1) The Nutrition Care Processa) What is the Nutrition Care Process?-established by the academy of nutrition and dietetics as a standardized process for the provision of nutrition careb) What are the steps of the NCP and what is involved in each step?ADIMEa. Nutrition Assessment-screen for at risk patients: gather info, risk factors, imbalance, intakeb. Nutrition Diagnosis-problem identification, write a PESc. Nutrition Intervention-address each diagnosis, create a plan of actiond. Monitoring and Evaluation-measure impact of interventions-goal is to meet nutritional needs of patientc) What are nutrition risk factors and how do they affect an individual's nutrition status?1. Intake2. Psycho-social3. Physical condition4. Biological make-up5. Food medication interactionsd) What are nutrition screening and assessment and why are they done? Screening-a process that identifies those who would benefit from a full nutrition assessment-alerts the Dietitian of who should be treated with ADIME-performed when warranted by the patient’s needs or condition-individual organization defines in writing the criteria that identify when these screening and more in depth assessment are performed-must be completed within 24 hours after inpatient admissionAssessment=comprehensive evaluation by an RD to define nutritional status using medical, social, nutritional and medication histories, physical examination, anthropometric measurements and lab data-gather data to make professional judgment about nutritional status-assessment involves evaluating an individual’s current status by comparing actual figures to expected normal valuese) What are the ABCDs of assessment? AnthropometricBiochemicalClinicalDietaryi) 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.-Height=cm/in-weight=kg/lb-BMI=Weight (kg) divided by (height [m]2)-Appropriate BMI between 18.5 and 24.9-IBWMen106 lbs for first 5 feet of ht and 6 lbs per inch over 5 feet; or 6 lbs subtracted for each inch under 5 ftWomen100 lbs for first 5 feet of ht and 5 lbs per inch over 5 feet; or 5 lbs subtracted for each inch under 5 feetBody composition-underwater weighing, Bioelectrical impedance analysis, DEXA, air displacemebt, skin fold thickness, circumference measurements-Handgrip dynamometrySignificant Weight Loss5% in 1 month7.5% in 3 months10% in 6 monthsii) Labs – what are they used for, types of labs, etc.Routine medical laboratory tests1. Clinical chemistry panels-basic metabolic panel to assess kidneys, electrolyte and acid/base balance, blood sugar, calcium levels-glucose, calcium, sodium, potassium, CO2, chloride, BUN, creatinine2. Comprehensive metabolic panel-add serum albumin, total protein, ALP, AST, ALT, bilirubin3. Complete blood count-RBCs, hemoglobin, hematocrit, MCV, MCH, MCHC, WBC, differential4. Stool testing-test for blood, pathogens, gut microflora5. Urinalysis-detects substances or cellular material associated with metabolic and kidney disorder6. Hydration status-Na, BUN, serum osmolality, specific gravity of urine-Bioelectrical impedance analysis=calculates total body wateriii) What is involved in clinical assessment?-Family history-race/ethnicities/culture-lifestyle choice-smoker/drinker-medical history-at risk population groupsImportant Questions: typical eating patter, shopping and cooking arrangement, meals eaten outside of the home, specialized diet, chewing/swallowing difficulty, bowel movement history, appetite and intake of alcohol, religion and food practices, dietary supplements, food allergies and intoleranceiv) What are the ways in which dietary intake information can be collected and assessed (e.g. exchange list)?Assess nutritional requirement-intake vs TEE-proportion of CHO, Fat, ProAssess nutritional status-MNA-Subjective Global Assessment-based on history, dietary data, GI symptoms, functional capacity, effects of disease, physical appearance-Food record or diary-food frequency questionnaire-24 hour recallNutrient Intake Analysis1. Collect dietary intake data2. analyzev) 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. Mifflin-St. Jeor equationMales: kcal/d = 10 (wt in kg) + 6.25 (ht in cm) – 5 (age) + 5Females: kcal/d = 10 (wt in kg) + 6.25 (ht in cm) – 5 (age in yrs) – 1611.5 g/kg bw/day for infants1.1 g/kg bw/day for 1-3 y0.95 g/kg bw/day for 4-13 y0.85 g/kg bw/day for 14-18 y0.8 g/kg bw/day for adults1.1 g/kg bw/day for pregnant (using pre-pregnancy weight) and lactating womenMethod 130-35mL/kg bwMethod 21ml/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.-problem identification-assess using all available data-identify, prioritize and document problems in medical recordPES Statement=problem, etiology and symptoms in a clear and simple statement1. Problem-use diagnosis terminology and code2. Etiology-cause, reason for problem3. Signs and symptoms-evidence from assessmentEx. Excessive energy intake related to eating frequently in fast food restaurants as evidenced by BMI of 30 and diet historyPrioritize: always address the reason they are seeing you FIRST unless there is a life threatening conditiong) What is a nutrition intervention? How are they linked to PES statements?-Most important part: diet prescription-translate assessment data into strategies or actions to meet established objectives-specific: what, where, when how-planning and implementation-vary from normal as little as possibleInterventions are focused on the etiology define in a PES statement-RD’s cannot state an intervention unless it was addressed in a previous PES statementi) What are the major diet modifications discussed in class and why would they be used?-change in consistency: liquid, soft, pureed, low fiber, high fiber-increase or decrease energy value-increase or decrease type of food or nutrient: sodium, lactose, potassium-eliminate specific foods: allergies, gluten free-change route of delivery-rearrange number/frequency of mealsh) What is a nutrition monitoring and evaluation? How is it linked to interventions?=following the patient to track their progress, symptoms and