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Week 15

Week 15. Diet Manual Nutrition Screening Calculating Nutrient Needs Interpreting Nutritional Data Documenting Nutritional Data. Chapter 6. Diet Manual. Diet Manual. Specifies therapeutic diets and their application Used as a reference book Standardizes names for diets

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Week 15

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  1. Week 15 Diet Manual Nutrition Screening Calculating Nutrient Needs Interpreting Nutritional Data Documenting Nutritional Data

  2. Chapter 6 Diet Manual

  3. Diet Manual • Specifies therapeutic diets and their application • Used as a reference book • Standardizes names for diets • States what foods are allowed and which ones are to be omitted

  4. Diet Manual • Readily available for all caregivers • Dictates what information may be given in nutrition education • Recommended by the Dietitian • Approved by the Medical Director • Must be updated every 5 years

  5. Liberalized Modified Diets • Advantages • Improved dietary compliance • Improved psychosocial status of resident • Improved appearance and flavor of food • Enhanced calorie and nutrient intake • Increased accuracy and efficiency of trayline

  6. Liberalized Modified Diets • Advantages (cont) • Improvement of fasting blood glucose levels • Improvement in ability to maintain acceptable weight and nutritional parameters • Decreased labor and food costs

  7. Liberalized Modified Diets • Advantages (cont) • Improved surveys due to reduced chance of error • Improved quality of life for residents • Happy, healthy, and satisfied residents

  8. Chapter 8 Nutrition Screening

  9. Nutrition Screening A systematic method of identifying individuals at risk for nutritional problems.

  10. Nutrition Screening • Effective Screening Process • Uses meaningful criteria as identified by a nutrition professional • Sets meaningful thresholds that correspond to known risks

  11. Nutrition Screening • Effective Screening Process (cont) • Is applied to every resident • Is implemented quickly at admission • Is implemented uniformly and consistently

  12. Nutrition Screening • The Nutrition Care Process • Screens patients for nutrition risk • Assess each patient identified in screening process as “at risk” • Develop a care plan for each patient • Document, communicate, and implement the plan • Re-assess patient at defined intervals • As appropriate, revise the plan

  13. Nutrition Screening • Nutrition Care Process • Nutrition Assessment • In-depth evaluation of a client’s nutritional well-being • Nutrition Diagnosis • Defines all nutrition related problems • Uses standardized terminology defined by the ADA

  14. Nutrition Screening • Nutrition Care Process (cont) • Nutrition Intervention • Actions taken to correct a nutrition problem • This starts with a care plan • Nutrition Monitoring/Evaluation • Follow-up to determine if interventions are working • Interventions are revised as needed

  15. Nutrition Screening • Indicators • Pieces of information that might suggest a concern or risk • Four basic indicators used in screening: • Anthropometric measurements • Biochemical tests • Clinical information • Diet history

  16. Nutrition Screening • Sources: • Professional Organizations • Researchers • Educational Institutions • Nutrition and Pharmaceuticals • Nestle and Ross • Software packages

  17. Nutrition Screening: Anthropometrics • Ideal body weight • Percent of ideal body weight • Percentage of weight change

  18. Nutrition Screening: Anthropometrics • Standards of weight loss that indicate a risk: • > 5 % in one month 30 days • >7.5 % in three months 90 days • >10 % in six months 180 days

  19. Nutrition Screening: Anthropometrics • Lean body mass • Weight of all parts of the body that are not fat e.g.: muscles, bones and organs

  20. Nutrition Screening: Anthropometrics • Body mass index [BMI] • Standard for evaluating body weight based on the proportion of weight to height • BMI = weight in kg divided by the height in meters [39.37] squared

  21. Nutrition Screening: Anthropometrics • Skinfold thickness • Measures percentage of body fat with the use of special calipers, at specified body locations • Desirable range men: 13-25 % • Desirable range women: 17-29 %

  22. Nutrition Screening: Biochemical • Laboratory values to assess malnutrition: • Serum Albumin • Serum Transferrin • Serum Prealbumin • Hemoglobin • Hematocrit

  23. Nutrition Screening: Diet • Diet History [Hx] • Assessment of food intake patterns • Describes actual food intake • Offers information about food preferences • May include factors regarding lifestyle, social factors, medical factors and conditions as well as medications

  24. Nutrition Screening: Initiative • Founded in 1989 • Developed a tool to identify nutrition risk factors in older adults: • DETERMINE- warning signs checklist

  25. Nutrition Screening: Calculations • Basal Energy Expenditure [BEE] • How much energy the body needs at complete rest: • Breathing, brain function, heartbeat • Differs between men and women • Accounts for two-thirds of daily needs

  26. Nutrition Screening: Calculations • Total Daily Expenditure [TDE] • Amount of estimated calories needed with an activity factor, and injury factor if needed, to maintain sound nutrition • Digesting food, moving and exercising, growing or healing, and fever

  27. Nutrition Screening: Calculations • Caloric needs estimate • Accounts for the total amount of calories needed for one day • Included factors to account for other energy needs • Activity factors • Injury factors “An estimate is only an estimate”

