Nutrition Care

Question 1

What is nutrition care?

Answer 1

nutrition care is an organized group of activities allowing:
- identification of nutritional needs, and
- provision of care to meet these needs

Question 2

what does coordination of care require?

Answer 2

regular discussions among team members and clear documentation of:
- in a common loaction (physical or virtual)
- standardization improves consistency and quality of care and enables collection and assessment of nutrition-related outcome measures

Question 3

what is the nutrition care process?

what does it provide guidelines for?

Answer 3

it is the standardized process for provision of nutrition care

provides guidelines for:
- identifying
- planning for, and
- meeting nutritional needs

Question 4

what are the nutrition care process steps?

Answer 4

1. nutrition assessment
2. nutrition diagnosis
3. nutrition intervention
4. monitoring and evaluation

Question 5

review nutrition diagnosis terms and definitions in book!

Question 6

Nutrition screening

Answer 6

nutrition screening helps to identify patients or clients at nutrition risk
- nutrition risk, when identified, triggers referral for RD assessment

can be employed in all settings
- in many places, nursing staff complete explicit nutrition screening upon admission to the facility
( may be incorporated into admission assessment )

Question 7

nutrition assessment terms classified into domains

Answer 7

diet history
anthropometrics
biochemical
nutrition-focused physical exam
client history

Question 8

what does the nutrition prescription include?

Answer 8

• estimated caloric needs
• estimated protein needs
• estimated fluid needs
• estimated for other nutrient needs as relevant to their condition

decide whether lose weight, maintain or gain

Question 9

what is the purpose of nutrition diagnosis?

Answer 9

to identify and describe a specific problem or problems that can be resolved or improved thorugh nutrition intervnetion by a nutrition and dietetics professional

Question 10

When it is possible to identify cause of the diagnosis it allows for:

Answer 10

• Greater understanding of the conditions in which the diagnosis came about, and
• Increased individualization of the intervention

Question 11

nutrition diagnosis should be documented using the:

Answer 11

PES format
P = problem
E = etiology (whats causing the problem)
S = Signs and symptoms

anything in signs and symptoms has to be included in the assessment

ex: unintended weight loss related to poor oral food and beverage intake as evidenced by 20% weight loss in 3 months

Question 12

what are the 2 steps of nutrition intervention?

Answer 12

• planning
• implemenetation

Question 13

what is the purpose of nutrition intervention?

they are the __, __, __ & __

Answer 13

to resolve the etiology or
to reduce/manage related signs and symptoms

what, where, when and how of the care plan

Question 14

intervention should , whenever possible, target the _ identified during

Answer 14

intervention should , whenever possible, target the etiology identified during assessment

not always possible (when etiology is unknown or poorly understood)

Question 15

after goals and objectives have been set, implementation begins. what may this include?

nutrition intervention

Answer 15

• food and nutrition therapies
• nutrition education
• nutrition counseling
• coordination of care

employing strategies

Providing appropriate handout and emphasizing whats important for them based on assessment

Question 16

frequency of monitoring will depend on:

Answer 16

the severity of the signs & symptoms and the sensitivity of the indicators to change

i.e., How soon would you expect to see a change in the indicator? Intake can change within 1-2 days & if it has not increased in that time you may need to change you plan
However, HgbA1C is a reflection of 3 months of glucose control & so it will take some time to assess the effectiveness of an intervention designed to ↓ HgbA1C

When you would follow up with the patient and what youd be looking for ( should follow from the diagnosis)

Question 17

Nutrition care process is continuous and so the initial plan may change:

3

Answer 17

• As the condition of the patient changes
• As new needs are identified
• If interventions prove to be unsuccessful

Question 18

Evidence-based practice is defined as

by The Centre for Evidence Based Medicine

Answer 18

the conscientious, explicit & judicious use of current best evidence in making decisions about the care of individual patients

Question 19

Evidence-based guidelines are developed by

Answer 19

Conducting a systematic review, then
Using the conclusions to develop practice-based guidelines

Question 20

RDs must be able to evaluate evidence-based guidelines to determine if a given guideline is appropriate for a

Answer 20

given patient or client in a given situation

Question 21

In dietetics, one of the most common forms of evidence-based guidelines is the

Answer 21

“Position Paper”

Question 22

medical record is a _ record

Answer 22

legal record
- if interventions are not recorded, it is assumed they did not occur

Question 23

advantages of documentation

Answer 23

• Ensures nutrition care will be relevant, thorough & effective by providing a record identifying the problem & setting criteria to evaluate care
• Allows the entire health care team to understand the rationale for nutrition care, the means by which it will be provided & the role each team member must play to reinforce the plan/ensure its success

Question 24

Medical record serves as a tool for _ among members of the health care team

Answer 24

communication

Question 25

what does ADIME stand for?

Answer 25

A – assessment D – diagnosis I – intervention ME – monitoring and evaluation

Question 26

What does the assessment part of ADIME include?

Answer 26

Reports of wt loss or appetite ↓ Chewing or swallowing difficulties (dentition) bowel movements (frequency, volume, consistency, colour) Food allergies Diet hx Relevant disabilities – e.g., impaired hearing/vision Ht (measured or self-reported?), weight (measured or self-reported?), usual body weight, ideal body weight, % usual body weight, % ideal body weight Pertinent lab values Diet order Estimated nutrient needs (EER, protein, fluid etc.) Diet-related medications and supplements

Question 27

what does D in ADIME mean?

