1.                  Jossy is 6 year old and is in elementary school.  At her last doctor visit, her measured height was 46 inches and her weight was 60 pounds.  Her pediatrician voiced concern over Jossy’s excessive weight gain over the past year.  Her usual diet consists of sweetened cereal with whole milk and fruit juice for breakfast and a juice drink and crackers for her mid-morning snack.  On school days, Jossy buys her lunch at school; her favorite menu items are pizza and tacos.  Jossy’s mother states that she started a new job this past year, which requires that Jossy attend an after-school program until 6 in the evening.  She receives a snack there, usually an 8 oz box of fruit juice and crackers.  Jossy’s parents report that Jossy is “always hungry” and they will often stop for her favorite chicken nuggets, fries, and soda on late evenings when the family is too tired to cook.  Jossy likes to play video games and has a computer and television in her room.  Her father complains that she spends more time in her room than playing outside.  Jossy’s mother is overweight and her father is of normal weight, although he states he was overweight as a child.  The family has discussed getting more exercise on the weekends but are not sure how to add this to their already busy schedules.

a.       Calculate Jossy’s body mass index (BMI) and use this to evaluate her weight status using the information in Figure 16-10.

b.      From the information in chapter 16, what are some factors that may have contributed to Jossy’s excess weight gain over the past year? 

c.       Considering her age and the information in chapter 16, what would be a reasonable weight management goal for Jossy? 

d.      Using the recommendations in Table 16-7, what strategies would you suggest that Jossy and her parents incorporate into their current lifestyle? 

e.       Based on her usual intake, identify at least 2 or 3 nutrients likely to be deficient in Jossy’s diet.  What major food groups provide these nutrients? 

f.       Assuming her current level of activity, what are Jossy’s estimated daily kcalorie needs according to Table 16-5? 

2.                  Chablis is a 14 year-old female who has been referred to you by her mother and family physician.  Mom is concerned that Chablis is not eating right and her doctor wants you to give Chablis some nutrition advice because she wants to be a vegetarian.  Chablis has heard that red meat contains a lot of fat and she “does not want to get fat.”  A physical exam by her physician shows that Chablis is in the early stage of sexual maturation, she weighs 89 pounds, and she is 5 feet tall.  Chablis is extremely active, spending every afternoon after school playing some kind of sport – basketball, swimming, track, or soccer. 

a.       List at least four questions you would include in your assessment session with Chablis.  Why would you include these questions?

b.      How would you address Chablis’ concern about meat and her desire to be a vegetarian? What are some sources of valid nutrition information you might recommend?

c.       How would you counsel Chablis regarding her desire not to get fat?

d.      What advice would you give Chablis’ parents regarding their interactions related to food?

3.                  Angela has been breastfeeding her baby since he was born seven months ago.  When she and her husband took the baby to the pediatrician for his check-up, they were told that he was anemic.  They were surprised, since they thought that human milk contained all of the nutrients the baby needed for the first year of life.  How can you explain the baby’s anemia?

5.         Compare the nutrient needs on the basis of per pound body weight for a 5 month male old infant (13 pounds) and the 20 year old male adult (160 pounds) for kcalories, protein, vitamin D, vitamin C, calcium, and iron – complete the following chart.  NOTE:  To calculate the per pound amount, divide the nutrient need by the number of pounds of the individual.:

6.         The ‘fountain of youth’ has been a mystery for many centuries.  People used believe if they drank water from the fountain, the aging process would stop.  Ponce de Leon was said to be searching for the fountain when he traveled to what is now Florida in the 16th century.  Today, the fountain is associated with Florida in St. Augustine.  Chase, a history student, maintains that the fountain of youth is not a place or a particular thing, but rather is a combination of diet and lifestyle.  How can Chase justify this claim?

7.         Jamie is interested in helping the elderly and works as a volunteer at a local retirement home.  She has noticed that a number of the residents have decreased appetites and diminished senses of taste and smell.  Also, depression seems to be common among the residents.  How can Jamie explain these observations?

8.         Mildred is a 75-year-old retired school teacher who lives in Florida.  About a year ago, Mildred lost her husband of forty-five years.  Mildred has three children, two of whom live out of state.  Her youngest daughter, Charlene, lives about an hour away.  Mildred has been retired for ten years.

Despite the demands of her teaching career, Mildred always managed to prepare and serve evening meals for her family.  During retirement, she continued this routine of cooking for herself and her late husband Vernon.  Now that she is living alone, Mildred continues to live independently preparing her own meals and doing light housekeeping.  She has realized, however, that it is difficult to cook for only one person.  On the positive side, Mildred is occasionally inspired to cook a creative meal and freeze the leftovers for later use.  In recent months, Mildred has become increasingly passive about cooking and has started skipping some meals.  She especially tends to forgo dinner.  Some days she snacks or eats what is available in her refrigerator.  She has also stopped her only form of exercise, walking on a daily basis. 

Mildred prefers to live independently but Charlene, her daughter, is concerned about her mother’s change of behavior and knows that her health will decline if her nutrition doesn’t improve.

What advice would you give to Mildred?

What could she do to improve her appetite and motivation to cook?

9.         The elderly may be challenged by chronic health issues as a result of physiologic challenges.  They also may suffer from mental health issues as a consequence of aging.  Discuss the many challenges one might work around to enhance the nutritional status of an elderly client as a healthcare professional.