nfmnt chapter 14 review effectiveness of nutrition care and manage professional communication

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

14

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


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


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


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


The Interdisciplinary Team (IDT)

Long-Term Care Administrator

Registered Dietitian Nutritionist

Certified Dietary Manager

Nurse


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


» 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


» 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


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?


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?



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?



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?


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


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


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


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)


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


Monitoring Diabetes

Check for hypoglycemia» Dizziness, shakiness, cool, clammy

Work with RDN to ensure adequate nutrition coverage throughout the day

Consider a liberalized diet


Weight Loss Review weight record

Review laboratory values

Review environmental factors

Review progress notes for intake and output records


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


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


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


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.


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


nfmnt chapter 14 review effectiveness of nutrition care and manage professional communication

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