Nutrition Care Process for Clinical PDF

Overview Nutrition Year 2016, republic 10862 Shall provide ethicall nutrition care process Nutrition care process- systematic problem solving method that dieteticas professionals utilize to critically think and make decision to address nutrition related problems and provide safe effective quality n...

Overview Nutrition Year 2016, republic 10862 Shall provide ethicall nutrition care process Nutrition care process- systematic problem solving method that dieteticas professionals utilize to critically think and make decision to address nutrition related problems and provide safe effective quality nutrition Republic Act No. 10862, Nutrition and dietetics law, provides that the scope of practice of nutrition and dietetics the provision of MNT in NCP. The Department of Health supports the implementation of quality nutiritoin care in the health facility with the issuance of Administrative Order No. 2019-0033 Guideline for the Implementation f the Nutrition Care Process in Hospitals. Policy Objective: Provide Guidelines Implement and Operationalize the following Processes as part of Nutrition care Process. 1.​ Nutrition Screening by the designated nurse 2.​ Referral for Medical Nutrition Therapy to the RND for appropriate nutritional assessment 3.​ Follow the Nutrition care Algorithm as provided in the policy 4.​ Regularly submits reports to the Health Faccility Development Bureau 5.​ Capacitates NDS staff on implementing NCP 6.​ Role delineation across different hospital staff and offices Nutritional Care Organized group of activities allowing the identification of nutritional needs and provision of care to meet these needs Nutrition Care Process Organized approach that consists of assessment, diagnosis, intervention, monitoring and evaluation (ADIME) Nutrition Care Process Terminology Academy of Nutrition and Dietetics: Develops a standardized language for nutrition and dietetics. The aim was to provide a dictionary o terms, codes and definitions specific to dietetic practice. Nutrition Care process and Terminologies (NCPT) Standardized nutrition language. Provides an infrastructure for dietetics research, enabling dietitians to measure and record health outcomes for individuals, groups and population in a range of practice settings. Terminologies Malnutrition- deficiencies, excesses, or imbalances in the intake of energy and or nutrients of a person. Registered Nutritionist-Dietitian (RND)- holds a valid certificate of registration and a valid professional identification card, which is renewed every three years and issued by the Board of ND of the PRC pursuant to RA No. 10862 or the Nutrition and Dietetics Law of 2016. Nutritional Care- Organized group of activities allowing the identification of nutritional needs and provision of care to meet these needs. Nutrition Care Process- Systematic problem-solving method that dietetics professionals utilize to critically think and make decision to address nutrition-related problems and provide safe and effective quality nutrition care. Nutritionally-at-risk patients: Actual or potential for developing malnutrition. Involuntary loss or gain >10% of usual body weight within 6 months. >5% of usual body weight in 1 month. Weight of 20% over and under ideal body weight. Altered diets or diet schedules. Inadequate nutrition intake including those not receiving food or nutrition products greater than 7 days. Critically ill patients are usually those patients in the ICU , geriatric, stroke and cancer patients, and those with pre and post operative conditions. Medical Nutrition Therapy: is the application of Nutrition Care Process for purposes of disease prevention, treatment, and management. Altered diets or diet schedules: receiving total parenteral or enteral nutrition, recent surgery illlness or trauma. Inadequate nutrition intake: not receiving food or nutrition product. Impaired ability to ingest or absorb food adequately. duration is greater than 7 days. Nutrition screening Nutrition Screening: identify nutritionally at risk patients through certain parameters (anthropometric measures, dietary intake and clinical conditions). To be accomplished by nurse upon admission of patients in the hospital using validated nutrition screening tools. Nutritionally-at-risk patients: actual or potenial for developing malnutrition, prsenece of chronic disease and increased metabolic requirements. Altered diets or diet schedules or receiving total parenteral or enteral nutrition , recent surgery , illness or trauma. Inadequate nutrition intake or those not receiving food or nutrition products for greater than 7 days. Anthropometric Measurement for ambulatory adult Weight: Use the Weigh beam eye level for ambulatory patients. Measurements are recorded to the nearest 0.1 kg. Height: Children >2 year old and adult. Measured patients in a standing position. The head should be in the Frankfurt position, and the shoulders, buttoks and the heels should touch the vertical stand. Measurements are recorded to the nearest cm. Ulna length: used to estimate the length of an adult non-ambulatory patients For Pediatrics: Weight: A mechanical weighing sling (spring balance) is used for measuring weight of children 2 yo, beam balance is used Length: Infantometer or length board is used for children 2 yo in a standing position. The head should be in the Frankfurt position , and the shoulders, buttcks and heels should