Module 1: Introduction to MNT and Review of NCP PDF

COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM Nutrition and Dietetics Program Nutrition Therapy 2 (Medical Nutrition Therapy 1)...

COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM Nutrition and Dietetics Program Nutrition Therapy 2 (Medical Nutrition Therapy 1) LECTURE Module 1 Review of Nutrition Care Process Introduction to Medical Nutrition Therapy 2021-2022 Module 1 Packet for Nutrition Therapy 1 (Medical Nutrition Therapy 2) Lecture: College of Nursing, Nutrition and Dietetics: Nutrition and Dietetics Program, University of San Agustin, Iloilo City,Philippines  COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM MODULE 1 PACKET NUTRITION THERAPY 1 INTRODUCTION TO MEDICAL NUTRITION THERAPY MODULE 1: OVERVIEW In this module, we will review the four distinct steps of the nutrition care process and its application to medical nutrition therapy. We will define what is medical nutrition therapy and its relevance to clinical nutrition and dietetic practice. During the course of the module, we will discuss the role of the nutritionist-dietitian in the delivery of medical nutrition therapy (MNT) in various disease conditions. We will explore how patient-centered care is applied in MNT, in a collaborative multi-disciplinary team working. We will also start to define the different dietary modifications that we will be referring to when planning diet management of different disease conditions e.g. Type 1 Diabetes Mellit The main textbook is Mahan , LK and Raymond, JL, 2017. Krause’s Food and Nutrition Care Process 14th ed or 13TH ed.Elsevier, 3251 Riverport Lane, St. Louis Mo. USA. Most of the information and discussion will be referenced from this. Module 1 : Learning Objectives By the end of the module the student is expected to be able to: describe the four steps of the nutrition care process define medical nutrition therapy and its function in disease management apply the four distinct steps of the nutrition care process in medical nutrition therapy management of diseases perform the role of a nutritionist-dietitian when carrying out MNT and patient-centered care practice collaborative work within a multi-disciplinary team describe what dietary modifications are and how it is used in therapeutic diets. 2021-2022 Module 1 Packet for Nutrition Therapy 1 (Medical Nutrition Therapy 2) Lecture: College of Nursing, Nutrition and Dietetics: Nutrition and Dietetics Program, University of San Agustin, Iloilo City,Philippines  COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM Description Lesson 1 Definition of Terms Lesson 2 Review of the Nutrition Care Process Lesson 3 Application of Nutrition Care Process in Medical Nutrition Therapy Lesson 4 The Nutritionist-Dietitian and Medical Nutrition Therapy Lesson 5 What are modified diets? Quiz 2021-2022 Module 1 Packet for Nutrition Therapy 1 (Medical Nutrition Therapy 2) Lecture: College of Nursing, Nutrition and Dietetics: Nutrition and Dietetics Program, University of San Agustin, Iloilo City,Philippines  COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM Lesson 1: Definition of Terms: 1.1 Medical Nutrition Therapy: Medical Nutrition Therapy (MNT) is a “Nutritional diagnostic, therapy and counselling service for the purpose of disease management which are furnished by a registered dietitian or nutrition professionals…” MNT is a specific and evidence-based application of the Nutrition Care Process in a clinical setting that is focused on the management of a disease. It involves in-depth individualized nutrition assessment/reassessment, nutrition diagnosis, nutrition intervention and nutrition monitoring and intervention that typically results in the prevention, delay, or management of diseases and/or conditions.1 Dietetics – study of diet prescriptions under special circumstances and other physiologic needs; science and art of regulating the planning, preparation, and serving of meals to patients Dietitian – translator nutritional principles for any individual; registered and licensed person who holds valid certificate of registration and valid professional identification card issued by the Board and Commission under ND Law of 2016 (RA 10862) Diet Therapy – food modification for therapeutic purposes Medical Nutrition Therapy – use of specific nutrition services to treat an illness or condition Clinical Nutrition – deals with the diagnosis, prevention, and treatment of diseases caused by nutrient deficiency or excess Nutrition Support – techniques in support to the patients who are unable to meet their nutritional needs What is MEDICAL NUTRITION THERAPY? What does MEDICAL NUTRITION THERAPY mean? https://www.youtube.com/watch?v=jpL7hq1S4Tg Accessed 22 August 2021 Nutrition Care Process: Nutrition Care