dietary managers training program review session becky rude, ms, rd, cdm, cfpp university of north...
TRANSCRIPT
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