touch the vertical stand. Measurements are recorded to the nearest 0.1 cm. Mid upper arm circumference (MUAC), children aes 6-59 months. An important screening tool for severity of malnutrition measured at the midpoint of the mid upper arm. MUAC >115 and 7.5% weight loss in 3 months ​ >10% weight loss in 6 months Formula: Percentage weight loss = Usual weight- Actual weight/ Usual weight x 100 Adjusted Weight for Amputation ​ Estimated IBW = [(100 - % amputation)/100)] x IBW ​ Example ​ Left Foot Amputee ​ IBW= 52 kg ​ Estimated IBW= = [(100 - % amputation)/100)] x IBW =[(100 - 1.8%) /100)] x 52 kg =[(98.2%) /100)] x 52 kg =[0.982] x 52 kg =51kg Nutrition Focused Physical Exam EDEMA +​ 1= 2mm or less (slightly pitting, disappears rapidly) +​ 2- 2-4mm indent: (somewhat deeper pit; disappears in 15 sec +​ 3 = 4-6 mm indent( pit is noticeably deep, may last for more than 30 sec) +​ 4= 6-8 mm indent ( pit is very deep , > 60 sec to rebound pale conjunctiva (iron deficiency): pale eyes Protein and energy deficiency: Easily pluckable, brittle, soarse hair Vitamin C deficiency: Corkscrew hair Vitamin C and K deficiency: Purpura Riboflavin, niacin, folate, B12, protein iron deficiency: Slick tongue/atrophic lingual papillae Protein, Vit c, zinc deficiency: Poor wound healing, decubitus ulcers Biotin and protein and energy deficiency: dyspigmentation Protein deficiency: Hair flag sign Vit A, essential fatty acids deficiency: xerosis Vit A, essential fatty acids deficiency: follicular hyperkeratosis Vit c and K deficiency: Perifollicular Niacin: dermatitis Niacin, riboflavin, b6 deficiency: nasolabial seborrhea Vit A: xerophthalmia, bitots spot Riboflavin: angular palpebritis B6, riboflavin, niacin: chielosis Ribo, b6, iron deficiency: angular stomatitis Vit c: bleeding or spongy gums Laboratory results Biochemical Assessment The only objective data used in nutrition assessment that is “controlled”. Laboratory tests are ordered to diagnose disease, support nutrition diagnoses, mnitor the effectiveness of nutrition preventions, evaluate medicatioin effectiveness and evaluate NCP interventions or MNT Hemoglobin A1C Evaluates three month average blood sugar levels. The chance of acquiring diabtees complications including diabetic retinopathy, diabetic kidney disease, increases with increaisng HbA1c levels Total Calcium Levels of non-borne stored calcium in the body Assess calcium matabolism, parathyroid hormone function, and patient monitoring for renal failure, renal transplant, and certain malignancies. Hypocalmcemia associated with: ​ VIt D deficiency ​ Inadequate hepatic or renal activation of Vit D ​ Hypoparathyroidism ​ Magnesium deficiency ​ Real failure ​ Nephrotic syndrome Metabolic panel Sodium (Na+) Reflects the relationship between total body sodum ad extracellular fluid volume as well as the balance between dietary intake and renal excretory function. Used in monitoring various patients, such as those receiving total parenteral nutrition or who have renl conditions, uncontrolled DM, various endocrine symptoms, or acidotic or alkalotix conditions; water dysregulation, and diuretics. Inscreaed with dehydration and decrease with overhydration. Potassium (K+) Regflects kidney function, changes in blood PH, and adrenal gland function. Often change with sodium levels. Sodium increases, potassium decreases , and vice versa. MOnitoring various patients such as: ​ Receiving total parenteral nutrition for those who have renal conditions  ​ Uncontrolled DM, various endocrine disorders ​ Ascitic and edamatous symptoms ​ Acidotc and alkalotic conditions Increased K+ is associated with ​ Kidney disease ​ Hemolysis ​ Postassium-sparing diuretics ​ Gastrointestinal hemorrhage ​ Rhabdomyolysis ​ Catabolism ​ Metabolic acidosis Can be critical, especially when levels exceed (6.5 mEq/L) ​ Muscle weakness ​ Paralysis ​ Respiratory failure ​ Arrhythmias/ECG changes Chloride (Cl+) ​ Reflects acid base balance, water balance, and osmolality ​ Used in mnitoring various patients, such a sthose receiving total parenteral nutrition or who have renal conditions, chronic obstructive pulmonary disease, diabetes insipidus, acidotic or alkalotic conditions. ​ Increased with dehydration, kidney disease, and metabolic acidosis, Decreased with overhydration, heart failure, lung disease, Addison disease, metabolic alkalosis. HCO3 (TOtal CO2) Used in monitoring: ​ Receiving total parenteral nutrition ​ Renal conditions ​ COPD ​ Uncontrolled DM ​ Various endocrine disorders ​ Ascitic and edematous symptoms ​ Acidotic or alkalotic conditions BUN or Urea ​ Used to assess the excretory function of the kidney and the metabolic function of the liver. Creatinine ​ INcreased in those with renal disease and after trauma or surgery ​ Decreased in those with malnutrition Albumin ​ Reflects severity of illness, inflammatory, stress and serves as marker for mortality ​ Decreased i those with liver disease or acute inflammatory disease and overhydration. ​ INcreases in dehydration it isnot a biomarker of protein status. ​ Skin with decreased turgor remains elevated after being pulled up and released. Total Protein ​ Reflects albumin and globulin in blood ​ Not a useful measure of nutrition or protein status. Major types: ​ Albumin (60%): major component of osmotic pressure in plasma ​ Globulins (35%)Antibodies (immunoglobulin) and transport proteins ​ Fibrinogens (4%) functions in blood clotting ​ Other(