Andrea Langis  Forum 2: Observing an elderly individual Discussion Board Forum 2 1.My subject. My subject is elderly individual. Demographic information of your subject. My subject is a 66-year-old female who both retired and disabled. Describe the location of your observation. The location where the observation took place was my residence, during a small Father’s Day gathering. Identify the foods eaten during the meal. The foods eaten during this meal were corn, hot dog with bun, and baked beans. Estimate the portion sizes eaten during the meal. The portion sizes consumed during this meal were about 2 tablespoons of baked beans, corn on the cob (1 ear) and one hot dog and bun. An evaluation/analysis While providing a detailed evaluation/ analysis I noticed that this meal provided both a good source of energy but also lacked depth to it. According to studies and research between 500-700 of your daily calories should come from dinner and/or lunch.1 Which means that this individuals dinner falls in the healthy amount of the caloric intake coming from that meal. While looking at her daily intake some may be worried, but I am not. I am not worried as I do not see any signs of malnutrition, which many elderly folks suffer from. You may be surprised to hear that not only people coming from developing countries suffer from malnutrition. Malnutrition within the elderly community can lead to some serious issues, and cause a weak immune system over time, which makes healing from anything nearly impossible. Often malnutrition can be caused by absorption issues, in fact the Institute of Medicine has their own guidelines for those 70 ages older. 2 While this specific meal accounts for nearly 37% of the daily fat, and calories, this meal lacks proper source of vitamins and minerals. After going through the report, this meal lacks variety, is not a nutrient dense meal and provides little nutrition and vitamins that our bodies need daily. However, it does provide over half of the daily allowance for Iron, and Sodium. This meal lacks proper sources of vitamins, such as Vitamin Bs, C, D, E and magnesium. Nutrition is extremely important to the health of an elderly individual and is a large factor that contributes to poor health condition.3 Concerns or hinderances. After analyzing both the report and seeing of the subject I noticed something concerning. I noticed that she lacked mobility issues, difficulty walking without a cane, and muscles cramps while sitting. I also noticed that lack of magnesium in her diet. Magnesium plays a major role within the neuromuscular system, and in particular the transmission of muscle contraction, if one suffers from magnesium deficiency cramps may become prevalent.4 The lack of magnesium in her diet is a concern for me, and impacts her overall health and further impacts her mobility issues. Specific suggestions for improvement. I think in general it is somewhat difficult to make suggestions for improving her diet and overall nutrition without seeing the rest of her diet and intake during the day. However, after seeing one meal I can suggest that she meet with a nutritionist as what she intakes impacts her body and can add more weight to her body. Because she lacks mobility, she is unable to do basic exercise movement or walk, which then impacts her body and bones. Bones and joins need exercise and mobility to keep functioning, so when they are not getting the correct movement due to lack of exercise its further attributes to the issue. It appears it is a double edge sword. I would recommend getting in water aerobics as it is low impact, and start taking a multi vitamin and perhaps another magnesium supplement on top of that to focus more on the muscle cramps. Water aerobics has been shown to be successful and improve motor function and general health of those older adult who participated in water exercising. 5 Discuss the role of a public health nutritionist as it pertains to your findings. While I feel it would be more beneficial in this circumstance to work with someone on an individual level. There are some great things that a public health nutritionist can do for my subject, as certain problems within the community can be put in place to help the elderly community. The role of the public health nutritionist can develop meal plans accessible to the elder community, that are low in cost as well as provide exercise programs with the local aquatics and fitness centers that focus on those above 65 years of age. The nutritionist also can work with her doctor or the hospital where she is getting care to help provide healthcare policies and work with programs that will better her access to care.                                                            