1. Elissa Gray

2. BREAKFAST: WHEAT TOAST WITH JELLY, COFFEE LUNCH: TUNA SALAD SANDWICH ON WHEAT BREAD, COTTAGE CHEESE, CHIPS, DIET COKE. DINNER: POT ROAST, MASHED POTATOES, ROASTED CARROTS, DINNER ROLL, MILK DESSERT: ICE CREAM SANDWHICH She also drank 4 glasses of water throughout the day GRANDMA PAM’S 24 HOUR DIET INTAKE

3. The pyramid for older adults includes adequate consumption of whole grains, vegetables, fruits, dairy and protein, while limiting fats and oils. Older adults may need to take in extra protein to reduce the likelihood of frailty. Also, older adults need to endure adequate intake of fiber. A flag depicting vitamin B12, vitamin D and calcium is atop the modified pyramid for older adults, reminding them that they may need extra intake of these vitamins. The bottom of the pyramid shows eight glasses of water, reminding older adults of the importance of hydration (Touhy and Jett, 2012, pp. 241-42, figure 14-1). DIETARY RECOMMENDATIONS FOR OLDER ADULTS

4. Whole grain breads Tuna and pot roast for protein Milk, ice cream, and cottage cheese for dairy Carrots and mashed potatoes for vegetables 4 glasses of water She needs additional fruits and vegetables She only drank half the recommended glasses of water She is not taking any supplementation for calcium or vitamins Empty calories with the chips Grandma Pam’s strengthsGrandma Pam’s weaknesses COMPARISON

5. Weight: 146 lbs Height: 62 inches BMI: 26.7 Below 18.5: Underweight 18.5-24.9: Healthy 25.0-29.9: Overweight 30.0-39.9: Obese Over 40: Extreme or high risk Elderly: Greater than 65, recommended BMI is 25-27 (Medline Plus, 2012) Grandma Pam’s BMIGeneral BMI BMI

6. Although my grandma Pam doesn’t have the worst diet in the world, she definitely has room for improvement. She is an older women and is therefore at high risk for osteoporosis, and really needs to increase her calcium and vitamin D intake. And although her whole wheat bread provides some fiber, she needs to increase her fruits and vegetables to ensure she gets all the fiber and vitamins needed. Lastly, she needs to double her water intake to ensure proper hydration; “Fluid intake is more important to emphasize in older than in younger adults, because compromised homeostatic mechanisms such as loss of thirst sensation can result in dehydration” (Lichtenstein, et al, 2007, p. 8). The food pyramid made for older adults is a great tool to educate about the importance of dietary intake: “The Modified MyPyramid provides food and nutrition professionals with an excellent visual aid that they can use when educating older adults” (Peregrin, 2008, p. 938). DRAWING CONCLUSIONS

7. Readiness for enhanced self health management Risk for deficient fluid volume Readiness for enhanced nutrition NURSING DIAGNOSIS

8. My dietary intake changes from week to week; on good weeks I would describe my intake as fair, and on bad weeks I would describe my intake as poor. I am basing these ratings on the foods that I enjoy eating and the foods that I do eat. At times the foods I eat are the foods recommended by the food pyramid, but at other times my intake is junk food. MY DIETARY INTAKE

9. Weight: 171 lbs Height: 67 inches BMI: 26.6 Below 18.5: Underweight 18.5-24.9: Healthy 25.0-29.9: Overweight 30.0-39.9: Obese Over 40: Extreme or high risk Elderly: Greater than 65, recommended BMI is 25-27 (Medline Plus, 2012) My BMIGeneral BMI BMI

10. I eat whole grain breads, pastas, and rice I drink 3-4 glasses of water while at work and at home I drink skim milk I eat lean meats for protein I take a multivitamin everyday I do not eat enough servings of fruits and vegetables I need to increase my water intake I regularly consume empty calories, such as pop or junk food I consume fast food at least twice a week StrengthsWeaknesses MY DIET

11. I spoke with my grandma Pam about ways that she can alter her nutritional intake to live a healthier lifestyle, but I too need to make dietary changes. I have decided to completely eliminate pop and fast food, and will instead drink low-calorie Gatorade and eat healthy option frozen meals when I am pressed for time. I plan on using the app My Fitness Pal to calculate my caloric intake while maintaining a maximum daily intake of 1500 calories. In addition, I will exercise for at least 30 minutes for three of my four days off of work. Talking with my grandma about her nutritional needs opened up my eyes to my own dietary shortcomings, and it is incredibly hard to teach someone about a healthy lifestyle when I am not living a healthy lifestyle myself. My short-term goal is to lose 15 pounds by the end of the year. MY PLAN

12. Lichtenstein, A., Rasmussen, H., Yu, W., Epstein, S., and Russell, R. (2007) Modified MyPyramid for older adults. The Journal of Nutrition. Retrieved from http://jn. nutrition.org/ content /138/1/5.full Medline Plus (2012) Body mass index. National Institute of Health. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article /007196.htm Peregrin, T. (2008, June). Getting to know the modified mypyramid for older adults. Journal of the American Dietetic Association, vol 108, (6). doi 10.1016/j.jada.2008.04.006 Touhy, T. and Jett, K. PhD (2012) Ebersole & Hess’ toward healthy aging: Human needs & nursing response (8th ed.) St. Louis, MO: Elsevier Mosby REFERENCES