Nutrition form
NURS 225: Nutritional Self-Assessment Name: Date: This assignment must be typed. No handwritten submissions will be accepted. Part 1: 10 points Subjective information. Answer each question: 1. Family History: (check all that apply) ☒Diabetes ☐High Cholesterol ☐Heart Disease ☐Hypertension ☐Cancer ☐Weight Problems ☐None ☐Other How could these disorders affect your diet? If you answered “none,” choose a disorder from the list above, and discuss how can that disorder affect your diet? Discuss in detail (at least 3 full sentences) 2. Culture: How does your ethnic culture or race or religion affect your nutritional choices? If you do not identify with an ethnic culture or race or religion, how would culture or race affect your nutritional choices? Discuss in detail (at least 3 full sentences) 3. Activity Level: ☐Never ☒Occasionally ☐1-2 days/week ☐3-4 days/week ☐5 or more days/week Discuss in detail (at least 3 full sentences) what activities do you do. 4. BMI Calculation: Height: 5.7 Weight: 150lbs BMI: Show full calculation to obtain BMI: Analysis of BMI. How does your current BMI affect your health? Discuss in detail (at least 3 full sentences): Part 2: 10 points Barriers to Healthy Living: Check the box if you agree or disagree with the statement. In at least 3 full sentences, explain in detail, why you agreed or disagreed with the statement. NURS 225: Nutritional Self-Assessment Provide an explanation of your answer choice. I do not have time to prepare healthy foods Explain: I find myself snacking on “unhealthy” foods while studying Explain: I do not like the taste of healthy foods Explain: I have problems making healthy food my family will eat Explain: I eat when I feel sad/depressed/stressed/happy/or other emotion Explain: I get “mad” at myself for not making healthier food choices Explain: I often eat past the time of feeling “full” Explain: I often have powerful cravings for “unhealthy” foods Explain: I do not have time to exercise Explain: I feel self-conscious when I exercise Explain: Agree ☐ Disagree ☒ ☒ ☐ ☐ ☒ ☐ ☒ ☒ ☐ ☒ ☐ ☒ ☐ ☒ ☐ ☐ ☒ ☐ ☒ Part 3: 15 points Two-day food recall: Write down all foods you have consumed for two full days. It does not have to be consecutive days. Day One Breakfast: Lunch: Dinner: Snacks: Day Two Breakfast: Lunch: Dinner: Snacks: Nutrition: Please show your calculations of your Recommended Daily Allowance (RDA) for your Proteins, Fats, and Carbohydrates. Find the nutritional values for the nutrients below for each day: Nutrient Your RDA based on weight/height/activity level (show calculations for Proteins, Fats, & Carbohydrates) Day One Day Two NURS 225: Nutritional Self-Assessment Protein Carbohydrates Fat Fiber Vitamin C Iron Cholesterol B: L: D: S: Total: B: L: D: S: Total: B: L: D: S: Total: B: L: D: S: Total: B: L: D: S: Total: B: L: D: S: Total: B: L: D: S: Total: B: L: D: S: Total: B: L: D: S: Total: B: L: D: S: Total: B: L: D: S: Total: B: L: D: S: Total: B: L: D: S: Total: B: L: D: S: Total: Part 4: 10 points Answer each question based on your food recall 1. Based on your subjective data, barriers, and nutritional analysis, what changes should you make to your current diet? Discuss in detail (at least 3 full sentences) (Support your answer with at least one reference) NURS 225: Nutritional Self-Assessment 2. Provide one SMART goal (specific, measurable, achievable, realistic, timed) and provide two strategies to help you obtain that goal. Discuss in detail (at least 3 full sentences) 3. Reflection: What did you learn from this assignment regarding your diet and health in regard to your dietary habits? Discuss in detail (at least 3 full sentences)
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