11/8/2012 Thursday 11:15
CLIENT PROGRESS NOTES
Last Week Goals Met?
- PA? volleyball 1x/week, band practice 3x/week (marching)
- Try 3 vegetables? YES liked this goal: Turner vegetable side, west end vegetables, new salads,
- Pair Protein + Fiber? Yes good balanced meals overall! (very conscious of choices)
- Mealtimes? Good stick to same time about every day about 12/12:30 everyday
- Meet protein needs? Protein 2x/day/5.5 oz? Yes 2x/day
- Salt? Make sure fresh foods, not as processed, no salt shaker, “I notice the actually taste of foods
more now” … still cramps!
Notes:
- How are cramps? Still very painful … lets try multivitamin, stretch 5 minutes before/after sleep… check
with doctor over break?
- Water intake? Drinking all the time – either water or green tea
- Stress? Has been able to manage this week (did have an exam but felt didn’t affect poor food habits)
- Drinking lots more water and green tea to help feel full, “If I am hungry I will drink a lot of water or drink
a lot of green tea and I have noticed it fills me up so much!! If I am hungry I have been getting a yogurt
with fruit for a midday snack to help stay full longer!”
- Looked at calorie intake (on target)
Student NC followup for LN: cramps and potassium, drinking water, “never been this bad”
Goals:
-
Veg/Fruit/Protein intake
Protein 2 x/day? Continue to keep up good work!
Water continue lots of fluids!
P.A. continue this week
Monitor/Eval:
- Meet in 2 weeks to continue to monitor goals (wants to know just have someone to talk to to make sure
continuing to “stick to goals, stay on track”
- Referral to physician at home for muscle cramping
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2 weeks has passed and last week was a challenge due to 3 exams and stressful work week. Client does very
well with wellness summary handout and helps her to see which groups she needs to “check off” each day. Client
finds it very difficult to resist free foods (ex. Free pizza at housing fair, free candy throughout the week, free meals
when goes on trips for band). Client wants to go to the store to get vegetables and new items she wants to try
(plans on going this weekend to get frozen corn, potassium rich foods, maybe spaghetti squash, hummus,
yogurts). LN is doing great with being aware of choices; When she feels she has been making a not so healthy
choice at one meal, she focuses on making her next meal better. LN seems to have taken a step back in some of
her success in the previous week and is not meeting all her recommended food groups (although getting
something in each category). LN has had difficulty with a lot more discretionary calories this week.
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CLIENT PROGRESS NOTES
Last week goals:
- PA – yes 2x week, now on intramural volleyball team
- Breakfast – YES has done a good job always getting something in the morning
- Skip meals? Mostly except for a few days with stressful exams
- Protein + Fiber worksheet – came up with 5 good feasible ideas
Ongoing Goals
- Water – good still sticking to water 3 bottles/day (other than water occasional 100% juice or chai latte)
- Fruits – OK, only getting 1/day (needs to increase to 2)
- Vegetables – OK, just usually getting salad for lunch/dinner option on some days, meeting needs 5075% of the time but needs more variety (needs 3.5 c/day)
- Protein – Not enough, only getting protein in 1x day (2-4 oz not meeting needs of 5.5 oz)
Next Week Goals:
- Goal 1. Try Vegetables as a side (not salad) 3x next week
- Goal 2. Increase protein to either meet 5.5 oz or 2x/day
- Goal 3. Limit salt (try and avoid salt shaker)
Handouts Provided: Wellness Summary sheets, potassium rich foods (WebMD), What counts as an ounce for
protein (choosemyplate.gov)
-----------------------------------------------------------------------------------------------------------------------------10/11/2012
Last weeks Goals:
- 1. PA – YES
- 2. Don’t skip meals – YES (had lunches and felt full, felt satisfied, not hungry later on, was able to curb
snacking and late night cravings)
- 3. ABP options? Has avoided ABP all together
Ongoing Goals/Traching:
- Water – YES – water all the time “I got a diet coke yesterday and it just made me feel more hungry.
But then I went to the gym and just couldn’t stop drinking water. It made me feel good!”
