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II. Analysis of 24-Hour Recall, Typical Day and Client History and

1. My clients name is Danielle Sinn. She is my younger sister and just began her
freshman year at West Chester University.
a. Demographic Data: She is currently 18 years old, her height is 5 feet
5 inches tall and she is 130 pounds
b. Health History: Danielle indicated that she has no current medical
concerns but did list that cancer, diabetes, heart disease, high
cholesterol, high blood pressure and thyroid disorders have affected
her blood relatives. Her only complaint was in regards to issues with
stress. Danielle has never abused tobacco but does enjoy physical
activity. She also has no known food allergies or intolerances.
c. Medication and Supplement History: Danielle acknowledged her
daily consumption of two medications. Triestrayella is her birth
control pill she takes daily and Fluoxatine is an anti-depressant she
takes daily as well.
d. Diet History: My sister identifies herself as a pescatarian but has
never followed any special diet. She has never experienced any
problems purchasing foods she wants to buy. Danielle does not eat
meat and says she typically eats (at least) three times per day.
Standard junk food items are things my sister typically likes to eat
when she can. Danielle listed that she does consume alcohol about
two times a week. Changes she hopes to make moving forward
include improvement of her overall eating habits, activity levels and
managing her cholesterol/triglyceride levels in addition to adding
more fitness to her daily life.
e. Social History: Danielles current occupation is that of a full-time
student. There are four people in our household and of those people
our mom is responsible for food shopping on a weekly basis. Danielle
also says that either herself or our mom is responsible for preparing
meals (which is not entirely true, I try and help sometimes too!). She
does not use convenience foods on a daily basis, says she eats out
approximately two times a week at local restaurants. Danielle also
states that she feels she has made food changes in her life that she
feels good about and that her sister (me) encourages and supports her
diet and lifestyle changes. Lastly, she acknowledges motivation,
finances and accessibility at college to be her major barriers while
trying to make lifestyle changes.
2. The 24-hour recall conducted on Danielle was done on Wednesday,
November 9th, 2016. Her first meal of the day began at 11 am at the
Starbucks on campus. She ordered a 20-ounce Skinny Peppermint Mocha. A
trip to Starbucks is something that has become a part of Danielles daily
routine since she came to WCU. Along with her drink she also ordered an
almond croissant. This is not something she would typically order or
prepare for breakfast but it is a family favorite and she does enjoy croissants
on occasion. Danielle did not eat again until after class around 3 pm when
she had two homemade chocolate chip cookies back in her dorm room.
Cookies are treats Danielle does like to enjoy when she can (who doesnt?).
At 6 pm, she prepared a microwavable Kraft mac and cheese and ate again
around 8:30 pm one can of Progresso macaroni and bean soup in her dorm
room. Mac and cheese is not something Danielle consumes regularly
however, soup is a recurring item in her diet especially during the winter
months. Danielle also recorded approximately 48 ounces of water
consumption throughout her day.
3. There are only a couple of strengths I found while analyzing Danielles 24-
hour recall. First, she appears to have consumed three meals and one snack
throughout her day, which is appropriate in any diet. Secondly, she has
plenty of water consumption during the day as well. Also, the addition of
Progresso soup is beneficial to her on this day due to the presence of protein
and vegetables that she had none of prior to consuming the soup.
4. I have several concerns and areas I feel need improvement within my clients
diet. The biggest issue I have with Danielles diet on this particular diet was
the absence of fruit and minimal consumption of vegetables. The only source
of vegetables and protein come from the soup. She also has no whole grains
throughout the entire day and several items on her food list are very high in
5. General recommendations I would make for my client would be to try and
plan out when she will have time to eat and where she may plan to go to get
food. In college, it can be difficult to find time around our class schedules to
eat but by planning ahead of time it can be easier especially if it is necessary
to pack a meal or snack. I would also suggest continuing to consume the
amount of water she is, especially when consuming foods so high in sodium
or after a night of drinking.
6. Two specific nutritional goals I would challenge Danielle to work on would
be to add at least one cup of fruit or vegetables to her diet on a daily basis.
Making a conscious effort consume the nutrients fruits and vegetables both
have to offer could only benefit her diet. I would also suggest that Danielle
try and limit her sweets to once or twice a week. Consuming a large
Starbucks drink, croissant and two cookies all in one day is not beneficial or
healthy, especially all at once. Lastly, one specific eating behavior goal I
would ask my client to try would be to work on establishing more
conventional meal times. From her 24-hour recall she ate a meal at 11 am,
had a snack at 3 pm, what I assume was a small dinner at 6 pm and a second
dinner at 8:30 pm. I would hope to see her eating meals around 9-10 am, 12-
2 pm, a snack around 4 and dinner between 6-8 pm. Eating her meals around
these times prevents late nights snacking and the need for junk food as often;
if she is eating more frequently I hope to see my client stay fuller longer.

