DIETARY MANAGERS TRAINING PROGRAM REVIEW SESSION Becky Rude, MS, RD, CDM, CFPP University of North Dakota [email protected].

DIETARY MANAGERS TRAINING PROGRAM

REVIEW SESSION

Becky Rude, MS, RD, CDM, CFPPUniversity of North Dakota [email protected]

What the Exam Includes

• Management of food services – 35%

• Nutrition – 22%

• Management of Personnel – 19%

• Sanitation – 24%

Be Prepared

• Know what to expect– Test outline

• Refer to the exam application booklet• Know the percentages for each area

– Resources needed• Calculator, pencils, test admission letter, ID, etc.

– Review your textbooks• Practice the multiple choice questions at the end of

each chapter

Test Taking Strategies

• Relax

• Be physically ready

• Be mentally ready

• Pace yourself– Don’t spend a large amount of time on one

question. Circle it, and go back later

• If in doubt – go with your first instinct

• Take a deep breath every now and then

Medical Nutrition Therapy

• Nutrients– CHO– Protein– Fat– Vitamins– Minerals– Water

Calculating Calories

• Chicken Alfredo C P F– 4 oz. chicken breast 0 28 12– 1 cup pasta 30 6 0– ¼ c. alfredo sauce 0 0 10

• Calculate kilocalories

• Calculate % Kcal from CHO, Pro, and Fat

Assessment

• Clinical

• Laboratory

• Anthropometric

• Diet

• Medical / Social hx (history)

Assessment Timeline

• New admission– Assessment – 5 day ; 14 day; 30 day– Care Plan –21 days

• Quarterly

• Annually

• Changing conditions

• Monthly weights

Triggers

• Significant weight loss

• Taste alterations

• TPN / IV / TF

• Mechanical altered diet

• Therapeutic diet

• > 25% food left

• Pressure ulcers (decubitus ulcers)

Calculate Nutrient Needs

• Kcal (Kilocalories)– Male 1 Kcal/kg body weight x 24 hours– Female 0.9 Kcal/kg body weight x 24 hours– Plus activity– Plus stress (injury factor)

• Protein (0.8 g, x kg. body weight)

• Fluids ( 30 ml c kg. body wt.) (1cc per Kcal)

Case Study

• 77 y.o. female – CC: productive cough and weakness– Alert and oriented x 3– Dx: pneumonia– Ht. 65”, wt. 135#. UBW = 145# (1 mo ago)– Nutrition related labs:

• hgb – 10.9• Hct – 32.1%

– PMHx: HTN and colon CA– Diet Order; NAS

Healthy Body Weight

• 65” client– 100# + (5# x 5”) = 100 + 25 = 125#– Large frame: + 10% → 125# + 13# = 138#

– % healthy body weight: 135# / 138# = 0.98%

– % weight change: 145# - 135# = 10#

10# / 145# = 0.07 or 7%

Estimated Needs

• BMR 135# / 2.2 = 61.36 kg.61.36 kg. X 0.9 kcal / kg x 24 hours = 1325 kcal

Maintenance

1325 kcal x (activity factor) x (stress factor)

Protein

61.36 kg. X 0.8 g. Pro / kg. = 49 g. Pro

Fluids

61.36 kg. X 30 ml. / kg = 1841 ml./day

Diet

• Diet Order: NAS

• Diet Hx C P F1 c. coffee 0 0 0

1 slice toast / 1 t. marg. 15 3 5

½ Roast Beef Sandwich 15 14 10

½ c. water packed pears 15 0 0

1 c. cornflakes 15 3 0

½ c. skim milk 6 4 0

Diet Analysis

• Totals C P F

66 24 15

Kcal: 264 + 96 + 135 = 495 Kcal

Percentages:

Food Guide Pyramid

Deficiencies?

Applications

• Appropriateness of diet / menu modifications

• Religious preferences

• Individualized care plan

• Tray accuracy

• Supplemental feedings

• Food acceptability

Education

• Assess needs / knowledge base-goal oriented

• Identify resources

• Adapt teaching materials

• Home care

Documentation

• Appropriate format

• Section K

• Other sources

• Confidentiality

Review -

• High Sodium Foods

• High Potassium Foods

• High Calcium Foods

• High Protein Foods

Review

• High Cholesterol Foods

• Gluten containing foods

• Lactose containing foods

• Common allergens / foods

Review

• 1 t. = _____ ml• 1 oz. = _______ ml• 8 oz. = ________ ml• 1# = ______ oz.• 1 c. = _____T.• 1 T. = _____t.• 1 qt = _____ c.• 1 gal = ____ qt.• #8 scoop = _____ cup• # 16 scoop = _____ cup

• 1 T. = _____ ml• 1 qt.= _____ ml• 1 qt. = _____ oz.• 1 c. = ______ oz.

