rewrite one of these goals so that it is SMART.

I will drink water at lunch three times a week (M-W-F) for the next two
weeks.

Step 10: List at least six items that you would monitor and evaluate.

At the next visit, monitor and evaluate:

- Weight and BMI (180 lbs./91st percentile 1st visit, 177 lbs./90th
percentile 2nd visit)
- Kcals (2400 kcals recommended)
- Soda intake (3 SSB/day goal)
- Fruit intake (1/2 serving intake, 2 servings recommended)
- Vegetable intake (1 serving intake, )
- Physical activity (30 minutes in PE class, but mostly sitting
around did she increase PA?)
- Goal adherence (Tonyas goal to lower SSBs to 3 SSB and
decrease fries to 1 small fry are both reasonable goals. How did
she do? Tonya should keep progressing these goals.)
- Monitoring system for goal (Calendar method)
- Reward