Nutrition Care Process and MNT Intro PDF

The Nutrition Care Process Clinical Dietetics Important Terms Nutrition Care Process The Nursing Care Process  The Nutrition Care Process  Nutrition Assessment Nutrition Assessment Nutrition Assessment ABCDs of Nutrition Assessment  Anthr...

The Nutrition Care Process Clinical Dietetics Important Terms Nutrition Care Process The Nursing Care Process  The Nutrition Care Process  Nutrition Assessment Nutrition Assessment Nutrition Assessment ABCDs of Nutrition Assessment  Anthropomorphic measurements are attributes of the human body including size and shape. Height, weight, and BMI Circumference (arm, abdomen, Anthropometric and thigh) measurements are indicators of protein stores Skinfold thickness (biceps, triceps, subscapular, and suprailiac skinfold) is an indicator of energy (fat) stores.  Routine laboratory tests such as serum electrolytes, blood urea nitrogen (BUN), Biochemical creatinine, blood glucose levels, lipid profile, liver enzymes, complete blood count, and cholesterol can identify malnourishment.  The patient’s nutritional status is Clinical often evident in the head-to-toe physical assessment. Dietary  Nutrition Diagnosis Nutrition Diagnosis At the end of the assessment step, data are: This will reveal a nutrition diagnostic category from which to formulate a specific nutrition diagnostic statement. Nutrition Diagnosis/ PES Statement  Nutrition Intervention Nutrition Intervention This Nutrition Intervention step involves 1) selecting, 2) planning, and 3) implementing appropriate actions to meet patient/client/groups' nutrition needs It is directed at the etiology or effects of a diagnosis. The selection of nutrition interventions is driven by the nutrition diagnosis and provides the basis upon which outcomes are measured and evaluated.  Nutrition Monitoring and Evaluation Nutrition Monitoring and Evaluation Clinical Nutrition Therapy Primary role of Registered Nutritionist- Dietitians QUESTION # 1 ________ is the systematic problem-solving method that nutrition and dietetics professionals utilize to address nutrition-related problems and to provide safe and effective quality nutrition care. The Nutrition Care Process (NCP) is the systematic problem-solving method that nutrition and dietetics professionals utilize to address nutrition-related problems and to provide safe and effective quality nutrition care. QUESTION # 2 One point each NCP Consists of FOUR distinct steps which are interrelated and interconnected: 1. _____________ 2. _____________ 3.______________ 4.______________ NCP Consists of FOUR distinct steps which are interrelated and interconnected: 1. Nutrition Assessment 2. Nutrition Diagnosis 3. Nutrition Intervention 4. Nutrition Monitoring and Evaluation The Nutrition Care Plan (NcP) RNDs are tasked to This plan is developed to develop a Nutrition Care improve the nutritional Plan to provide status of the patients appropriate nutrition and achieve the targeted interventions to patients. outcomes. Other Intervention done by RNDs  In the advent of Universal Health Care (UHC), it is important to consider that such interventions made by the RNDs should be part of the patient’s clinical pathway. Nutrition Care Process in Hospitalized Patients (In- Patients) The Multidisciplinary Team in Nutrition Care Attending Physician Registered Nutritionist-Dietitian Registered Nurse Registered Pharmacist or Registered Clinical Pharmacist Registered Social worker 1. Attending Physician Shall refer all cases Conform and duly Lead the Conduct nutrition Actively convene of Medical Nutrition sign the NCP administration of support access interdisciplinary Therapy (MNT) to recommendations care plan provided conferences to RNDs developed by the by the RNDs, present results of RND nurses, managed cases pharmacists, and other allied health professionals. 2. Registered Nutritionist-Dietitian Shall develop Implement the Monitor, evaluate, and Prepare bi-annual Actively participate in nutrition care plan for nutrition care plan document the accomplishment case conferences, e.g. nutritionally-at-risk and nutrition care plan to report and submit ward rounds and critically-ill patients determine progress such report to the interdisciplinary health and nutrition outcome hospital health care planning. of the interventions information management worker and to DOH through the Health Facility Development Bureau 3. Registered Nurse Shall complete Carry-out the Prepare and update diet Document changes in prescribed list for submission to the eating/drinking patterns in nutrition screening Nutrition and Dietetics the patient’s chart and upon admission medications, diet and Service/Department or tolerance/intolerance to fluid requirements, and Dietary Department certain foods, and discuss diagnostic tests related such matters with the RND to nutrition care 4. Registered Pharmacist/Registered Clinical Pharmacist Discuss with RND for food/nutrient and drug Participate in case conferences and interaction interdisciplinary planning of healthcare team 5. Registered Social Worker NCP (In-Patient) Nutrition Care Nutrition Nutrition Process (In- Screening Assessment Patients) Nutrition Nutrition Diagnosis Interventions Implementation Monitoring and of the Nutrition Evaluation of Care Plan Nutritional Care A. Nutrition Screening A. Nutrition Screening B. Nutrition Assessment 1. Prioritization to do nutrition assessment should be categorized by risk as follows: 1. Prioritization 2. Timeliness 3. Reassessment  Nutrition Assessment Domains (Categories) QUESTION # 3 The ______ Leads the Nutrition Care multidisciplinary team. The Attending Physician Leads the Nutrition Care multidisciplinary team. QUESTION # 4 One point each The Multidisciplinary Nutrition Care Team consists of: 1. Attending Physician 2. 3. 4. 