Nutrition Fundamentals and Medical Nutrition Therapy
Review Effectiveness of Nutrition Care and Manage Professional Communication
Corresponds with LEARNING PLAN 14Copyright 2016 Association of Nutrition and Foodservice Professionals
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Objectives
Applying Nutrition Data» Identify the effectiveness of the nutrition care plan» Evaluate care plans for individual needs
Manage Professional Communication» Identify what client information needs to be communicated» Identify the need for client referrals» Implement consultant recommendations as appropriate» Honor client rights and confidentiality
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14
Objectives
Participate in Client Care Conferences» Prepare for client care conference» Participate in a conference to identify client care concerns» Work with the interdisciplinary team to develop solutions» Implement goals and approaches with appropriate follow up
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14
Basics of Good Communication with the Interdisciplinary Team Written
» Documentation in the medical record» Email
Verbal» Be prepared during the care plan to provide facts about the
status of the client and progress made towards the goals of the nutrition care plan
» Be prepared to respond to questions from the family
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14
Basics of Good Communication with the Interdisciplinary Team Non-verbal
» Anticipate the questions and concerns of family members, watch your own non-verbal cues
» Watch for clues that the family and IDT members are following your reporting
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14
Overcoming Communication Barriers Message quality
» Seek feedback by asking questions such as, “Would you like to go through that again?”
» Try not to use jargon and explain if more clarity is needed
Time» “Free up” the time from other distractions (phone, pager,
other meetings)
Conflict» Don’t take conflict personally; remain professional
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14
The Interdisciplinary Team (IDT)
Long-Term Care Administrator
Registered Dietitian Nutritionist
Certified Dietary Manager
Nurse
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14
Occupational Therapist (OTR)
Physician
Social Worker
Speech Pathologist
Role of the RDN in the IDT
Assume primary responsibility and accountability for nutrition screening and assessment and client nutrition care planning. (This is why there should be ongoing communication with the Registered Dietitian Nutritionist)
Select and set up a nutrition screening/assessment system (in cooperation with the nursing service and facility administration); train facility staff as needed
Monitor the screening system
Perform nutritional assessments; may complete the Resident Assessment Instrument (RAI) and care plan
Develop a care plan
.Nutrition Fundamentals and Medical Nutrition Therapy • Food Preferences and Customs • Learning Plan 1
Record assessment findings, recommendations, and follow-up plans in medical record and client care plan.
Alert other team members to any part of the nutritional care plan needing their cooperation.
Define the role of a Certified Dietary Manager in clinical care and provide training.
Provide nutrition counseling.
Provide nutrition counseling.
Monitor the accuracy of diet service.
Participate in quality management.
May participate in client care conferences
.
RDN Role in the IDT
Coordination of care: The Certified Dietary Manager and the Registered Dietitian Nutritionist work closely together to coordinate care. Depending on the facility, the RDN may only be physically present on a monthly basis (or more often)
The CDM needs to have open lines of communication with the RDN in order to effectively implement the nutrition care plan. Any significant change in client status should be referred and communicated within 24-48 hours to ensure that quality care is provided.
Nutrition Fundamentals and Medical Nutrition Therapy • Food Preferences and Customs • Learning Plan 1
Brain Break
Physician
CDM
Speech Therapist
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14
» Orders a diet and other treatment that affects nutritional status
» Conducts a diet history to determine food preferences and intolerances
» Recommends diet for a possible swallowing disorder
For each IDT member, identify their role in the following scenario: A new admission of a 105-year old woman with chronic UTIs, right-side weakness from a stroke, and a 10 lb. weight loss in the past two weeks.
Brain Break
Occupational Therapist
Nurse
Registered Dietitian
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14
» Helps client develop strength and skills to feed herself
» Provides assistance at mealtime, encourages client to eat, distributes medications; records client food and fluid intake
» Develops nutrition care plan
For each IDT member, identify their role in the following scenario: A new admission of a 105-year old woman with chronic UTIs, right-side weakness from a stroke, and a 10 lb weight loss in the past two weeks.
