Imagine yourself in the role of a Nutrition Counselor and Josephine is your client. Josephine is a 20-year-old
female who is present for purging disorder, an “Other Specified Feeding or Eating Disorder” (OSFED).She
currently teaches salsa lessons at the community college and is in her last semester of college. She reports
she is living at home and the food her mom prepares is not the healthiest because her mom is from Honduras
and her father is from Guatemala, so the food is prepared differently. She indicates she has been thin all her
life, although she has struggled to maintain her weight since going through puberty, and since she is a salsa
instructor, she has to remain fit. She reports she feels very guilty if she has consumed fried foods during the
day, but since that is the way her mom primarily cooks, she feels awful to tell her mom to stop cooking that
way. She reports if she does consume too much fried foods or junk food, she will run at least 2-3 miles that day
or else force herself to vomit, but all the food does not come out. She reports sometimes if she has a later
class, she will not eat dinner or only eat 1 meal per day. She has tried counting calories, but then she gets so
mad at herself for having more than 1200 calories it causes her to exercise more, which then leads her to
feeling exhausted. She indicates she is on no medication, but does take a multivitamin when she remembers.
She indicates she has gone from 110 pounds to 125 pounds over 5 years and wants to be back down to 110 or
even less. She also had gone to the doctor and he was quite concerned with her lab values. She has provided
you a 24 hour meal record:
Breakfast:
1-6” corn tortilla
½ cup fried beans cooked with peppers, onions and oil
½ cup rice
1 cup no sugar added orange juice
Lunch:
1 slice of whole wheat bread
2 slices turkey
1 small apple
Dinner:
2- 6” tortillas
Beef with onions, peppers cooked in oil
Tomato, onion, pepper salad (made with oil and lime juice)
2 cups of rice
Height: 5’2” Weight: 117 pounds (based on your scale in the office)
Labs:
Test
Result
Reference Units
Albumin (visceral protein stores)
3.3 g/dL
3.5-4.8 g/dL
Sodium
133 mEq/L
136-145 mEq/L
Potassium
3.8 mEq/L
3.5-5.2 mEq/L
Iron
0.4 mg/dL
0.6-1.1 mg/dL
Vitamin B12
185 pg/mL
200-835 pg/mL
Questions for Unit 9:
Documentation needs to be completed at each nutrition counseling session. What information needs to be
documented and kept in Josephine’s medical record?
Can we provide Josephine’s health and nutrition information to another health professional? Why or Why not?
When is her permission required? When is it not required?
In order for Josephine to continue to follow up, how do we address payment and reimbursement? How will you
handle it if she has insurance? If she does not have insurance?
What motivational techniques would you use to motivate Josephine to continue making progress?
It is important to ensure Josephine is progressing through each counseling session. Answer the following
questions regarding Josephine’s progress:
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a .How often would you schedule follow-up sessions with Josephine, and why?
b. What type of information would you like to collect at the follow-up appointments?
c. How would you assess her previously set goals? How would you modify her treatment based on her
progress?
d. Identify any obstacles which could impede her success at achieving these goals.
e. How would you help her get beyond these obstacles?
TIP: Notice that In order to achieve “Mastery” level on GEL 8.3, you must analyze a problem, then generate
more than one possible solution, and evaluate those solutions to find the best one.
Please do not use question and answer format in your essay. Instead, please write an essay with a separate
paragraph to answer each question
Sample Solution
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