NS310 Unit 10 Shift Worker Assessment Example

From Consent to Referral Letter: A Unit 10 Comprehensive Nutrition Assessment Report on a Warehouse Supervisor Working Rotating Shifts

[Student Name]

Purdue University Global

NS310: Nutritional Assessment

Unit 10 Comprehensive Assessment Report

[Instructor Name]

[Date]

The volunteer, his workplace, measurements and laboratory values are composite; the Nutrition Care Process update, shift work review and diabetes standards cited are real.

First Contact and Consent

T.B. responded to a notice asking for a volunteer for a nutrition assessment course. He read and signed a consent form explaining that the assessment was a learning exercise, that he could withdraw at any time, that no diagnosis or treatment would be given, and that his records would be kept under initials only, on a protected drive, until grades were final and then erased. He agreed to share a laboratory report from a workplace screening done three weeks earlier.

Screening

On MUST he scored 0, low risk of malnutrition. The full assessment proceeds as a course requirement, not because the screen called for it, and this report says so because a low-risk screen followed by a full assessment would otherwise look like a misreading of the tool.

Why ADIME, and Where It Stops

ADIME stands for assessment, diagnosis, intervention, and monitoring and evaluation, the four steps of the Nutrition Care Process as they appear in documentation (Swan et al., 2017). The report uses it because it is the format a dietitian reading the referral will expect, and because it makes the boundary of a student's role visible. Assessment is where a student can contribute most, so it is the longest section. Diagnosis appears only as a labeled practice exercise. Intervention is limited to sharing public guidance and referring. Monitoring describes what could be measured again, not what will be prescribed. A reader can see at a glance which parts are findings and which are handed on.

Assessment

Food and nutrition history. Two nonconsecutive 24-hour recalls were taken by phone using the multiple-pass method: one covering a night shift, 7 p.m. to 7 a.m., and one covering a day off. On the night shift he ate a fast-food dinner at 6 p.m., then vending machine snacks at 11 p.m. and 3 a.m., drank two 16-ounce energy drinks, and ate cereal at 8 a.m. before sleeping. Estimated intake was about 3,100 kcal. On the day off he slept until noon, ate two meals and an evening snack, and drank no energy drinks, for about 2,300 kcal. A short beverage questionnaire covering the past month estimated four energy drinks and five regular sodas a week.

Anthropometric measurements. Height was 180.2 cm and weight 98.6 kg, giving a body mass index of 30.4. Waist circumference at the iliac crest was 106.1 cm, the mean of three readings within 0.6 cm.

Biochemical data. The workplace screening reported a fasting glucose of 104 mg/dL, with triglycerides at 210, HDL at 36 and LDL at 128, all in mg/dL. Fasting values between 100 and 125 mg/dL sit in the band the American Diabetes Association calls prediabetes, which requires confirmation by repeat testing (American Diabetes Association Professional Practice Committee, 2024).

Nutrition-focused observation. No signs of nutrient deficiency were seen. He reported sleeping five to six hours after night shifts.

Client history. He rotates two weeks of nights with two weeks of days, supervises a team of fourteen and has no diagnosed conditions. He said his main concern was "falling asleep on the drive home" after nights.

Synthesis of the Assessment

The streams agree on a pattern. Intake rises sharply on night shifts, mostly from vending snacks and sugared drinks. Waist circumference is above the threshold commonly used for men, and the laboratory values cluster around glucose and triglycerides. Each stream has a weakness: two recalls describe two days, the body mass index cannot separate fat from muscle, and the laboratory values come from a single draw. The agreement across streams carries more weight than any single value.

Shift work explains much of the pattern. A review of eating and shift work found that night workers tend to eat at times when the body handles food less efficiently, and that meal timing and quality on night shifts are linked to metabolic risk (Lowden et al., 2010). His energy drinks, used to stay awake, add sugar at the same hours.

The pattern belongs to the night shift, not to the man: on his day off he eats about 800 kcal less and drinks no energy drinks, which suggests the most useful changes target the shift rather than his diet as a whole.

Diagnosis

The Nutrition Care Process places a nutrition diagnosis after assessment, written as a PES statement of problem, etiology and signs (Swan et al., 2017). As a coursework exercise, to be confirmed or revised by a registered dietitian, the practice statement reads: undesirable food choices related to reliance on vending machines and energy drinks during night shifts, as evidenced by recall intake of about 3,100 kcal on a night shift compared with 2,300 kcal on a day off, four energy drinks a week and a waist circumference of 106 cm.

Intervention Within Scope

A student assessor can share general, publicly available guidance and can refer. The report does not prescribe a diet. With T.B.'s agreement, three things were done.

1. He was given the plate-planning guide from the federal dietary guidelines and a list of foods that keep without refrigeration, for packing before a night shift.

2. He was encouraged to discuss the fasting glucose result with his primary care provider, since a single value needs confirmation.

3. He was offered, and accepted, a referral to a registered dietitian through his employer's wellness program.

Monitoring and Evaluation

If the referral is taken up, the dietitian could repeat the two recalls after a month of nights and days, remeasure waist circumference with the same protocol and review any repeat laboratory values from his provider. The report lists these measures so that change can be judged against a baseline.

Referral Letter

To: Registered Dietitian, Employer Wellness Program. Re: T.B., 36-year-old warehouse supervisor, rotating shifts. T.B. completed a student nutrition assessment for coursework and consented to this referral. Findings: two 24-hour recalls showing about 3,100 kcal on a night shift and 2,300 kcal on a day off; four energy drinks and five regular sodas a week; BMI 30.4; waist 106.1 cm; workplace fasting glucose 104 mg/dL and triglycerides 210 mg/dL, single draw. A practice PES statement is attached for your review, not as a diagnosis. T.B. has been encouraged to see his primary care provider about the glucose result. His stated goal is to feel less tired on the drive home after nights.

Limits

The assessor is a student. Two recalls cannot describe usual intake across a rotating schedule. The laboratory values came from a screening event, not a clinical laboratory order. The report makes no claim beyond the assessment and leaves diagnosis and treatment to qualified professionals.

References

American Diabetes Association Professional Practice Committee. (2024). 2. Diagnosis and classification of diabetes: Standards of care in diabetes-2024. Diabetes Care, 47(Suppl. 1), S20-S42. https://doi.org/10.2337/dc24-S002

Lowden, A., Moreno, C., Holmbäck, U., Lennernäs, M., & Tucker, P. (2010). Eating and shift work: Effects on habits, metabolism and performance. Scandinavian Journal of Work, Environment & Health, 36(2), 150-162. https://doi.org/10.5271/sjweh.2898

Swan, W. I., Vivanti, A., Hakel-Smith, N. A., Hotson, B., Orrevall, Y., Trostler, N., Beck Howarter, K., & Papoutsakis, C. (2017). Nutrition Care Process and Model update: Toward realizing people-centered care and outcomes management. Journal of the Academy of Nutrition and Dietetics, 117(12), 2003-2014. https://doi.org/10.1016/j.jand.2017.07.015