1 The Nutrition Care Process a What is the Nutrition Care Process established by the academy of nutrition and dietetics as a standardized process for the provision of nutrition care b What are the steps of the NCP and what is involved in each step ADIME a Nutrition Assessment screen for at risk patients gather info risk factors imbalance intake c What are nutrition risk factors and how do they affect an individual s nutrition status b Nutrition Diagnosis problem identification write a PES c Nutrition Intervention address each diagnosis create a plan of action d Monitoring and Evaluation measure impact of interventions goal is to meet nutritional needs of patient Intake 1 2 Psycho social 3 Physical condition 4 Biological make up 5 Food medication interactions d 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 admission Assessment 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 values e What are the ABCDs of assessment Anthropometric i 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 Biochemical Clinical Dietary Height cm in weight kg lb IBW Men Women BMI Weight kg divided by height m 2 Appropriate BMI between 18 5 and 24 9 106 lbs for first 5 feet of ht and 6 lbs per inch over 5 feet or 6 lbs subtracted for each inch under 5 ft 100 lbs for first 5 feet of ht and 5 lbs per inch over 5 feet or 5 lbs subtracted for each inch under 5 feet Body composition Handgrip dynamometry underwater weighing Bioelectrical impedance analysis DEXA air displacemebt skin fold thickness circumference measurements Significant Weight Loss 5 in 1 month 7 5 in 3 months 10 in 6 months ii Labs what are they used for types of labs etc Routine medical laboratory tests 1 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 creatinine 2 Comprehensive metabolic panel add serum albumin total protein ALP AST ALT bilirubin 3 Complete blood count RBCs hemoglobin hematocrit MCV MCH MCHC WBC differential test for blood pathogens gut microflora 4 Stool testing 5 Urinalysis 6 Hydration status Na BUN serum osmolality specific gravity of urine Bioelectrical impedance analysis calculates total body water detects substances or cellular material associated with metabolic and kidney disorder iii What is involved in clinical assessment Family history race ethnicities culture lifestyle choice smoker drinker medical history at risk population groups list Assess nutritional requirement intake vs TEE proportion of CHO Fat Pro Assess nutritional status MNA Subjective Global Assessment appearance Food record or diary food frequency questionnaire 24 hour recall Nutrient Intake Analysis Important 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 intolerance iv What are the ways in which dietary intake information can be collected and assessed e g exchange based on history dietary data GI symptoms functional capacity effects of disease physical 1 Collect dietary intake data 2 analyze v 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 equation Males kcal d 10 wt in kg 6 25 ht in cm 5 age 5 Females kcal d 10 wt in kg 6 25 ht in cm 5 age in yrs 161 1 5 g kg bw day for infants 1 1 g kg bw day for 1 3 y 0 95 g kg bw day for 4 13 y 0 85 g kg bw day for 14 18 y 0 8 g kg bw day for adults Method 1 30 35mL kg bw Method 2 1ml kcal consumed 1 1 g kg bw day for pregnant using pre pregnancy weight and lactating women 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 problem identification assess using all available data PES Statement identify prioritize and document problems in medical record problem etiology and symptoms in a clear and simple statement 1 Problem use diagnosis terminology and code 2 Etiology cause reason for problem 3 Signs and symptoms evidence from assessment Ex Excessive energy intake related to eating frequently in fast food restaurants as evidenced by BMI of 30 and diet history Prioritize always address the reason they are seeing you FIRST unless there is a life threatening condition g 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 possible Interventions are focused on the etiology define in a PES statement RD s cannot state an intervention unless it was addressed in a previous PES statement i 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 meals h What is a nutrition monitoring and evaluation How is it linked to interventions following the patient to track their progress symptoms and education Goal is to achieve the intervention curing the etiology by monitoring the symptoms when symptoms subside or don t subside further evaluation is