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Lecture 2 Flashcards

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1
Q

In the nutrition assessment what should you consider to contribute to someones nutritious status?

A

Biological
Lifestyyle
Food Intake
Environmental

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2
Q

In the nutrition assessment what re the mothods of organizing data/domains of assessment?

A 
Food/nutrition related history
Anthropometric
Biochemical, medical tests and procedures
Nutriton focused physical findings
Client history
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3
Q

In the nutriton assessment t what would we do to evaluate data using reliable standards?

A

Scientifically valid
Basis for formulating a nutrition diagnosis
Formulate nutrition prescriptions

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4
Q

What is a nutrition diagnosis?

A

Described the problem for which nutrition related activities provide the primary intervention
-not a medical diagnosis

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5
Q

What are the 3 domains/categories whiten which the nutritional diagnoses or problem fall?

A

Intake
Clinical
Behavioural-Environmental

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6
Q

How are you supposed to formulate a PES statement

A

P is related to E as evidence by S

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7
Q

What in an intake diagnosis (NI)?

A

Too little or too much intake compared to needs

  • excessive oral intake
  • inadequate fluid intake
  • malnutrition
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8
Q

What is a Clinical diagnosis (NC)

A

Nutrition problems related to medical or physical condition

  • swallowing difficulty
  • overweight/obesity
  • altered GI function
  • Breastfeeding difficulty
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9
Q

What is a behavioural-Environmental diagnosis (NB)?

A

Lack of knowledge about food or access to food

  • self monitoring deficit
  • limited adherence to nutrition related recommendations
  • Food and nutrition related knowledge deficit
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10
Q

What happens when all things are equal and there is a choice between stating the PES statement between 2 nutrition diagnoses from different domains?

A

Consider the INTAKE nutrition diagnosis as the one more specific to the role of the RD

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11
Q

What is never a nutrition diagnosis?

A

Type 2 diabetes

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12
Q

What are the steps in the nutrition intervention?

A 
Prioritize the nutrition diagnosis
Write thee nutrition prescription 
Set goals
Plan the intervention
Implement the intervention
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13
Q

What is the purpose of a medical record?

A

Documentation
Communication
Evaluation
-all done by interdisciplinary healthcare team

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14
Q

What is a clinical pathway?

A

Course of action for some hospital programs for meeting patrons needs, includes:

  • goals for patients over time
  • All areas of clinical practice
  • Program outcome indicators

Inserted in patients medical record

• For specific conditions we use a set of things that we neeed to do because they normally require all these things for the condition

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15
Q

how should the documentation in the medical record look?

A 
Systematic recording of patient care
-Ongoing conversation
-Clear and comprehensive record
-Continuous quality
Improvement 
-Legal documentation
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16
Q

What are the different charting styles?

A 
SOAP
DAP (data, assessment, plan)
ADIME
IER
Charting my exception
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17
Q

What are some of the guidelines for all charting?

A

Include patient full name and address
Chart what you see as significant
Sign with full name and status
Be timely; include date and time of chart note
Do you own charting; never chart for anyone else
Do not chart procedure until it is completed
Write clearly so the meaning of your note is clear
Cross out mistakes with single horizontal line; write word “error” above it

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18
Q

What content should be in charts?

A
  • Comprehensive but specific and easy to read
  • Accurate
  • Clear but concise
  • When writing objective notes, do not assume or infer
  • Set aside biases, be pt. centered
  • Use neutral language, be objective
  • Correct medical abbreviations
  • Use “patient” or “client” rather than name
  • Always sign name followed by designation (ie. RD)
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19
Q

When charting, what should you not forget to do?

A

Round numbers
Keep info confidential and private
Insert in medical record ASAP the same day
Keep patient record 10 years after
-and when patient turns 18 keep for 10n years

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20
Q

What is the initial care plan?

A 
Different one for each main problem
Different one for each healthcare area/specialty
Data and Assessment detailed
-specific intervention measures
-patient education
-patient centered
-specific
-measurable
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21
Q

What are progress notes?

A

Updates
Status of care over time
Detail interventions
All health care professionals contribute

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22
Q

What are the 2 kids of progress notes?

A

Narrative: Telling story, using words to describe your interaction with patient

Flow sheets: Records of data obtained periodically
-Numbers really over the course of the day

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23
Q

What are the rounding rules in charting?

Study These Flashcards
A 
Energy to nearest 10
Macro nearest unit
BMI nearest decimal
Ht nearest 2 decimals if using meters, full unit if cm
Wt in kg nearest 1 decimal
Wt in lbs neatest unit
24
Q

What is the DAP ?