Session 2 with Client:

7. My client and I agreed that, moving forward, it is extremely important for her
to incorporate more fruits and vegetables into her diet. She also
acknowledged her consumption of several foods high in sodium and the
absence of whole grains in her diet. Danielle did not appear nervous or upset
when discussing her current nutrition-related problems within her diet but
rather excited and willing to make changes.
8. Written plan of action to address nutrition goals and behavior changes
9. Written plan outline:
a. One benefit to the relationship I have with my client is that we live in
the same home and attend the same University. With that said, we are
around one another very often and I am a good resource for her to use
as she moves forward making lifestyle changes. I plan to use the
Transtheoretical approach when working with my client. Important
concepts that are a part of this model include precontemplation,
contemplation, preparation, action, maintenance, termination and
recycling. I find Danielle to currently be in the preparation stage of
this model. She has already contemplated making changes and,
especially after our discussions, she is prepared to make lifestyle
changes. Another very important part of this model is the clients
readiness to change and self-efficacy. I strongly believe that my client
is both willing and able to make changes however; I feel that working
through this model could help establish goals that are clearer in order
for her to make progress. Due to my clients recent relocation to West
Chester University her struggles could be easily solved with an
adjustment to her current schedule, eating habits and resources while
living on campus.
b. Due to the fact that I have also lived in the dorms and was confined to
on-campus dining and without a car similarly to how my sister is now
I can relate to her frustrations on limited food choices and dining
options. From my experiences, I was able to relate to my client and
make several suggestions for her moving forward. I advised her to
stock up on healthy snacks from Larrys market or the POD in Main
Hall. These locations have many healthy snack options including
Greek yogurt, trail mix, sun chips or pirate booty popcorn. Another
suggestion I made was to utilize a to-go box in Lawrence dining hall or
taking food to go from Sykes earlier in the day if her busy schedule
prevents her from being able to pick up food later in the day. It would
be more beneficial for her to pick-up food ahead of time rather than
skipping a meal because she was not able to get to a dining facility in
time. Another important lifestyle adjustment I suggested was to make
time for the gym. In the past, I have found that by planning out my
days ahead of time I was able to accomplish more. I am optimistic
that my sister would have the same success if she were able to plan
c. Danielle and I agreed on four goals for her to work towards. First, we
discussed including fruits and vegetables in her diet on a daily basis.
Secondly, when grains are involved, she agreed to make a conscious
effort to choose whole grains instead of processed grains. Next, we
discussed the importance of managing her sodium intake and working
on avoiding high-sodium foods, which may prove difficult at the
dining halls. Lastly, Danielle hopes to become more physically active.
d. During our time at home for the Thanksgiving holiday, I was able to
spend a lot of time with my client and oversee her eating habits daily.
This was the perfect opportunity for me to provide an intervention
and make suggestions on her choices. Suggestions made were in
regards to food preparation methods (ie: frying versus baking) or
better snack options throughout the day (ie: sun chips or a piece of
fruit versus cookies).
e. There were not rewards provided to my client during our meetings,
however I attempted to include positive reinforcements to Danielle
when she acknowledged her concerns with making changes. She
expressed concern while on campus but I assured her that it is doable
to practice healthy living as a college freshman. Furthermore, she will
be moving off campus next school year, which will make preparing
healthy meal choices easier.
f. Behavior modification techniques were not applicable to my client
due to her readiness to make changes.
g. Educational materials attached below: