nutrition- chapter 17 Flashcards
registered dietitian nutritionist (RDN)
- a.k.a. registered dietitian (RD)
- provide medical nutrition therapy
support staff
nurse, dietitian, physical therapist, occupational therapist, speech therapist, respiratory therapist, radiologist, physician assistant, kinesiotherapist, pharmacist, and social worker
roles of the nurse and dietitian
dietitian:
- determines needs
- plans and manages therapy
- evaluates plan of care
- documents results of nutrition therapy
nurse:
- develops, supports, and carries out plan of care
nursing role
- coordinator and advocate; advocate for patient nutrition
- interpreter: explanations help reduce patient anxiety
- teacher and counselor: reinforces dietitian’s care plan with patient
Nutrition Care Process for RDNs
- nutrition assessment
- diagnosis
- intervention
- monitoring and evaluation
nutrition assessment
- family and medical history questionnaires
- current status and goals
- patient and family are primary sources of information
- other sources: medical chart, communication with staff, and related research
food and nutrition related history
- RDN evaluates patient’s diet
- guides for gathering nutrition history
- underreporting energy intake is common
- physical activity logs
- doubly labeled water method
anthropometric measurements
- height: fixed measuring stick against wall is preferred
- weight and BMI: weight should be measured at consistent times in similar clothing
- body composition: skin fold thickness using calipers, hydrostatic weighing, bioelectrical impedance analysis, dual-energy x-ray absorptiometry, BOD POD
- waist circumference: at stored in abdominal region raises risks for chronic disease
- MAC: mid-arm circumference in cm. used frequently in home health
biochemical data, medical tests, and procedures
- plasma proteins
- liver enzymes
- blood urea nitrogen, serum electrolytes
- urinary urea nitrogen excretion
- creatinine height index
- complete blood count
- fasting glucose
- total lymphocyte count
data cont.
- skeletal system integrity: several tests for bone integrity, osteopenia, or osteoporosis
- GI function
- resting metabolic rate: to determine total energy needs
client history
- guided questioning
- dietary supplements
- socioeconomic status, religion, culture, etc
- psychologic and emotional problems
- evaluate data collected
nutrition diagnosis
- problem: data is analyzed and diagnostic category assigned
- etiology: cause or contributing risk factors identified
- signs and symptoms: changes in patient’s health status that indicate nutrition problem
nutrition intervention
- follows assessment and diagnosis
- written care plan addresses personal and medical needs
food/nutrient delivery
- personalized: personal needs, disease, nutrition therapy, and food plan
- mode of feeding: total energy of diet, nutrients or texture may be modified
enteral feedings
- patient’s GI tract is functioning, but they cannot or will not orally consume food
- done by specialized tube
parenteral nutrition therapy
- patient unable to tolerate any nutrition delivery to the GI tract
- administered intravenously
nutrition education and counseling
- patients with education about the specific nutrition intervention plan are more likely to be compliant
- long-term lifestyle modifications to promote health
monitoring and evaluation
3 components:
- monitor progress
- measure outcomes
- evaluate outcomes
- nutrition history outcomes
- anthropometric measure outcomes
- biochemical data, medical tests,
procedure outcomes
- nutrition-focused physical findings
diet-drug interactions
- risks with polypharmacy, especially in elderly
- must gather information about all drug use, including OTC, prescription, alcohol, street drugs
drug-food interactions
- high-fat meals
- high-fiber meals
- grapefruit juice
- foods high in vitamin K with warfarin
- medications that alter taste or smell sensations, thus interfering with appetite
- medications that stimulate appetite
drug-nutrient interactions
- usually when medications are taken with OTC vitamin and mineral supplements
- patients rarely report supplements to physicians
drug-herb interactions
- least well defined category
- St. John’s wort interacts with many medications
- others include gingko biloba, garlic, ginseng, ginger
