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Response 1(100 words need references ):

1. Two questions I would ask to those who needed a nutritional assessment would be:

- medical history

-stress history

The reason I would ask those would be to get an insight on the life of my client to put myself into their shoes to understand the reasoning behind their diet and what they are eating. Making connections with what they are eating and how that could affect their stress and vice versa. Obviously a poor diet can lead to many chronic disease, just like stress could. This also could give you insight on how active he/she is.

2. Asking critical thinking type of questions initiates self reflection. Self reflection added with positive reinforcement could lead to positive action in their lives. "Higher-level questions involve the ability to analyze, evaluate, or create." says one article listed below. To create a higher level of thinking could help the client solve their own problems and get them to excited to solve their own problems. 

3. I would like to gather their physical activity record, the reason why would be to see where and what they are doing to help with their stress levels. Physical activity lowers mental stress due to production of endorphins. Acute stress could be knocked down a notch by just going for multiple walks a week. I would like to gather their food logs after reassessing them. The reason behind this would be to make some sort of nutritional intervention if spotting a serious issue. The steps taken don't need to be extreme either. For example, if someone is drinking five sodas a day, it would still tremendously benefit them to only drink two sodas. These baby steps will eventually help this client out with their results, once they are seeing results, they are building their trust for you, once you they have built trust they will eventually listen to all of your words of wisdom. 

"Evidence Based Questioning Archives." Teach Like a Champion. N.p., n.d. Web. 12 Sept. 2018.

"Questioning Strategies." CITL. N.p., n.d. Web. 12 Sept. 2018.

https://jandonline.org/article/S2212-2672(17)31625-8/fulltext

Response 2(100 words need references):

The Nutrition Care Process is used to identify, plan, and meet nutritional needs and involves nutritional assessment, diagnosis, intervention, and monitoring and evaluation (Mahan & Raymond, 2017). A comprehensive nutritional assessment is important in order to identify nutritional status of at-risk individuals. Dietary intake as well as medications and supplement use history have a major impact on an individual’s health. Two questions I would ask a client would be:

1. What is your daily food intake pattern or diet history? 
2. What medications, including vitamins and supplements, are you taking?
   
   

Assessing a client’s diet history is necessary for a comprehensive nutritional assessment since inadequate intake and poor nutrition can lead to a number of health problems from malnutrition, vitamin and mineral deficiencies, and chronic diseases. A diet history can help the nutrition professional identify possible deficiencies, compare nutritional intake with nutrient requirements, and target areas of the diet where more healthful choices can be made. According to 2015-2020 Dietary Guidelines for Americans, about half of all Americans have one or more chronic diseases related to poor quality diet and lack of physical activity. The proper dietary changes can reduce an individual’s cancer and all-cause mortality risk (Shim, Oh, and Kim, 2014). Also, as cited in Shim, Oh, & Kim (2014), dietary information can be helpful in predicting the risk for cardiovascular disease.  The diet history can be obtained by using a daily food record, a 24-hour recall, as well as a food frequency questionnaire (Mahan & Raymond, 2017). It is important to note that assessment methods which rely on self-reporting are often inaccurate. However, it can still provide insight into the quality of the foods being consumed. It may be necessary to assess biochemical markers in addition to self-reporting if a deficiency is suspected in order to obtain a clear picture of the client’s nutrition status. 

Drug-nutrient interactions or food-drug interactions have the potential for life threatening consequences. “Interactions may occur between prescription drugs, over-the-counter drugs, dietary supplements, and even small molecules in food” (National Institutes of Health, 2015). These interactions can alter the intended response to medication, cause drug toxicity, and alter nutritional status (Mahan & Raymond, 2017). For example, grapefruit juice enhances systemic drug exposure and may cause dermatologic toxicity when consumed with docetaxel, an anticancer pharmaceutical (Choi & Ko, 2017). Green leafy vegetables, which are high in vitamin K can alter the effects of blood-thinning drugs like warfarin (AND, 2014). Knowing what medications and supplements a client is taking can be extremely important and helpful in avoiding serious health consequences. 

In addition to anthropometric data, diet history, and medication and supplement use, I would want to assess the client’s physical appearance, determine level of physical activity, obtain the client’s medical, social, and family history, review any laboratory data that might be available, and assess the client’s readiness to change. Examining the physical appearance of the client can help determine nutritional status. Signs of malnutrition and nutrient deficiencies and toxicities can be observed as loss of muscle mass or subcutaneous fat, edema, posture, condition of fingernails, teeth, and skin (Dennett, 2016). Physical inactivity can lead to obesity and other serious chronic conditions. Determining the client’s current physical activity level will help in making recommendations for an appropriate activity level to reach nutritional goals.  Medical, social, and family history can provide valuable information regarding the client’s past and current health status, potential future disease risk, and possible occupational or personal aspects of life that may have a significant impact on the client’s health. Biochemical assessment of nutritional status through laboratory data can be effective in diagnosing diseases and  monitoring the effectiveness of a nutrition intervention (Mahan & Raymond, 2017). Lastly, inquiring about a client’s readiness to change is an important step in determining how to proceed with a nutrition intervention. 

References

Academy of Nutrition and Dietetics. (2014). 5 common food-drug interactions. Retrieved from https://www.eatright.org/health/wellness/preventing-illness/common-food-drug-interactions (Links to an external site.)Links to an external site.

Choi, J. H., & Ko, C. M. (2017). Food and Drug Interactions. Journal of Lifestyle Medicine, 7(1), 1–9. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5332115/ (Links to an external site.)Links to an external site.

Dennett, C. (2016, February). Nutrition-focused physical exams. Today’s Dietitian, 18(2), 36. Retrieved from http://www.todaysdietitian.com/newarchives/0216p36.shtml (Links to an external site.)Links to an external site.

Mahan, L. K., & Raymond, J. L. (2017). Krause's food & the nutrition care process (14th ed.). St. Louis, MO: Elsevier.

National Institutes of Health. (2015). Herb-drug interactions. Retrieved from https://nccih.nih.gov/health/providers/digest/herb-drug (Links to an external site.)Links to an external site.

Shim, J., Oh, K., & Kim, H. (2014). Dietary assessment methods in epidemiologic studies. Epidemiology and Health, 36. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4154347/pdf/epih-36-e2014009.pdf (Links to an external site.)Links to an external site.

U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015 – 2020 Dietary Guidelines for Americans. 8th Edition. December 2015. Retrieved from https://health.gov/dietaryguidelines/2015/guidelines/introduction/nutrition-and-health-are-closely-related/ (Links to an external site.)