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