  28. Chapter 9 Calculating Nutrient Intake

  29. Calculating Nutrient Intake • Caloric Distribution • Describes what proportion of total calories come from each macronutrient and alcohol if applicable

  30. Calculating Nutrient Intake • Macronutrients providing calories: • CHO: 4 calories per gram • Protein: 4 calories per gram • Fat: 9 calories per gram • Alcohol: 7 calories per gram

  31. Calculating Nutrient Intake: Protein • Estimating Protein Needs • Healthy adult: 0.8 grams per kg • Malnourished client: 1.2-1.5 grams per kg • Following surgery: 1.0-2.0 grams per kg • Trauma, burns, fractures: 2.0 grams per kg

  32. Calculating Nutrient Intake • Sources of Nutrient Information • Bowes and Church’s: “Food Values of Portions Commonly Used” • USDA Nutrient Database • www.ars.usda.gov/main/site_mainhtm? modecode=12-35-45-00 • Nutrient Analysis Software

  33. Calculating Nutrient Intake: Nutrition Facts Labels • Nutrition Fact Label • Nutrition information on almost every food in the grocery store • Easy to read format • Information on amount of nutrients per serving • Standardized serving sizes • Nutrient reference values as percent daily values to fit into daily diet

  34. Calculating Nutrient Intake: Nutrition Label Facts • Nutrition Fact Label [cont] • Uniform definitions • Nutrition claims • Declaration of total percent of juice in juice drinks

  35. Calculating Nutrient Intake: Nutrition Label Facts • Daily Value [DV] • Generalized figures for nutrients that can be applied to healthy people as a single group • Daily Reference Values [DRV’s] • References used for fat, saturated fat, cholesterol, carbohydrates “fiber”, alcohols, protein, sodium, and potassium • Reference Daily Intakes [RDI’s] • References for essential vitamins and minerals

  36. Calculating Nutrient Intake: Fluids • Calculating Fluid Intake • Healthy Adults: 30-35cc per kg • Heart Failure: 25-30cc per kg • If BMI >30, use adjusted body weight (ABW) as fat does not hold water • ABW= CBW – IBW x .25 + IBW • ABW ÷ 2.2 x 30cc= estimated fluid intake for healthy adult

  37. Chapter 10 Interpreting Nutritional Data

  38. Interpreting Nutritional Data • Nutrition Related Information • Medical record • Direct observation • Interview • Nutrition care documents • Communication with the health care team

  39. Interpreting Nutritional Data • Food and Drug Interactions • Extent of interactions between food and drugs depends on: • Drug dosage • Individual age and size • Specific medical condition

  40. Interpreting Nutritional Data • Examples of Food/Drug Interactions • Tetracycline and dairy • Fosamax taken without food • Excessive consumption of foods high in Vitamin K hinders the effectiveness of anticoagulants • Potassium-sparing diuretics interacts with large quantities of potassium in the diet, causing irregular heartbeat

  41. Interpreting Nutritional Data • Comparing Nutrient Intake to Standards • Identify RDA’s for age/sex • Consider laboratory data, physician’s diagnosis, diet history, and food frequency • Consider intolerances to certain foods and be able to replace these foods with appropriate nutrients • Milk • Meat (chewing/swallowing difficulties)

  42. Interpreting Nutritional Data and Dietary Management • Factors to Provide Effective Dietary Care • Blood sugar levels • Blood pressure readings • Meal time observations – tolerance to intake • Weight, Percent body weight, and weight changes • Pressure Ulcers

  43. Interpreting Nutritional Data and Dietary Management • Factors to Provide Effective Dietary Care [cont] • Laboratory values • Clinical information • Calorie counts

  44. Chapter 11 Documenting Nutritional Data

  45. Documenting Nutritional Data • Purpose • Provides a reference that you and other caregivers use on an on-going basis • Communication tool with other members of the healthcare team • Required by government agencies • Lays the groundwork to receive reimbursement • Legal record • Quality standard • Resource to monitor quality of services

  46. Documenting Nutritional Data • Medical Records • Also known as the medical chart or “chart” • Formal, legal account of a patient’s health and disease includes test results, diagnosis, and treatment plans

  47. Documenting Nutritional Data • Problem Oriented Medical Record [POMR] • A system of collecting data and planning client care that focuses on the client’s problems, includes the following: • Collection of data • Problem list • Plans for addressing each problem • Evaluation of care plans

  48. Documenting Nutritional Data • Progress Note • Notation in the medical record by a health professional • Written at key intervals during the course of a patient’s stay at a healthcare institution • Notes in the chart are structured according t the SOAP method format Subjective, Objective, Assessment, Plan

  49. Documenting Nutritional Data • Rules for keeping good client records • Medical record is a legal document • Follow the rules per facility policy to prevent litigation • Used medical abbreviations per facility policy • Narrative documentation is usually used in long term care [LTC] facilities

  50. Documenting Nutritional Data: Meal Related Documents • Diet Order • Diet prescribed by the physician for a individual client • Written order by physician in the medical record of available diets per diet manual • Verbal orders are discouraged because they do not provide solid documentation

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