References: 1. Reid KJ, Baron KG, Zee P C. Meal timing influences daily caloric intake in healthy adults. Nutrition Research. 2014;34(11):930-935. doi:10.1016/j.nutres.2014.09.010 2. Providing Healthy and Safe Foods As We Age. 2010. doi:10.17226/12967 3. Wells JL, Dumbrell AC. Nutrition and aging: assessment and treatment of compromised nutritional status in frail elderly patients. Clinical Interventions in Aging. 2006;1(1):67-79. doi:10.2147/ciia.2006.1.1.67 4. Schwalfenberg GK, Genuis SJ. The Importance of Magnesium in Clinical Healthcare. Scientifica. 2017;2017:1-14. doi:10.1155/2017/4179326 5. Irandoust K, Taheri M, Mirmoezzi M, et al. The Effect of Aquatic Exercise on Postural Mobility of Healthy Older Adults with Endomorphic Somatotype. International Journal of Environmental Research and Public Health. 2019;16(22):4387. doi:10.3390/ijerph16224387 Second reply: Andrea Belk Toddler - Andrea Belk Subject – The subject is a toddler. Demographic Information – The subject is a 14 month old female. Location – The home of the toddler is located on Fort Stewart, GA. Foods Eaten – The toddler consumed 1/6cup shredded cheese, 1oz of taco meat, 2/3 cup of peas and 4oz of whole milk. Portion Sizes – The toddler was given the portions stated above. At the end of her meal she threw the rest of the food on the floor. I would guess she ate about ¾ of the food she was given. Evaluation/Analysis – Toddler’s need small and frequent meals so it would not be safe to assume this meal would make up 1/3 of the subjects nutritional needs.1Toddlers need to consume 1,000 to 1,400 kilocalories each day. Of that 45-65% should be carbohydrates. Good choices for carbohydrates include fruits, vegetables and whole grains. Toddlers need 5-20% of their diet to be protein. 1.1 gram per kilogram of body weight. This toddler is about 23 pounds/10.5kilograms. She needs to consume around 11 grams of protein each day. Fat intake for toddlers is around 30-40% of kilocalories. Fat is a crucial part of a toddler’s diet because it contributes to brain development.2 Iron, calcium and vitamin D are a super important part of a toddler’s diet. Iron contributes to preventing developmental delays, toddlers need at least 7 mg per day. Calcium and vitamin d support rapid bone growth.1 Toddlers need about 700 milligrams of calcium and 15 micrograms of vitamin d each day.1 The given meal was 235 calories. The meal contained 18grams of protein, 18grams of carbohydrates and 9 grams of fat. This meal provided 10mg of iron reaching her daily goal. While the toddler did not eat all of this food, it’s a good start to consuming all of her daily nutrients. Concerns – My biggest concern is that the toddler may be consuming too much protein. I’m the mother of this toddler so I know that she only consumes meat at 1-2 of her 5-6 meals per day. She eats plenty of carbohydrates in the form of iron fortified cereals such as Cheerios. Specific suggestions for improvement – I believe this toddler needs to consume an adequate amount of carbs. In the future the mother (me) can incorporate more fresh fruits. She consumes plenty of vegetables. The mother can also offer more whole grain pastas and yogurt to provide variety. Role of a public health nutritionist – A public health nutritionist could work at the health department. They can provide educational class and guidance for parents in terms of toddler nutrition. They can ensure parents understand not only nutritional goals but also fluid intake. Parents should be provided information about sugary drinks and healthy snack ideas. Public health nutritionist can also educate parents that toddlers should never be left unattended when eating.2 1. Blake JS, Munoz KD, Volpe S. Nutrition: from Science to You. 2nd ed. New York: Pearson; 2019. 2. Nutrition: Toddler. Stanford Children's Health. https://www.stanfordchildrens.org/en/topic/default?id=toddler-nutrition-90-P02291. Accessed June 22, 2020.