Process (NCP) “ a systematic problem-solving method that dietetic professionals use to critically think and make decisions to address nutrition related problems and provide safe and effective quality nutrition care” 1 American Dietetic Association The nutrition care process consists of four distinct, but interrelated and connected steps which we will review in following lessons. Nutrition Care Process https://www.youtube.com/watch?v=mq35L3v5GvI Accessed 22 August 2021 Nutrition Care Process 2021-2022 Module 1 Packet for Nutrition Therapy 1 (Medical Nutrition Therapy 2) Lecture: College of Nursing, Nutrition and Dietetics: Nutrition and Dietetics Program, University of San Agustin, Iloilo City,Philippines  COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM https://www.youtube.com/watch?v=vH4pnmhbvPw Accessed 22 August 2021 FSHN 361: Nutrition Care Process https://www.youtube.com/watch?v=yD6UF3ogn_U Accessed 22 August 2021 2021-2022 Module 1 Packet for Nutrition Therapy 1 (Medical Nutrition Therapy 2) Lecture: College of Nursing, Nutrition and Dietetics: Nutrition and Dietetics Program, University of San Agustin, Iloilo City,Philippines  COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM 2.0 Review of the Nutrition Care Process STEP 1: NUTRITION ASSESSMENT 1,3,6,8 “ A systematic approach for collecting, classifying, and synthesizing important and relevant data to describe nutritional status related nutritional problems, and their causes.” 1 It is an on-going process of collecting not only the initial data but the continuous assessment and reassessment of client’s needs to provide information for nutrition diagnosis and intervention/care planning.2 Food and Biochemical data, Anthropometric Nutrition Client history nutrition related Medical tests and measurement focused physical history Procedures findings Food and nutrition Laboratory data Height, weight, Body Physical Personal history intake, medication, e.g. electrolytes. mass index (BMI) appearance, muscle e.g age, gender, race, herbal supplement glucose, renal, liver, weight history, weight and fat language, education intake, knowledge, gastrointestinal profile change wasting, medical/health family beliefs, attitudes, swallow function, history, treatments and food and supplies Tests e.g. gastric appetite complementary, availability, physical emptying time, affect alternative medicine activity, nutrition resting metabolic rate used. social history e.g. quality of life socio-economic status housing situation STEP 2: NUTRITION DIAGNOSIS 1,3,6,8 Nutrition diagnosis is identification and formulating a specific nutrition problem(s) that can be resolved or improved through treatment/intervention by a nutritionist-dietitian. Nutrition diagnosis (e.g. inconsistent carbohydrate intake) should not be confused with medical diagnosis (e.g. diabetes), which could be defined as a disease or pathology of specific organs or body systems that can be treated or prevented.1 2 Registered Nutritionist-Dietitians use nutrition assessment data to identify, ascertain and describe the nutrition diagnosis to provide a link to setting realistic, attainable, and measurable outcome, selecting appropriate intervention, and tracking progress in attaining those expected outcomes. Components of nutrition diagnosis: Intake Clinical Behavioral-Environmental 2021-2022 Module 1 Packet for Nutrition Therapy 1 (Medical Nutrition Therapy 2) Lecture: College of Nursing, Nutrition and Dietetics: Nutrition and Dietetics Program, University of San Agustin, Iloilo City,Philippines  COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM Too much or too little of a food Nutrition problems that relates to Knowledge, attitudes, beliefs, or nutrient compared to actual or medical or physical conditions physical, environmental, access estimated needs to food or food safety The format for describing nutrition diagnosis is in the form of a PES (Problem, Etiology, Signs and Symptoms) statement. It describes the problem, its root cause, and the assessment data that provides the evidence for the nutrition diagnosis. How should it be written: PES statement is “ Nutrition diagnosis term (Problem) related to (Etiology) as evidenced by (Signs and Symptoms) (P) Problem or Nutrition (E) Etiology (S) Signs and Symptoms Diagnosis Term Cause/Contributing Risk Data or indicators used to Factors determine the patient/client’s Describe alteration in the nutrition diagnosis patient/client’s nutritional status Linked to the nutritional diagnosis term by the word Linked to the etiology by the “related to” word “as evidenced by” Study question: 1. What is the difference between a medical diagnosis and nutrition diagnosis? STEP 3: NUTRITION INTERVENTION 1,3,6,8 Nutrition intervention is “ purposefully planned actions designed with the intent of changing a nutrition-related behavior, risk factor, environmental condition, or aspect of health status.” It is directed towards resolving and improving the identified nutrition diagnosis(es) or nutrition problems by planning and implementing appropriate intervention to eliminate nutrition etiology and/or relieving the signs and symptoms of the nutrition problem. 