- Fruits? Yes meets or exceeds everyday (loves applesauce)
- Vegetables? Yes meets/exceeds – has tried and loves new West End Salads, new vegetable sides at
Turner, tried new foods
- Protein? Yes – making conscious choices “ Yesterday I got a cheese quesadilla and instead of just
cheese I added beans to get the protein”
New Goals:
- PA – get in definitely 2x week (especially may be challenging with upcoming week
- Work on fast breakfast choices (try to not just grab PB crackers or granola bar) – maybe oatmeal with
fruit, WASA crackers and pb (homemade)
- Continue to not skip meals (may be a challenge for next week with lots of exams)
- Homework: Protein + Fiber worksheet – come up with 5 of your own ideas and check off that you get
those
Notes: During this session we went over portion control, portion quiz, looked at a few meals at dining centers went
to recently, helped strengthen she knows A LOT very knowledgeable and making good conscious decisions
everyday. Client loved the wellness summary – acted as her own food diary and really helped her see and track
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CLIENT PROGRESS NOTES
that she got something in every group. She is now getting all she needs and now we just need to start fine tuning
(what options is she getting in each category). Voiced she has not more “empty calories” and is filling up on
healthy foods that is good for her (i.e. a filling lunch instead of skipping and wanting high cho, refined grains for
snacking later on). She has been snacking less.
Handouts provided:
- Protein + Fiber worksheet (homework assignement)
- More summary wellness worksheets for food tracking
- Portion worksheet to use for tracking
- Hidden sources of sodium worksheet (provided from own computer)
Monitor/Evaluation:
- Plan to meet in 2 weeks to see if met goals, what were recent challenges/obstacles, how is physical
activity?
- Look into physical activity adding strength for future?
- Look into fine tuning small decisions for each food she chooses
Client: LN
Date: 10/5
Assessment: Age: 19 Race: Gender: F Reason/concerns: General Nutrition tips and help; would like to lose 10#
Client description here: Pt presents happy with goals made thus far and is excited to continue. Shows enthusiasm towards
change and has made much progress thus far.
Height: 5’5” Weight: 160 Ideal Weight: 125 Preferred Weight: 145
Weight Hx: Was 145-150 in High School
but has gained 10# since coming to college
Personal Medical Hx:
None
Family Medical Hx: Mom has High Blood Pressure/Hi Cholesterol
Activity level: Less than 30 minutes, participates in band (expresses this as activity)
Alcohol consumption: 1x/week
Smoker? No
Medications/Supplements: Occasional Iron and Calcium supplement
Previous diet efforts: Always tried losing in the past but never seen any progress “ I will cut my intake in half and workout an
hour+/day for a couple weeks but I am hungry all the time and just go back to normal eating patterns”
Behavior: 24 hour intake vs. ChooseMyPlate goals
Meat /Beans Discretionary
Calories
Grains
Vegetables
Fruits
Dairy
Recommended
2000
6 oz
2.5 c
2c
3c
5.5 oz
Actual
1500
4
3c
2c
3c
5-6 oz
Past week food intake/habits/barriers
- Always starts off days very well! (Perfect Breakfast – easy to do at D2, stays full and feels satisfied) – good self talk
- Found new salad at West End (soba noodles/edamame) – kept her full and satisfied and lots of Veg and protein!
- Water was easy goal to meet
Previous Goals met?
- Water – YES
- PA – No (challenges: too busy with 2 tests and project and going home this weekend) – still has time to make up
- 2 veg/day – YES
- Grocery Store – YES – carrots and applesauce
Challenges/Obstacles with current diet:
- feels not that hungry so doesn’t eat for a while (skips meals) and then eats “everything in sight when getting home”
- P.A. is difficult with schedule
- Starts day off good and then falls as day goes on
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CLIENT PROGRESS NOTES
Diagnosis: Overweight related to low fruit and vegetable intake as evidenced by 10# weight gain in past 2 years. Low
phto-nutrient diet related to lack of knowledge of fruit and vegetable intake as evidenced by unbalanced MyPlate and food
record.
Intervention: goals,strategies and handouts
Ongoing Goal: Continue to eat 1 fruit, 2 vegetables, 3 bottles water every day
Goal 1: ABP choices – if going to choose mac and cheese do ½ mac and cheese with side salad
Goal 2: Don’t skip meals! Focus on eating lunch and not missing out because not as “hungry” – try Hokie Grill and Owens
instead of only ABP for lunch choices
- bring fruit in bag, small bag of nuts to hold off until meal time (prevent from starving for long amount of time)
Goal 3: Physical Activity 2-3x/week for 30-60 minutes
Handouts provided: Snack ideas, breakfast and lunch ideas, wellness summary goals
Strategies: Input foods in fatsecret.com to track meals, going to market this weekend at home, less busy week next week to
start P.A., work on trying new places for lunch ideas (Hokie Grill and Owens instead of only ABP where it is hard to resist
mac and cheese temptation),
M/E Monitoring and evaluation: follow-up plans
- plan to meet in 1 week to evaluate goals and see what we have met and what were challenges
- plan to go over goals to see they have been met and identify challenges through the week
- next time plan to decipher food labels, input food tracking (fatsecret.com)
Nutrition Counselor’s Signature: Kristen DeAngelis 10/5 @ 11:30 A.M.
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