Quiz 1 – Sample Exam

• Nutrition

Foodservice Operation

• Centralized

• Decentralized

• Menu Planning / Recipe conversion

Recipes

• Adjustment – new yield / old yield

• Standardized recipe components

• Proper cooking techniques

• Calculate nutrition content / cost

• Design new recipe– Criteria– Client acceptance

Example: Meatloaf

Ingredients:

3# ground beef 1 egg

¼ c. chopped onion 1 c. bread crumbs

1 t. ground mustard 1 c. tomato sauce

1 T. worcestershire sauce

Yield: 12 – 3 oz. portions

Bake: 350 ° F. for one hour

Scaling

Original yield: 12 – 3 oz. portions

New yield: 57 – 3 oz. portions

57 / 12 = 4.75 (factor)

AP = 16 oz.

EP = 12 oz.

12 / 16 = 0.75 or 75%

Recipe Costing

Ground Beef $2.29 / lb.

Egg 1.79 / doz

Onion .35 / cup

Ground Mustard .05 / t.

Worcestershire Sc .05 / T.

Bread crumbs .45 / c.

Tomato sauce .79 / c.

Workflow

• Configuration– U- shaped– Galley

• Workflow– Placement of equipment– Work simplification– Ergonomics

Production

• Production Sheet

• Forecast

• Menu Items / substitutions

• Portion control / food waste

• Tray line systems

• Productivity

Purchasing

• Specifications

• Menu

• Space and utilities

• Material (NSF / UL)

• Cleaning

• Maintenance

• Repair vs. replacement

Specifications

• Evaluate existing equipment

• Evaluate replacement equipment

• Budget justification

• Vendor / product comparison– Can cutting

• Vendor / product selection

Budget

Cafeteria – gross receipt

Raw food cost– beginning inventory $ 5000.00

+ purchases 8000.00- Ending inventory 3000.00

Raw food cost 10,000.00

Meals served 8250

Cost per meal (10,000 / 8250) = $1.21

• Cost per unit

• Cost a catered event

• Cost menu

• Calculate daily cost per client

Calculate Variance

Actual money spent $66,250 - budget - 64,751 ___________ 1499

Divide by budget1499 ÷ 64,751 = 0.023 x 100 = 2.3%

over-budget

Quiz 2 – Sample Exam

• Foodservice Management

Human Resources / Personnel

• Implement change

• Identify personnel needs– Job analysis / specifications / description

• Orient / motivate

• Present work procedures / plans

• Teach / coach employees

• Set goals

Management Styles

• Authoritative

• Participative

• Proactive

Employees

• Communicate

• Schedules

• Calculate FTE’s

• Work assignments

• Define needs

• Performance evaluation

• US Department of Labor

Professional Interactions

• Organizational Chart

• Patient Care Conferences

• Meet community needs

• Audits

Quiz 3 – Sample Exam

• Personnel Management

Sanitation

• Contaminants / Hazards– Biological– Chemical– Physical

• Symptoms of foodborne illness

Personal Hygiene

• Hand washing

• Diseases transmitted by people– Universal precautions

• Training

HACCP

• Purchasing / receiving– Purchase order– Grade / inspection– Rejection process– Verify order– Signs of contamination– Storage temps– FIFO

Ground Beef

• Purchasing

• Inventory– Security– Perpetual– Physical– Cost control

Preparation

• Cross contamination

• Safe thawing

Cooking

• Critical control points

• End point cooking temps (critical limits)

• Temperatures

• Service

• Cooling

• Re-heating

Continued

• Corrective action

• Record keeping

• Verify

• 7 steps of HACCP

Materials

• Easy to clean

• Equipment maintenance schedule

• Preventative maintenance

• Proper cleaning technique

• Training– Right to know– MDS

• IPM

• Clean vs. Sanitary– Temperatures in dishwashing

• Safety inspection checklist

• OSHA

Crisis Management

• Emergency contact

• Call list

• Secure inventory

• Alternate menu

• Potable water

Review

TDZ

TCS foods– A.– B.– C.

Thawing– A.– B.– C.

Temps– Beef– Pork– Chicken– Grd Beef (meats)– Eggs– Fish– Reheating

Quiz 4 – Sample Exam

• Sanitation

Questions???

Best Wishes

• Thank you for your attendance, and best wishes on your credentialing exam, and in your career as a CDM,CFPP. I am looking forward to having you as a colleague in our profession.

Becky Rude

[email protected]