1 Nutrition interventions are selected and tailored to the needs of the individual patient/client, group, community, or population. The nutrition diagnosis and its etiology determines the selection of a nutrition intervention for the purpose of changing/modifying nutrient intake, nutrition-related knowledge or behavior, access to supportive care and services or environmental conditions, organizational process, and public policies that impact the nutritional problems.2 Nutrition intervention goals provide the basis for monitoring progress and measuring outcomes. It is accomplished in two distinct and interrelated steps. Planning: RND prioritizes the nutrition diagnoses based on the severity of the problem, 2021-2022 Module 1 Packet for Nutrition Therapy 1 (Medical Nutrition Therapy 2) Lecture: College of Nursing, Nutrition and Dietetics: Nutrition and Dietetics Program, University of San Agustin, Iloilo City,Philippines  COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM safety, and the patient needs Implementation: the action phase during which the RND carries out and communicates the plan of care to all relevant parties The five domains of nutrition intervention: Food and/or Nutrient Individualized approach for food/nutrient provision. Delivery Meals and snacks, supplements, enteral and parenteral nutrition, feeding assistance, feeding environment, nutrition-related medication management Nutrition Education A formal process to instruct a patient/client/group/community in a skill or to impart knowledge to help them voluntarily manage or modify food, nutrition and physical activity choices and behavior to maintain or improve health. e.g. diet instruction at bedside or out-patient clinic. Nutrition Counseling A supportive process characterized by a collaborative counselor-patient relationship, to establish food, nutrition, and physical activity priorities, goals, and individualized action plans that acknowledge and foster responsibility for self-care to treat an existing condition and promote health. e.g use of cognitive behavior therapy (CBT) techniques and motivational interviewing (MI) Coordination of care Plan Consultation with, referral to, or coordination of nutrition care with other health care providers, institutions, or agencies that can assist in treating or managing nutrition-related problems. Discharge and transfer of nutrition care in new setting or provider. Population Base Nutrition Interventions designed to improve the nutritional well-being of a population. Action STEP 4: NUTRITION MONITORING AND INTERVENTION 1,3,6,8 Nutrition monitoring and evaluation identifies outcomes and indicators relevant to the nutrition diagnosis and nutrition intervention. It determine and measure the amount of progress made for the nutrition intervention and whether nutrition related goals/expected outcomes are being met. RND should select nutrition care indicators that will reflect a change as a result of nutrition care. The monitoring and evaluation phase should be considered during the assessment phase whilst determining the nutrition diagnosis and nutrition intervention. Additional factors to consider when monitoring and evaluating are medical diagnosis, health care outcomes goals, nutrition quality management goals, practice setting, patient/population disease state and/or severity.1,2 Study Question: 1. What are the five domains of nutrition monitoring and intervention? 2021-2022 Module 1 Packet for Nutrition Therapy 1 (Medical Nutrition Therapy 2) Lecture: College of Nursing, Nutrition and Dietetics: Nutrition and Dietetics Program, University of San Agustin, Iloilo City,Philippines  COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM PATIENT ASSESSMENT: 8 The RND assess the patient information, involving the systematic recording, verification, and interpretation of the information. The following patient information is gathered by the RND during the consultation process: Anthropometric measurements Diet history Knowledge and skills Medical history Medical and biochemical tests Psycho social history Assessment against standards Physical indicators of disease The physical indicators of the disease is usually related to some nutritional inadequacies and excesses that can affect the different parts of the boy/systems. The signs and symptoms of the nutritional disorders that might be considered by an RND could include the following: ► Overall