5. Nutrition Diagnosis C. Nutrition Diagnosis PES Statement  Nutrition Diagnosis/ PES Statement This statement has a distinct format: Problem related to Etiology as evidenced by Signs and Symptoms Example of PES Statements Excessive Fat Intake related to limited access to healthful options – frequent consumption of high-fat, fast-food meals as evidenced by serum cholesterol level of 230 mg/dL and patient report of 10 meals per week of hamburgers and fries Excessive Energy Intake related to unchanged dietary intake and restricted mobility while fracture heals as evidenced by 5 lbs weight gain during last 3 weeks due to patient report of consumption of 500 kcal/day more than estimated needs Example of PES Statements Swallowing Difficulty related to post stroke complications as evidenced by results of swallowing tests and reports of choking during mealtimes Nutrition Diagnosis Etiology Nutrition Diagnosis may lead to: D. Nutrition Intervention  Nutrition Intervention D. Nutrition Intervention Other types of nutrition interventions that can be vital to improving or maintaining nutrition status Nutrition Intervention Diet counseling involves four activities: Interviewing Counseling Consulting Documenting Interviewing Counseling Consulting Documenting  Nutrition Monitoring & Evaluation  Nutrition Monitoring & Evaluation Nutrition Care Indicators Nutrition Monitoring & Evaluation QUESTION # 5 __________ provides the basis for the development of nutrition care plan, that is implemented subsequently. Nutrition Assessment provides the basis for the development of nutrition care plan, that is implemented subsequently. QUESTION # 6 The __________ is responsible for Nutrition Screening The Staff Nurse is responsible for Nutrition Screening QUESTION # 7 ________ is the identification and labelling of and actual occurrence, risk of, or potential for developing a nutritional problem that dietetics professionals are responsible for treating independently. Nutrition Diagnosis is the identification and labelling of and actual occurrence, risk of, or potential for developing a nutritional problem that dietetics professionals are responsible for treating independently. QUESTION # 8 One point each Nutrition Diagnosis has three components: 1. 2. 3. Nutrition Diagnosis has three components: 1. Problem 2. Etiology 3. Signs/Symptoms QUESTION # 9 One point each The components Nutrition Diagnosis Statement or PES Statement are: 1. Problem = 2. Etiology = 3. Signs/Symptoms = The components Nutrition Diagnosis Statement or PES Statement are: 1. Problem = diagnostic label 2. Etiology = cause/contributing risk factors 3. Signs/Symptoms = defining characteristics Medical Nutrition Therapy Terms and Definitions Medical Nutrition Therapy Refers to the use of specific nutrition services to treat an illness, injury, or condition. It consists of two phases: o Nutrition Assessment o Nutrition Therapy Nutrition Therapy Refers to interventions used in the treatment if a disorder or illness and includes diet therapy, nutrition counseling, and/or the use of specialized nutrition therapies o Supplementation with nutritional or medical food o Nutritional Support through enteral or parenteral methods Dietetics The combined science and art of regulating the planning, preparing, and serving of meals to individuals or groups under various conditions of health and disease according to the principles of nutrition and management with due consideration for economic, social, cultural, and psychological factors. Diet Refers to food and drink regularly consumed according to a regimen of time and amount. May be normal or special/therapeutic The attending physician writes out the diet order. The nurse and the dietitian cooperate closely in carrying out this order "RD consult" Diet Therapy The branch of dietetics that is concerned with the use of food for therapeutic purposes. Drug-Nutrient Interaction Certain foods taken with certain drugs can affect drug effectiveness. Certain drugs can interfere with the absorption of some nutrients This is why physicians specify orders on when to take medicine e.g. before meals, with the meal, on an empty stomach Basic Concepts of Diet Therapy Diet Therapy is the treatment component for a patient that involves the modification of food intake. Diet therapy supports the overall therapeutic program (e.g. sodium-restricted diet for hypertension) Diet therapy supports other modes of treatment (e.g. progression to from a liquid diet to a regular diet following surgery) Modified diets are also used as preventive measures like the fat- modified diet (elevated blood lipids and who are at risk for coronary heart disease) Therapeutic Diets are Modifications of the Normal Diet Hospital Diets accomplish one or more of the following: To maintain good nutritional status. To correct deficiencies that may have occurred. To provide rest to the whole body or to certain organs that may be affected by the disease. To adjust the food intake to the body's ability to metabolize the nutrients. To bring about changes on body weight whenever necessary. The normal diet may be modified according to these categories: 1. Nutrient level, e.g. 500 mg sodium, 30 g fat, 100 g protein 2. Energy or Caloric intake, e.g. 1000 kcal or 3000 kcal 3. Specific non-nutrient substance or metabolite, e.g. gluten, purine & cholesterol. 4. Texture and flavor, e.g. bland diet, soft and liquid diet, high fiber diet Responsibilities of the Dietary Department Provide food service primarily for the patient Feeds the hospital staff and personnel Foodservice director or administrative dietitian o Supervises food production and service for large scale food planning Therapeutic or clinical dietitian o Coordinates activities with the physician and the nurse in a comprehensive teamwork for patient cure and care. o Ward rounds, visits, and interviews patients, diet counseling Individualization is the key to successful nutrition counseling Responsibilities of the Nursing Department The nurse is usually the first person who observes the patient's feeding problems such as inability to chew, and physical handicap to feed himself, complaints about the food, etc. Has more direct and continuous communications with the patient and must be well-informed about the principles of the diet, and food items allowed and prohibited. Any question regarding food -> referred to dietitian Responsibilities of the Nursing Department The nurse should immediately forward the physician's diet prescription to the dietary department. If a patient is going home on a special diet ("discharge" diet or "take home" diet), the nurse should notify the dietitian. Food charting is usually accomplished by the nursing staff. The nursing aide sees to it that the patient is ready for his food tray, help with washing hands, sitting up, cutting food, feeding the patient etc.