Develop a 3-4 page preliminary care coordination plan for a selected health care problem. Include physical, psychosocial, and cultural considerations for this health care problem. Identify and list available community resources for a safe and effective continuum of care. Introduction NOTE: You are required to complete this assessment before Assessment 4. The first step in any effective project is planning. This assignment provides an opportunity for you to strengthen your understanding of how to plan and negotiate the coordination of care for a particular health care problem. Include physical, psychosocial, and cultural considerations for this health care problem. Identify and list available community resources for a safe and effective continuum of care. As you begin to prepare this assessment, you are encouraged to complete the Care Coordination Planning activity. Completion of this will provide useful practice, particularly for those of you who do not have care coordination experience in community settings. The information gained from completing this activity will help you succeed with the assessment. Completing formatives is also a way to demonstrate engagement. Preparation Imagine that you are a staff nurse in a community care center. Your facility has always had a dedicated case management staff that coordinated the patient plan of care, but recently, there were budget cuts and the case management staff has been relocated to the inpatient setting. Care coordination is essential to the success of effectively managing patients in the community setting, so you have been asked by your nurse manager to take on the role of care coordination. You are a bit unsure of the process, but you know you will do a good job because, as a nurse, you are familiar with difficult tasks. As you take on this expanded role, you will need to plan effectively in addressing the specific health concerns of community residents. To prepare for this assessment, you may wish to: Review the assessment instructions and scoring guide to ensure that you understand the work you will be asked to complete. Allow plenty of time to plan your chosen health care concern. Note: Remember that you can submit all, or a portion of, your draft plan to Smarthinking Tutoring for feedback, before you submit the final version for this assessment. If you plan on using this free service, be mindful of the turnaround time of 24-48 hours for receiving feedback. Instructions Note: You are required to complete this assessment before Assessment 4. Develop the Preliminary Care Coordination Plan Complete the following: Identify a health concern as the focus of your care coordination plan. In your plan, please include physical, psychosocial, and cultural needs. Possible health concerns may include, but are not limited to: Stroke. Heart disease (high blood pressure, stroke, or heart failure). Home safety. Pulmonary disease (COPD or fibrotic lung disease). Orthopedic concerns (hip replacement or knee replacement). Cognitive impairment (Alzheimer's disease or dementia). Pain management. Mental health. Trauma. Identify available community resources for a safe and effective continuum of care.

You have been hired as a Deputy Secretary of Health of your home state or the state of your choosing. The topic of healthcare is mentioned in the national news on an almost weekly basis. Given the upcoming gubernatorial election, the governor has asked the health commissioner to provide a summary of the state’s health status. The Secretary has tasked you to develop the analysis. Go to the Country Health Rankings & Roadmaps website https://www.countyhealthrankings.org/ and complete the following steps: 1.     Access the Rankings for your home state or the state of your choosing. 2.     View the maps for health outcomes and health factors for the most recent year available, and compare the two. Which counties rank first and last in the state? 3.     Use the “Compare Counties” feature to examine your home county with another (it can be either the first, last, or another of your choosing). Describe how your home county compares to the state as a whole. 4.     Go to the Action Center and explore the sections there. Based on the Governor’s elections concerns, you think that he might be questioned -on the ethical issues around the public health concern you chose to analyze. -It would drive the question about the local policies in place to address it, -and the state/federal regulations and agencies responsible for their enforcement. 5. Conduct analysis and develop a research brief (research report) addressing 1-4 no longer than 6-8 pages long. 6. Develop a Press Release conveying the information from your research report  (https://www.semrush.com/blog/hook-the-media-with-7-easy-steps-to-writing-a-press-release-free-template/?kw=&cmp=US_SRCH_DSA_Blog_Core_BU_EN&label=dsa_pagefeed&Network=g&Device=c&utm_content=515715474945&kwid=dsa-1053501807067&cmpid=11769537497&agpid=117335014711&BU=Core&extid=167368304751&adpos=&gclid=Cj0KCQjw3f6HBhDHARIsAD_i3D-3LCkm2dQSd22SYHE2pJFDebWWglrhJZfuTuzf78FTny1doQslwtwaAvifEALw_wcB) for the Candidate to be presented at the press conference dedicated to the election. The Candidate will be expected to demonstrate viable ideas and plans in counteracting the issue as well as leadership tools applied to calm and reassure the public.