EXAM 1 STUDY GUIDE DIE 4244 Medical Nutrition Therapy Spring 2014 1 The Nutrition Care Process a What is the Nutrition Care Process NCP i Established by the AND Academy of Nutrition and Dietetics which was previously the ADA ii The standardized process for the provision of nutrition care iii The patient or client relationship with the registered dietitian is at the center of the NCP b What are the steps of the NCP and what is involved in each step i ADIME Assessment Diagnosis Intervention Monitoring and Evaluation 1 Assessment identify RISK FACTORS analyze and interpret with evidence based standards also includes SCREENING and REFERRAL system 2 Diagnosis identify the PROBLEM determine cause cluster the signs and symptoms 3 Intervention goals and plan of action plan and implement nutrition intervention 4 Monitoring monitor progress measure outcome indicators 5 Evaluation evaluate outcomes ii NCP Model of the model 1 Relationship of the target patient client or group with the RD central component 2 Represents skills and abilities of the RD outer ring 1 3 Represents environmental factors aka healthcare systems socioeconomics and practice settings that impact the ability of the client to benefit from the services outer ring 2 c What are nutrition risk factors and how do they affect an individual s nutrition status i Intake ii Psycho social iii Physical condition iv Biological make up labs v Food medication interactions i The A in ADIME d What are nutrition screening and assessment and why are they done ii Identified those who would benefit from a full nutrition assessment iii Quick simple only when a patient is identified to be at risk patients should be rescreened at regular intervals during hospitalization iv Assessment the comprehensive evaluation completed by an RD using medical social nutritional and medication histories as well as a physical and lab data e What are the ABCDs of assessment 1 Anthopometric physical measurements evaluate over under nutrition a Serial measurements most valuable 2 Biochemical Lab Tests 3 Clinical Physical signs 4 Dietary 1 Height ii What is used to measure height and weight and how are these interpreted e g IBW percent weight change etc You should know these calculations significant weight changes etc a Direct Measurement stand or recline flat measuring rod or stadiometer b Indirect measurement those who cannot stand knee height measurements arm span tape measure 2 Weight a ideal body weight IBW i Current weight IBW x 100 b usual body weight UBW i Current weight UBW x 100 c weight change i UBW current weight UBW x 100 ii 5 loss in 1 month 7 5 loss in 3 months 10 loss in 6 months iii B Biochemical Labs what are they used for 1 Diagnose diseases 2 Support nutrition diagnoses 3 Monitor medication effectiveness 4 Evaluate NCP interventions iv Types of labs 1 Clinical chemistry panels a Basic metabolic panel to assess kidneys electrolyte and acid base balance blood sugar and calcium levels Glucose calcium sodium potassium CO2 chloride BUN creatinine 2 Comprehensive metabolic panel a Add serum albumin total protein ALP AST ALT Bilirubin 3 Complete blood count a RBCs hemoglobin hematocrit MCV MCH MCHC WBC Differential a Tested for blood pathogens and gut microflora 4 Stool testing 5 Urinalysis 6 Hydration status a Na BUN serum osmolality specific gravity of urine b Overhydration edema v What is involved in clinical assessment 1 Physical signs a Examination techniques inspection palpation percussion and auscultation i Inspection general observation using sight smell and hearing most often used in field ii Palpation exam to feel pulses and vibrations assessment of body structures texture sixe temperature tenderness and mobility iii Percussion listen to sounds to determine body organ borders shape and position not always used in this field iv Auscultation use of ear or stethoscope to listen to body sounds heart vi What are the ways in which dietary intake information can be collected and lung bowel blood vessels 2 Handgrip dynamometry a 35 kg for males and 23 kg for females assessed e g exchange list 1 Nutrient Intake Assessment 72 hours 2 Food freq questionnaire 3 24 hour recall not most reliable 4 REVIEW EXCHANGE LIST SLIDE 34 vii How are nutritional requirements estimated Know Mifflin equation dietary guidelines protein and fluid requirements etc You do not need to memorize EER for children and adolescents or activity and injury factors these will be provided 1 Mifflin St Jeor equation a Males kcal d 10 x wt in kg 6 25 x ht in cm 5 x age in yrs 5 b Females kcal d 10 x wt in kg 6 25 x ht in cm 5 x age in yrs 161 2 Protein Requirements a 1 5 g kg bw day for infants b 1 1 g kg bw day for 1 3 y c 0 95 g kg bw day for 4 13 y d 0 85 g kg bw day for 14 18 y e 0 8 g kg bw day for adults women 3 Fluid Requirements a Method 1 30 35 mL kg bw f 1 1 g kg bw day for pregnant using pre pregnancy weight and lactating b Method 2 1 mL kcal consumed f What is a nutrition diagnosis what does each letter stand for in a PES statement and how are they written Understand how to prioritize and evaluate them i Where the problem is identified ii PES 1 Problem 3 domains nutrition diagnosis label connects to etiology by RELATED TO 2 Etiology cause of the problem focus of the intervention connects to symptoms by AS EVIDENCED BY 3 Signs Symptoms evidence focus of monitoring and evaluation g What is a nutrition intervention How are they linked to PES statements i Should address each diagnosis should address each problem in assessment include a Signs objective b Symptoms subjective patient centered goals ii Targeted at ETIOLOGY iii What where when how iv PLANNING AND IMPLEMENTATION 2 STEPS h What are the major diet modifications discussed in class and why would they be used i Gluten free liquid soft pureed low fiber ii Change of freq diabetes post gastrectomy iii The ketogenic diet is a high fat adequate protein low carbohydrate diet i What is a nutrition monitoring and evaluation How is it linked to interventions i Measures impact of intervention ii Determine what to monitor and should match the signs and symptoms 2 The Digestive System a What is the gastrointestinal tract GIT and system what are their features and what does it do i Digests macronutrients micronutrients and is a barrier b How is overall health linked to the health of the GIT i After only a few days of starvation the GIT atrophies 1 GIT returns to normal after a few days cellular proliferation and return of normal GI