EXAM 1 STUDY GUIDEDIE 4244Medical Nutrition TherapySpring 20141) 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 careiii) The patient or client relationship with the registered dietitian is at the center of the NCPb) 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(1) Relationship of the target patient, client, or group with the RD (central componentof the model)(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) Intakeii) Psycho-socialiii) Physical conditioniv) Biological make-up (labs)v) Food-medication interactionsd) What are nutrition screening and assessment and why are they done? i) The “A” in ADIMEii) 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) Dietaryii) 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.(1) Height(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 monthsiii) (B- Biochemical) Labs – what are they used for(1) Diagnose diseases(2) Support nutrition diagnoses(3) Monitor medication effectiveness(4) Evaluate NCP interventionsiv) 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(4) Stool testing(a) Tested for blood, pathogens, and gut microflora(5) Urinalysis(6) Hydration status(a) Na, BUN, serum osmolality, specific gravity of urine(b) Overhydration= edemav) 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, lung, bowel, blood vessels)(2) Handgrip dynamometry (a) ≥ 35 kg for males and ≥ 23 kg for femalesvi) What are the ways in which dietary intake information can be collected and 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(f) 1.1 g/kg bw/day for pregnant (using pre-pregnancy weight) and lactating women(3) Fluid Requirements(a) Method 1- 30-35 mL/kg bw(b) Method 2- 1 mL/kcal consumedf) 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 identifiedii) 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(a) Signs= objective(b) Symptoms= subjectiveg) What is a nutrition intervention? How are they linked to PES statements?i) Should address each diagnosis, should address each problem in assessment include patient-centered goalsii) Targeted at ETIOLOGYiii) What, where, when, howiv) 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-gastrectomyiii) The ketogenic diet is a high-fat, adequate-protein, low-carbohydrate dieti) What is a nutrition monitoring and evaluation? How is it linked to interventions?i) Measures impact of interventionii) Determine what to monitor and