Study These Flashcards
A

Data
Assessment
Plan

25
What gets recorded under Data in DAP?
``` Age • Gender • Reason for assessment • SomemedicalHxdata • Medications • ABCD findings • Patient’s perception of problem • Relevant info from patient & family • Lifestyle • Psycho / socio / economic factors • Factual relevant information and observation confirmed by health care professionals ```
26
What gets recorded under Assessment in DAP?
RD’s analysis + interpretation of data ``` Evaluation of: • Prior / current intake • Nutrition Rx • Nutritional needs / status • Acceptance of nutrition care plan • Collaborative approach for patient education • Progress ``` Determine Nutrition Diagnosis(es) • PES statement(s)
27
What gets recorded under Plan in DAP?
Recommendations- Specific course of action to solve the problem Outline of treatment plan: NCP Detailed Plan of Action
28
Where does PES go in the DAP?
• PES statement goes under the Assessment portion and can have more than one PES in the Assessment part
29
What is nutrition screening?
Quick, initial identification of individuals - at risk for nutritional imbalances - requiring more in depth nutrition assessment - already malnourished and requiring nutrition intervention • Shuld be quick and easy for someone without a nutrition abckground could do it, the RD doesn’t do this
30
What are examples of high risk factors in nutrition screening?
``` Wt loss >5% in 1 mo. or > 10% in 6 mos.  BMI < 18.5 kg/m2  %IBW  70%  %UBW  74%  Anorexia, NPO or clear fluids > 5 d  N & V or diarrhea > 3 days  Edema/ascites  Severe muscle wasting, loss of subcutaneous fat  TPN, EN ```
31
What are the important anthropometry equations?
%UBW = (CBW  UBW) X 100 BMI = Wt (kg)/ht (m)2 %IBW = (CBW  IBW) X 100 % Weight change = ((UBW - CBW)  UBW) X 100
32
What are the important interpretations for intentional wt loss?
* Significant weight loss * 5% in 1 mo, 7.5% in 3 mos, 10% in 6 mos * Severe weight loss * >5 % in 1 month, >7.5% in 3 mos, >10% in 6 mos
33
What is the difference between mild, moderate and sever malnutrition?
Mild malnutrition • 85-95%UBW;80-90%IBW • Moderate malnutrition • 75-84%UBW;70-79%IBW • Severe malnutrition • ≤74% UBW; ≤69% IBW
34
What is more informative, UBW or IBW?
UBW more informative, IBW may not be realistic
35
How do you evaluate the diet?
Gather information on dietary intake Quantify energy & nutrient intake Dietary Evaluate diet adequacy
36
What ways can we gather info on dietary intake?
``` Dietary assessment methods: –24-hour recall –Food frequency questionnaire –Food intake records –Direct observation ```
37
What are the ways in which we can quantify energy and nutrient intake?
``` Exchange lists Food Comp databases Food analysis software programs Food labels Ingredients list ```
38
How do we evaluate the diet for accuracy?
Government recommendations • Canada’s Food Guide & Canada’s Guidelines to Healthy Eating • Dietary Reference Intakes (DRI) Professional Association Guidelines/Clinical Practice Guidelines
39
How much protein do adults and elderly need?
Adults: RDA = 0.80 g/kg BW/d Elderly:1.0-1.3g/kgBW/d
40
How do we estimate energy requirements?
Indirect calorimetry MSJ equation Penn State equation
41
What is indirect calorimetry?
* Resting energy expenditure * Oxygen consumption * Carbon dioxide production * Metabolic cart * Limitations * Cost * Availability
42
What is the MSJ equation?
Non-critically ill With or without obesity W in kg, H in cm and A in years Females: REE = 10W +6.25H – 5A – 161 Males: REE = 10W + 6.25H -5A +5
43
What is the Penn State equation?
• Ventilator-dependent, critically ill With or without obesity • RMR = Mifflin(0.96) +VE (31) + Tmax (85) – 3,085
44
What is TEE?
``` Total energy expenditure TEE=REExAFxSF -resting metabolic rate -Activity factor -Stress factor ```
45
What are the energy ranges when you are trying to estimate energy intake with bw in kg?
``` • Normal 25-30 kcal/kg • Obesity 20-25 kcal/kg • Obesity, critically-ill** 11-14 kcal/kg (actual body weight) or 22-25 kcal/kg (IBW) • Clinical Stress - Mild 30-35kcal/kg - Moderate to severe 35-45 kcal/kg ```
46
What does hydration affects?
* Anthropometry | * Biochemical measurements • Physical exam
47
How do you evaluate hydration status?
* Fluid intake * Urine output * Physical signs * Biochemical signs * Disease-related fluid imbalances
48
What Is euvolemia?
Adequate hydration
49
What are the signs and symptoms of dehydration?
* Thirst * Oliguria * Dry mouth / lips * decrease body temperature * decrease BW * decrease BP * increase Heart rate * Headache, dizziness, confusion
50
What are the signs and symptoms of over hydration?
``` • Edema • increase BP • decrease Heart rate • decrease serum [Na+] • decrease serum [albumin] • SOB, dyspnea • Fast wt gain >2-3lbs in 2d >5lbs in 7d ```
51
What are the different methods for calculating fluid requirements?
1) Age + wt: 18-55 yrs -30-35 mL/kg 55-65 yrs-30 mL/kg >65 yrs-25 mL/kg requirement Energy intake: 1 mL / kcal s Fluid balance: Urine output + 500 mL Disease-specific recommendations: ex - renal disease, heart failure
52
What is nutrition counselling?
• Supportive -Encourage pt and positively guide changes • Process -Not a one-time encounter • Collaborative -Working with the pt as a partner in problem solving • Relationship -Professional relationship built on trust and honesty - Building a rapport is essential • Individualized care and plan of action -Goal setting • Self-care -Ultimate goal is for the patient/client to take responsibility for behaviours
53
What is the trans theoretical model?
Stages of change - Precontemplation (no intention to change) - Contemplation (ambivalent about changing0 - Preparation (taking steps to change) - Action (practicing new behaviours - Maintenance (sustained behaviour change)
54
What are the ways in which to deliver nutrition education?
• Group classes, individual instruction, written instruction, via phone or electronic communication • Outpatient setting more conducive to education - Most often provided in acute care setting
55
Which method to delivering nutrition education is more effective?
• Outpatient setting more responsive to education
56
What its the theoretical framework for nutrition counselling?
Theories and models provide research-based rationale for design and tailoring of interventions • Guides information needed at different times in the behavior change process • Identifies best tools and strategies to use • Uses outcome measures to determine effectiveness
57
What are the nutrition education tools?
``` Dietary recommendation sheets Eating Well with Canada’s Food Guide Information sheets / flyers Food models Food & food labels Recipes / cookbooks Posters ```

Clinical I (17 decks)

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