MNT — Exam #2 : Part 2 Flashcards
(139 cards)
What is the purpose of nutrition INTERVENTION?
- Resolve or improve the nutrition problem;
- Done by determining and implementing the correct and most appropriate nutrition interventions;
- Must be tailored to the patient’s needs
What are the IDNT intervention terminologies?
-Use that terminology to “structure” documentation;
-Choose the most appropriate strategy
→ The intervention strategy is determined by the nutrition diagnosis and its etiology and often helps to resolve the signs and symptoms
What are intervention strategies chosen to CHANGE?
- Nutritional intake;
- Nutrition-related knowledge or behavior;
- Environmental conditions;
- Access to supportive care and services
What are Nutrition Intervention goals?
- Nutrition intervention GOALS determine how the patient’s progress is MONITORED and EVALUATED;
- Two sets of goals → Clinical (long-term) and Personal (short-term)
What are the 2 components of intervention?
- Planning;
2. Implementation
What is involved in PLANNING?
- Prioritize nutrition dx;
- Consult AND’s EAL practice guidelines and other practice guides;
- Determine expected outcomes for each Nutr dx;
- Work with patient and/or caregivers (setting is very important!);
- Define a nutrition intervention plan and strategies;
- Define time and frequency of care;
- Identify resources needed (educational tools, handouts, videos, etc - document)
What is included in IMPLEMENTATION of intervention?
- Action portion of intervention
- RD carries out the plan of care
- Communicates the nutrition care plan
- Continues with data collection
- Revises the nutrition intervention based on the patient’s response
How do you PRIORITIZE the nutrition diagnosis?
(PLANNING)
- Based on severity of problem, safety, patient needs, likelihood that the intervention will impact the problem, and the patient’s perception of importance;
- Determine which Nutr Dx will be affected most and give best outcome
How do you know what intervention strategy/strategies to choose?
(PLANNING)
- Use evidence-based guidelines = DGA, RDA, EAL practice guidelines, Specialized organizations- American Diabetes Association, ASPEN, AND…;
- Use institutional policies and procedures
What is the first part of “planning” for intervention?
- Plan the nutrition prescription!!;
- Rx states the patient/client’s individualized plan for best meeting nutritional needs;
- Will be the FIRST intervention done
What might be included in the nutrition prescription?
-Consistency needed;
-Schedule of food/fluids;
-Specific foods/ beverages;
-Other
(see IDNT)
What is the nutrition prescription NOT?
NOT the current diet order;
- Current would be what the pt was doing at home or what the dr. prescribed upon admission;
- Rx should CHANGE something
What is the nutrition prescription?
- It IS an individualized statement of NEEDS of a patient at that moment;
- Purpose of Nutrition Rx: “to communicate the RD’s diet/nutrition recommendation based on a thorough nutrition assessment.”
- Prescription is AFTER assessment!!!;
- Based on evidence-based dietetics practice
What does the prescription have to be related to?
- The the nutrition DIAGNOSIS;
- Ex: If PES is related to inadequate energy intake then Nutrition Rx should include method to increase energy and to what level (may also include meal schedule)
What is included in the prescription?
- If any part of the order is standard, do NOT include it in the order;
- If it is SPECIAL to the patient then MUST be as SPECIFIC as possible!;
- Include PROTEIN in all assessments and orders ;
- ** Don’t forget to put in ( ) what factors you used to calculate needs. Example: (AF=1.3, IF= 1.5), protein(1.3 g/kg)
When might a change in energy intake require a dictation?
- A change in “consistency” might not require a dictation in a change in energy intake;
- Only changing the form of the food, not the amount of energy provided by the food
Examples of Nutrition Prescription Components
- Calories (specify calories/d)
- Carbohydrate (specify grams/d, percent of kcal)
- Protein (specify g/d, g/kg/d, percent of kcal)
- Fat (specify g/d, percent of kcal)
- Recommended saturated fat level (specify g/d, % of kcal)
- Recommended unsaturated fat level (specify g/d, % of kcal)
- Recommended vitamin intake (ex: amt. of vitamin D/d)
- Recommended mineral intake (ex: amt. of calcium/d)
- Recommended fluid intake (specify ml/day)
- Recommended fiber intake (specify type and g/d, g/1000 kcals/d)
- Recommended level of bioactive substances (specify substance and amount)
What are Bioactive Substances?
- Any component of food that is thought to have health benefits beyond typical micro and macro nutrient requirements.;
- Examples: soy protein, soluble fiber, plant sterols (Benacol that is prescribed for treating cholesterol)
Examples of altered diets components that might be int the Nutrition Prescription?
- Recommended enteral nutrition order (specify formula, rate/schedule);
- Recommended parenteral nutrition order (specify solution, rate, access);
- Recommended liquid diet (Clear liquid, full liquid);
- Recommended texture modification (ex: mechanical soft, puree…);
- Recommended liquid consistency modification (ex: thin, nectar, honey, pudding)
What might be recommended food intakes for the Nutrition Prescription?
- Grains (Ex: servings, exchanges, amounts…);
- Fruit and vegetables;
- Meat, poultry, fish, eggs, beans, nuts…;
- Milk and milk product intake;
- Fat foods (specify types, servings, exchanges amounts)
What is the first step in prevention and treatment of malnutrition?
First step in prevention and treatment of malnutrition is adequate supply of acceptable food composing a diet that has been individualized to age, height, weight, activity level, and medical condition
What causes malnutrition seen in acute care?
Malnutrition in ACUTE care (short-term hospital/clinic) is due to chronic illness before admission, but heightened by pain, anxiety, depression and unfamiliar foods or meal schedules with admission to a health care setting
Who writes hospital diet orders?
- Dr’s or nurses write diet orders;
- RDs write and approve the menus that are used in each scenario of prescriptive diets;
- All patients must have diet order!
What is the Regular or “House” Diet?
- Standard diet served;
- General-purpose or “house diet” supplies a minimum of three meals each day with regulations dictating timing, frequency and nutrient content of the meals