Nutrition Fundamentals and Medical Nutrition Therapy

Apply Standard Nutrition Care

Corresponds with LEARNING PLAN 13Copyright 2016 Association of Nutrition and Foodservice Professionals

13

Objectives

Explain the purpose and basic steps of care planning

Review client’s nutritional needs based on guidelines provided

Assess nutrition content of food

Identify sources to consult to assist in implementing nutrition care plans

Nutrition Fundamentals and Medical Nutrition Therapy • Apply Standard Nutrition Care • Learning Plan 13

Care Plan

A written plan for medical care

Identifies client’s interests, preferences, and abilities

Identifies objectives to help a client reach the best possible physical, mental, social, and spiritual well-being

Nutrition Fundamentals and Medical Nutrition Therapy • Apply Standard Nutrition Care • Learning Plan 13

Care Plan

Describes steps IDT members will take to accomplish plan and the disciplines that will carry out the approaches

Each care plan is unique and planned specifically for one client

The care plan charts the course for actions that will support and improve an individual’s well-being

Nutrition Fundamentals and Medical Nutrition Therapy • Food Preferences and Customs • Learning Plan 1

Quality of Life for the Client

Comprehensive Care Plan» Personal interview of client» Obtain as much input from the client as possible» Clients’ family is included» Developed by the IDT» Teamwork approach to care plan is essential

Nutrition Fundamentals and Medical Nutrition Therapy • Apply Standard Nutrition Care • Learning Plan 13

Quality of Life for the Client

Measureable objectives and timelines

Developed within 7 days after completion of the Care Area Assessment (CAA)

Reviewed periodically and revised by team after each assessment

Nutrition Fundamentals and Medical Nutrition Therapy • Food Preferences and Customs • Learning Plan 1

Steps to the RAI

Assessment (MDS)

Decision-Making (CAA)

Care Plan Development

Care Plan Implementation

Evaluation

Nutrition Fundamentals and Medical Nutrition Therapy • Apply Standard Nutrition Care • Learning Plan 13

Brain Break

Why is it important for a care plan to be comprehensive?

» A comprehensive care plan addresses the multi-faceted needs of a client. This requires ongoing communication and coordination with IDT members.

Nutrition Fundamentals and Medical Nutrition Therapy • Apply Standard Nutrition Care • Learning Plan 13

Care Plan Objectives

Client, client’s family and IDT develop quantifiable objectives for the highest level of functioning the client may be expected to attain, based on the comprehensive assessment

CAA summary identifies triggered CAA areas, known as Care Area Triggers (CATs)

Nutrition Fundamentals and Medical Nutrition Therapy • Apply Standard Nutrition Care • Learning Plan 13

Care Plan Objectives

Rationale whether to proceed with a care plan or not

Care plans must be developed for all CAAs triggered by the MDS

Care plan objectives are used to monitor client’s progress

Updated quarterly and as the client’s condition changes

Nutrition Fundamentals and Medical Nutrition Therapy • Food Preferences and Customs • Learning Plan 1

Characteristics of Decline

Decline in decision making ability

Change in mood or increase in symptom frequency

Decline in ADL functioning

Incontinence pattern or placement of a catheter

Nutrition Fundamentals and Medical Nutrition Therapy • Apply Standard Nutrition Care • Learning Plan 13

Characteristics of Decline

Unplanned weight loss» 5% change in 30 days» 10% change in 180 days

Initiation of restraints

Overall deterioration of client’s condition

Nutrition Fundamentals and Medical Nutrition Therapy • Food Preferences and Customs • Learning Plan 1

Characteristics of Improvement

Improvement in ADL functioning

Decrease in behavioral symptoms

Increased ability to make decisions

Incontinence pattern improves

Overall improvement of client’s condition

Nutrition Fundamentals and Medical Nutrition Therapy • Apply Standard Nutrition Care • Learning Plan 13

Brain Break

A client who normally weighs 128 lbs now weighs 122 lbs after 14 days. What is the percent weight change? Is this a significant weight change?

» 122 ÷ 128 = .953 x 100 = 95.3%» 100% - 95.3% = 4.7% or 5% when rounded up» This is significant because a 5% weight loss over 30 days is

significant so a new care plan must be developed.

Nutrition Fundamentals and Medical Nutrition Therapy • Apply Standard Nutrition Care • Learning Plan 13

Identify Nutrition Problems

Develop a statement of the problem as it relates to the client

Be as specific as possible

Identify possible reasons for the problem, including the client’s perspective

Identify any strength the client has that will help in overcoming the problem

Nutrition Fundamentals and Medical Nutrition Therapy • Apply Standard Nutrition Care • Learning Plan 13

Role of Nutrition Professionals

Step 1: collect or verify data needed to determine nutrition problems

Care Area Triggers important to the CDM/RDN» Falls» Nutritional status» Feeding tube» Change in dentition» Dehydration/fluid maintenance» Pressure Ulcers

Nutrition Fundamentals and Medical Nutrition Therapy • Apply Standard Nutrition Care • Learning Plan 13

Role of Nutrition Professionals: Monitoring During Eating Occasions What risk factors for decline of eating skills were identified?

» Decrease in the ability to chew and swallow food» Deficit in the ability to move food onto a utensil and into the mouth» Changes in oral health status affecting eating/chewing ability» Depression or confused mental state

What care is the client receiving to address risk factors to maintain eating abilities?» Assistive devices to improve client’s ability to grasp or coordination» Seating arrangement to improve sociability» Seating in a calm, quiet setting for clients with dementia

Nutrition Fundamentals and Medical Nutrition Therapy • Food Preferences and Customs • Learning Plan 1

Role of Nutrition Professionals

Step 2: Assess the client» Determine triggered areas and how they affect the client’s

functioning or well-being» Address only if it is a concern for the client

Nutrition Fundamentals and Medical Nutrition Therapy • Apply Standard Nutrition Care • Learning Plan 13

Role of Nutrition Professionals

Step 3: Gather data and complete MDS care plan» Calculation of nutrient needs» Percent of intake» Weight monitoring» Laboratory data» Skin status

Nutrition Fundamentals and Medical Nutrition Therapy • Food Preferences and Customs • Learning Plan 1

Role of Nutrition Professionals

Step 4: Agree on intermediate goal(s)» If the RDN isn’t present, the CDM will be responsible for

understanding and relaying any nutrition diagnosis and care standards

» Confirm the nutrition goal is feasible

Nutrition Fundamentals and Medical Nutrition Therapy • Apply Standard Nutrition Care • Learning Plan 13

Role of Nutrition Professionals

Step 5: Identify specific steps or approaches» CDM should become familiar with the documentation

process for care planning» Care planning documentation should comply with all

regulations

Communicate the goal(s) and objectives» CDM is responsible for alerting the RDN to any changes in

the client’s condition

Nutrition Fundamentals and Medical Nutrition Therapy • Food Preferences and Customs • Learning Plan 1