Answer 27

nutrition **D**iagnosis - Written in PES statement(s) using standardized language for the nutrition care process

Question 28

what does I in ADIME stand for?

Answer 28

**I**ntervention Be specific Define nutrition prescription in terms understood by the “reader” (i.e., nurse, unit clerk, doctor, PT, OT, SLP) How involved/engaged was the client/patient and their family?

Question 29

what does M & E stand for in ADIME?

Answer 29

**M**onitoring & **E**valuation Identify patient outcomes relevant to nutrition diagnosis When will you follow up next with the patient?

Question 30

what does the ADIME chart note always include?

Answer 30

Date Time (for inpatient notes) signature Credentials Contact information On letter/notes sent to referring health professionals (in outpatient work)

Question 31

centralized | clinical

Answer 31

all part of a core nutrition department

Question 32

Decentralized | clinical

Answer 32

RDs report up within the particular unit or program they serve

Question 33

union vs non union - public health care system - private facilities

Answer 33

Within the public health care system - Near always unionized In private facilities - Most likely to be contract work

Question 34

RD should provide food & nutrition services that are | 2

Answer 34

Reliable Highly individualized

Question 35

RDs are responsible for using

Answer 35

Evidence-based practice, that is NOT compromised by marketforces

Question 36

a document telling the client what they should adopt

Answer 36

prescription

Question 37

Therapeutic Diets

Answer 37

Therapeutic or modified diets are based on a general, adequate diet modified to provide for individual requirements, such as - Digestive & absorptive capacity - Alleviation or arrest of a disease process - Psychosocial factors Should vary as little as possible from the individual’s normal diet ## Footnote Should always be a justified reason why you altered someones diet

Question 38

what to consider in a Therapeutic Diet

Answer 38

Always consider Personal eating patterns Food preferences Socioeconomic conditions (particularly for outpatient nutrition prescription) Religious practices Environmental factors that may impact food intake, such as - where meals are eaten - Who prepares them

Question 39

diverse forms of diet modifications

Answer 39

Change in consistency of foods (e.g., liquid, pureed, low-fiber) ↑ or ↓ in energy value of diet (high- or low-calorie) ↑ or ↓ in type of food or nutrient consumed (e.g,. sodium-restricted, lactose-restricted, high-potassium) elimination of specific foods (e.g., allergy diet, gluten-free) Adjustment in level/ratio/balance of protein, fat and CHO (e.g., diabetic diet, ketogenic diet, renal diet) Rearrangement of # and/or frequency of meals (e.g., postgastrectomy diet) Change in route of delivery of nutrients (enteral or parenteral) e.g. Keto can help epilepsy Renal diet – balance protein as it can be more work for the kidneys Postgastrectomy diet – small frequent meals as part of stomach has been removed

Question 40

Diet for Hospitalized Patients

Answer 40

Attempts must be made to honor patient preference during illness & recovery - Patient must be involved in the decision to follow a therapeutic diet ---- Patient choices of foods are most likely to be consumed Menu should be created with attention to color, texture, composition & temperature of the foods

Question 41

Hospitals and long-term care facilities must adopt a diet manual serving as a reference for diets served in the facility

Question 42

types of diets

Answer 42

Regular or General Serve as the foundation for more diversified diets Used when patient’s medical condition does not warrant limitations Typically ~1600-2200 kcal 60-80 g protein 80-100 g fat 180-300 g CHO Regular or general (cont.) Sometimes referred to as the house diet Many institutions have selective menus allowing the patient certain choices Adequacy then depends on the patient’s selections Consistency modifications May be needed for those with chewing or swallowing ability May involve chopping, mashing, pureeing or grinding food to modify texture Clear liquid diets include some electrolytes and small amounts of energy from tea, broth, carbonated beverages, clear fruit juices, gelatin Addition of milk & liquids prepared with milk are permitted on a full fluid diet, as are juices containing pulp Little evidence to support use of clear liquid diets as transition diets post-surgery Average clear liquid diet contains only 500-600 kcal, 5-10g protein, minimum fat, 120-130 g CHO & small amounts of Na and K Inadequate in calories, fibre & other essential nutrients

Question 43

When food intake is inadequate, measures should be included in the _ _ to provide food or supplements that may be better accepted or tolerated

Answer 43

nutrition prescription

Question 44

Poor acceptance of foods and meals may be caused by:

Answer 44

Unfamiliar foods, Change in eating schedule, Improper food temps, Patient’s medical condition, Effects of medical therapy

Question 45

Stays in hospital are typically brief, so RDs typically provide only brief education to hospitalized patients such as

Answer 45

What foods should they limit? How should they time their meals? What are appropriate portion sizes?

Question 46

Appropriate discharge documentation includes:

Answer 46

Summary of nutrition therapies & outcomes Pertinent information such as weights (date, measured vs. reported), lab values & dietary intake Recommendations for follow-up services Types of therapies attempted & failed Amount & type of education/instruction given, patient’s comprehension & expected degree of adherence to the prescribed diet