IDT Basic Tasks
Assess client needs
Develop a plan of care
Evaluate a plan of care
Provide education to clients
Involve the client and client’s family
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14
Gathering and Sharing Information
The details for each of the IDT tasks may differ but the overall objective is the same» Work together to improve a client’s nutritional status
- To be effective Share information Communicate effectively
Finally, the CDM determines if the nutrition care plan is working; how do you know?
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14
Is the Nutrition Care Plan Working?
Has the client’s ability to eat or eating skills improved, declined, or stayed the same?
Was any deterioration or lack of improvement avoidable or unavoidable?
If the client’s eating abilities have declined, is there evidence that the decline was unavoidable?
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14
Is the Nutrition Care Plan Working?
What risk factors for decline of eating skills did the facility identify in the care plan?
Is there sufficient staff time and assistance provided to maintain eating abilities?
Were CATs and the CAA process used to assess reasons for decline, potential for decline, or lack of improvement?
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14
Is the Nutrition Care Plan Working?
Were individual objectives of the plan of care periodically evaluated and alternative approaches encouraged as needed to maintain eating ability?
Was the care plan driven by client’s strengths identified in the comprehensive assessment?
Was the care plan consistently implemented and closely monitored?
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14
Hydration
The facility must provide each client with sufficient fluid intake to maintain proper hydration and health
Water is one of six essential nutrients
A common clinical concern in long-term care is dehydration or lack of sufficient water in the body
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14
Brain Break What physical signs of dehydration would help you know
if a client was dehydrated?
» Sudden weight loss (5% or more of body weight)» Sunken eyes» Hollow cheekbones» Dry, cracked lips» Change in state of alertness» Deep, gasping breathing» Decrease in urinary output or dark urine
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14
Dehydration
Risk factors» Decreased sense of thirst» Coma/decreased sensory ability» Fluid loss due to diarrhea, fever, uncontrolled diabetes» Fluid restriction secondary to renal dialysis» Functional impairments that make it difficult to drink, reach
fluids, or communicate fluid needs» Dementia – client forgets to drink or how to drink
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14
Edema
Unhealthy water retention
Edema is not a disease, but a symptom
Can make heart and lungs work harder
Fluid restriction may be ordered by MD
Risk factors» Visible swelling in legs, ankles, feet, abdomen» Elevated blood pressure» Sudden weight gain (> 5% body weight)
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14
Monitoring Diabetes
Blood glucose monitoring» Fasting blood sugar
Measure glucose or ketones in urine
Review of glycosylated hemoglobin (laboratory value)
Check for symptoms that may indicate elevated glucose» Thirst, excessive hunger, excessive urination
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14
Monitoring Diabetes
Check for hypoglycemia» Dizziness, shakiness, cool, clammy
Work with RDN to ensure adequate nutrition coverage throughout the day
Consider a liberalized diet
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14
Weight Loss Review weight record
Review laboratory values
Review environmental factors
Review progress notes for intake and output records
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14
Weight Loss
Interview client, update preferences
Observe at mealtime» Swallowing» Functional abilities» Change in ability to communicate
Initiate interventions to reverse weight loss as appropriate
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14
Brain Break
List six reasons why weight loss might occur in long-term care
Examples:» Dehydration» Not enough time» Adaptive equipment needed or not used» Depression» Cancer» Ill-fitting dentures» Unhappiness with table mates» Food preferences not honored
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14
Pressure Ulcers
Improvement of nutritional status is a key component of resolving a pressure ulcer
Consider» Protein» Fluid» Caloric intake
Have a process to record progress of healing and interventions implemented and follow the process
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14
Brain Break
What should be added to the following menu for a client who has a Stage 3 pressure ulcer?» Swiss Steak, Green Beans, Mashed Potatoes, Fruit Crisp
» Add whole milk to the Swiss steak gravy and to the mashed potatoes to add calories and protein; add butter to the green beans for added calories; add ice cream to the fruit crisp to add calories, protein and fluid.
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14
Progress Notes
Summarize how a client is responding to treatment
Success in achieving goals identified in care plan
Follow facility protocol for documentation in the progress notes» Specific» Accurate» Objective» Concise» Thorough
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14