DIETARY MANAGERS TRAINING PROGRAM REVIEW SESSION

1
DIETARY MANAGERS TRAINING PROGRAM REVIEW SESSION

• Becky Rude, MS, RD, CDM, CFPP
• University of North Dakota
• beckyrude_at_mail.und.edu

2
What the Exam Includes

• Management of food services 35
• Nutrition 22
• Management of Personnel 19
• Sanitation 24

3
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

4
Test Taking Strategies

• Relax
• Be physically ready
• Be mentally ready
• Pace yourself
• Dont 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

5
Medical Nutrition Therapy

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

6
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

7
Assessment

• Clinical
• Laboratory
• Anthropometric
• Diet
• Medical / Social hx (history)

8
Assessment Timeline

• New admission
• Assessment 5 day 14 day 30 day
• Care Plan 21 days
• Quarterly
• Annually
• Changing conditions
• Monthly weights

9
Triggers

• Significant weight loss
• Taste alterations
• TPN / IV / TF
• Mechanical altered diet
• Therapeutic diet
• gt 25 food left
• Pressure ulcers (decubitus ulcers)

10
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)

11
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

12
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

13
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

14
Diet

• Diet Order NAS
• Diet Hx C P
  F
• 1 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

15
Diet Analysis

• Totals C P F
• 66 24 15
• Kcal 264 96 135 495 Kcal
• Percentages
• Food Guide Pyramid
• Deficiencies?

16
Applications

• Appropriateness of diet / menu modifications
• Religious preferences
• Individualized care plan
• Tray accuracy
• Supplemental feedings
• Food acceptability

17
Education

• Assess needs / knowledge base-goal oriented
• Identify resources
• Adapt teaching materials
• Home care

18
Documentation

• Appropriate format
• Section K
• Other sources
• Confidentiality

19
Review -

• High Sodium Foods
• High Potassium Foods
• High Calcium Foods
• High Protein Foods

20
Review

• High Cholesterol Foods
• Gluten containing foods
• Lactose containing foods
• Common allergens / foods

21
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.

22
Quiz 1 Sample Exam

• Nutrition

23
Foodservice Operation

• Centralized
• Decentralized
• Menu Planning / Recipe conversion

24
Recipes

• Adjustment new yield / old yield
• Standardized recipe components
• Proper cooking techniques
• Calculate nutrition content / cost
• Design new recipe
• Criteria
• Client acceptance

25
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

26
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

27
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.

28
Workflow

• Configuration
• U- shaped
• Galley
• Workflow
• Placement of equipment
• Work simplification
• Ergonomics

29
Production

• Production Sheet
• Forecast
• Menu Items / substitutions
• Portion control / food waste
• Tray line systems
• Productivity

30
Purchasing

• Specifications
• Menu
• Space and utilities
• Material (NSF / UL)
• Cleaning
• Maintenance
• Repair vs. replacement

31
Specifications

• Evaluate existing equipment
• Evaluate replacement equipment
• Budget justification
• Vendor / product comparison
• Can cutting
• Vendor / product selection

32
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

33

• Cost per unit
• Cost a catered event
• Cost menu
• Calculate daily cost per client

34
Calculate Variance

• Actual money spent 66,250
• - budget -
  64,751
• 
  ___________
• 
  1499
• Divide by budget
• 1499 64,751 0.023 x 100 2.3
• over-budget

35
Quiz 2 Sample Exam

• Foodservice Management

36
Human Resources / Personnel

• Implement change
• Identify personnel needs
• Job analysis / specifications / description
• Orient / motivate
• Present work procedures / plans
• Teach / coach employees
• Set goals

37
Management Styles

• Authoritative
• Participative
• Proactive

38
Employees

• Communicate
• Schedules
• Calculate FTEs
• Work assignments
• Define needs
• Performance evaluation
• US Department of Labor

39
Professional Interactions

• Organizational Chart
• Patient Care Conferences
• Meet community needs
• Audits

40
Quiz 3 Sample Exam

• Personnel Management

41
Sanitation

• Contaminants / Hazards
• Biological
• Chemical
• Physical
• Symptoms of foodborne illness

42
Personal Hygiene

• Hand washing
• Diseases transmitted by people
• Universal precautions
• Training

43
HACCP

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

44
Ground Beef

• Purchasing
• Inventory
• Security
• Perpetual
• Physical
• Cost control

45
Preparation

• Cross contamination
• Safe thawing

46
Cooking

• Critical control points
• End point cooking temps (critical limits)
• Temperatures
• Service
• Cooling
• Re-heating

47
Continued

• Corrective action
• Record keeping
• Verify
• 7 steps of HACCP

48
Materials

• Easy to clean
• Equipment maintenance schedule
• Preventative maintenance
• Proper cleaning technique
• Training
• Right to know
• MDS

49

• IPM
• Clean vs. Sanitary
• Temperatures in dishwashing
• Safety inspection checklist
• OSHA

50
Crisis Management

• Emergency contact
• Call list
• Secure inventory
• Alternate menu
• Potable water

51
Review

• TDZ
• TCS foods
• A.
• B.
• C.
• Thawing
• A.
• B.
• C.

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

52
Quiz 4 Sample Exam

• Sanitation

53
Questions???
54
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
• beckyrude_at_mail.und.edu