appearance ► Cardiovascular-pulmonary system ► Cognition ► Digestive system ► Head and neck ► Muscles ► Nails ► Nervous system ► Skin ► Vital signs Additional Tools for NFPA Skinfold calipers Bioelectrical impedance analysis (BIA) Dynamometer Stethoscope Watch with second hand Pen light Measuring tape Tongue blade Reflex hammer Blood pressure cuff 2021-2022 Module 1 Packet for Nutrition Therapy 1 (Medical Nutrition Therapy 2) Lecture: College of Nursing, Nutrition and Dietetics: Nutrition and Dietetics Program, University of San Agustin, Iloilo City,Philippines  COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM 3.0 Application of Nutrition Care Process in Medical Nutrition Therapy Example of the application of NCP in MNT 2 Atherosclerotic cardiovascular disease Cancer: Condition that results from dysregulated cell ASCVD involves progressive narrowing of the arterial growth and is caused by an interaction of dietary, tree, giving rise to collateral vessels. genetic, and environmental risks factors. Nutrition Assessment: Medication, lab value, current Medical diagnosis: Dyslipidemia use of herbs and botanical products. Diet history Nutrition Assessment Data: Food frequency recall indicating appetite and intake have decrease since and intake records, computer nutrient analysis cancer surgery. Nutrition Diagnosis (PES): Inappropriate intake of Nutrition Diagnosis (PES): Inadequate oral intake food fats related to food and nutrition-related knowledge related to medical therapies as evidenced by intake deficit as evidenced by daily consumption of bacon, records showing average of 25% of food and fluid sausage, butter, and ice cream, saturated fats intake of consumed with meals and discussion with patient. 15% of kcal, total cholesterol 220mg/dL and LDL Nutrition Intervention: cholesterol of 1165mg/dL. Food and nutrient delivery: Focus on favourite Nutrition Intervention: Food and nutrient delivery: foods; enhance foods with extra calories while Clarify current diet to include no fried foods, bacon, appetite is poor. sausage, and creams/custards. Provide cornflakes or Counseling with responses to specific oatmeal for breakfast to further lower LDL. Add plant questions about medications that might sterols or stanols. stimulate appetite Education: Identify alternate source of fats from meals Coordinate care: Work with medical and and snacks that are more suitable. nursing team to schedule meals separately Nutrition Monitoring and Evaluation: Repeat lab from therapies; identify medication that are values after 3 to 6 months; dietary recall and to aim for causing anorexia. total cholesterol below 200mg/dL Nutrition Monitoring and Evaluation: Improved oral intake at all meals following adjustment of Make appointment to see attending physician and RND medications and timing of therapies. for review of medical and dietary treatment respectively. Study questions: 1. What domain of the nutrition assessment step is considered in this data? 2. Why is food and nutrient delivery domain chosen in nutrition intervention plan? 4.0 The Nutritionist-Dietitian, Medical Nutrition Therapy, and Patient-centered Care Patient-centered care is the practice of caring for patients (and their families) in ways that are meaningful and valuable to the individual patient. It includes listening to, informing and involving patients in their care. The IOM (Institute of Medicine) defines patient-centered care as: “Providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions.” 3 Patient-centered care (PCC)…. actively gives you and your family a say in the decision-making process when planning care and treatment is about respecting your individual preference and diversity 2021-2022 Module 1 Packet for Nutrition Therapy 1 (Medical Nutrition Therapy 2) Lecture: College of Nursing, Nutrition and Dietetics: Nutrition and Dietetics Program, University of San Agustin, Iloilo City,Philippines  COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM involves recognizing your needs and respects your right to make health decisions and choices includes your right to comment, ask questions, and make complaints about your healthcare. Chaboyer et.al in their integrative review of the role of dietitian in patient-centered care six themes were discovered inductively which are (1) establishing a positive dietitian-patient relationship, (2) displaying humanistic behavior, (3) using effective communication, (4) individualism and adapting care, (5) redistributing power to the patient, and (6) lacking time for PCC practices 4 In clinical setting, RND play a vital role in the healthcare team by providing nutrition care to patients with various disease states and conditions, as compromised nutrition can lead to slow healing and recovery and may extend hospital stay. Clinical dietitians: assess, plan, monitor, and optimize nutrition status based on the patient’s current nutrition and medical conditions confer with physicians and other healthcare professionals to coordinate medical and nutritional needs make recommendations for tube and intravenous feedings and/or dietary supplements. teach patients how to make nutritionally sound food choices to speed the recovery process, prevent illness and disease, and maintain a healthy lifestyle. 2021-2022 Module 1 Packet for Nutrition Therapy 1 (Medical Nutrition Therapy 2) Lecture: College of Nursing, Nutrition and Dietetics: Nutrition and Dietetics Program, University of San Agustin, Iloilo City,Philippines  COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM The Eight Principles of Patient-Centered Care https://www.oneviewhealthcare.com/the-eight-principles-of-patient-centered-care/ 5.0 What are modified diets? Dietary modification are changes made during food preparation, processing, and consumption to increase or decrease nutrient content of food for the purpose of correcting/improving nutritional status. A modified diet is any diet altered to include or exclude certain components of a diet, such as calories, fat, protein, carbohydrates, vitamins, minerals, fiber. Diets are modified for therapeutic reasons, for example for the treatment of high blood pressure, diabetes mellitus, dysphagia, vitamins and mineral deficiencies. Therapeutic diets are prescribed to patients as part of the nutrition intervention plan. Standard or regular diet is a diet that includes all foods and meet the nutrient needs of a healthy individual whilst modified or therapeutic is a diet that is altered by changing food consistency or nutrient content, by including or eliminating specific foods, by increasing or decreasing the energy value of the diet, by changing the flavour (e.g. bland), or modify the interval of feeding. Study question: 1. What are some of the diseases that needs modified or therapeutic diets and why? End of module 1: Nutrition Therapy 1 (Medical Nutrition Therapy 2) Introduction to the Course 2021-2022 Module 1 Packet for Nutrition Therapy 1 (Medical Nutrition Therapy 2) Lecture: College of Nursing, Nutrition and Dietetics: Nutrition and Dietetics Program, University of San Agustin, Iloilo City,Philippines  COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM References 1. Academy of Nutrition and Dietetics Definition of Terms May 2020 eatright.org/-media/eatrightpro-files/practice/scope-standards-of-practice/20190910- academy-definition-of-terms-list.pdf Accessed 26 May 2020 2. Escott-Stump, S. 2015. Nutrition Diagnosis-Related Care 8th ed. Wolsters Kluwer, USA Last accessed 31 July 2021 3..Lacey K. and Pritchett E. Nutrition Care Process and Model:ADA adopts road map to quality care and outcomes. J Am Diet Assoc. 2003;103:1061-1072 in Nutrition Diagnosis: A Critical Step in the Nutrition Care Process Management: 2006 American Dietetic Association U.S.A. Last accessed 31 July 2020 4. The Eight Principles of Patient-Centered Care https://www.oneviewhealthcare.com/the-eight-principles-of-patient-centered-care/ Accessed 02 August 2020 5. Patient-centered care to improve dietetic practice an integrative review https://www.academia.edu/34613473/DIETETIC_PRACTICE_Patient- centred_care_to_improve_dietetic_practice_an_integrative_review Accessed 2 August 2020 6. Reinhard, T. and Width, M. 2019. The Essential Guide to The Nutrition Care Process. Cognella Academic Publishing. USA Last Accessed 02 August 2020 7. The Patient-Centered Medical Home — The Dietitian’s Role in This Healthcare Model That Improves Diabetes Outcomes https://www.todaysdietitian.com/pdf/courses/Riggs-PCMH.pdf Accessed 02 August 2020 8. Stewart, R 6th ed 2020 Handbook of Clinical Nutrition and Dietetics. Australian Dietitian, Australia pp.120-123 Accessed 23 August 2021 2021-2022 Module 1 Packet for Nutrition Therapy 1 (Medical Nutrition Therapy 2) Lecture: College of Nursing, Nutrition and Dietetics: Nutrition and Dietetics Program, University of San Agustin, Iloilo City,Philippines  COLLEGE OF NURSING, NUTRITION AND DIETETICS NUTRITION AND DIETETICS PROGRAM Assignment: Please answer the following questions briefly? 1. Why is Medical Nutrition Therapy important in the clinical practice of a RND? 2. What are the knowledge and skills competencies an RND must have to enable the application of the nutrition care process in medical nutrition therapy? 3. In your opinion should RND be allowed to do Nutrition Focused Physical Assessment to patients referred to them? And why? 2021-2022 Module 1 Packet for Nutrition Therapy 1 (Medical Nutrition Therapy 2) Lecture: College of Nursing, Nutrition and Dietetics: Nutrition and Dietetics Program, University of San Agustin, Iloilo City,Philippines