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Certified Dietary Manager Exam Secrets Study Guide 8, Exams of Nutrition

The concepts of nutrition screening and assessment, the difference between them, and the indicators used in screening. It also covers the Joint Commission the Accreditation of Healthcare Organizations (JACHO) and other agencies' requests, the Nutrition Screening Initiative, and HIPPA. The document also explains the roles of different healthcare professionals in the care of patients, including administrators, dieticians, dietary managers, nurses, occupational therapists, physicians, social workers, and speech pathologists. a study guide for the Certified Dietary Manager Exam.

Typology: Exams

2023/2024

Available from 09/24/2023

DrShirleyAurora
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Download Certified Dietary Manager Exam Secrets Study Guide 8 and more Exams Nutrition in PDF only on Docsity! Certified Dietary Manager Exam Secrets Study Guide What is Nutrition Screening - *systemic method for identifying individuals at risk for nutrition problems.* - part of standard admission procedure or out patient setting. - applied to all members in order to select out those who may be at risk. -performed by a CDM, diet technician or other deemed appropriate by the situation. What is Nutrition Assessment - *in-depth evaluation of a client's nutritional well being; include issues such as: lifestyle, cultural, psychosocial, procurement and preparation of food, support system.* -Performed by an RD using interview, lab data, clinical information, anthropometrics. -Makes a final assessment based on all information gathered. What is the difference between Assessment and Screening - *Nutrition screening:* systemic method for identifying individuals at risk for nutrition problems. *Nutrition Assessment:* in-depth evaluation of a client's nutritional well being. Indicators - *information that may suggest a risk or concern based on parameters set by the institution.* -May be based on diagnosis, age, lab data, or weight. - May develop a nutrition risk scoring system. -Institutions may develop their own or use one developed by an organization. Screening Tools - -often developed by staff or organization. - Build into software package. -May us "risk levels" -Use meaningful screening criteria identified by the RD. -Sets meaningful thresholds that correspond to know risks. -Is applied to every client. -It is implemented upon admission. -It is implemented consistently. Joint Commission the Accreditation of Healthcare Organizations (JACHO) and other agencies request... - *other standards to be met.* Including: - Assessment must be within a given time frame CDM,DTR,RD may vary from institution to institution, region to region. - Method of Screening also may vary. -Employee needs to be aware of policy and procedure of each institution. Screening Indicator #1. - *Nutritional Status: state of nutritional health.* -measured in a variety of ways. Gives and estimate of optimal or suboptimal protein and energy intake. Screening Indicator #2. - *Anthropometrics: Body Measurement.* - precise and accurate height and weight with repeated measurements using same scale, at the same time a day at varying intervals -BEDSCALES, HOYA LIFTS, WHEELCHAIR SCALES -HYDRATION STATUS TAKEN INTO ACCOUNT -IBW, BMI, Weight History etc. Screening Indicator #3. - *Biochemical test:* -Serum albumin->50% of body protein, half life of 21 days -Serum transferrin- protein in blood that carries irons-more sensitive than ALB -Serum prealbumin- protein made in the liver; 2-3 day half life -Total lymphocyte count- WBC involved in fighting infection. Decreases with poor protein status -Hematocrit- % of RBC -Hemoglobin- oxygen carrying pigment of RBC - low in iron deficient anemia -Cholesterol- below 100 can indicate malnutriton -BUN- Blood urea nitrogen- high in renal disease, dehydration -Serum potassium (K) - high in renal disease, dehydration Nutrition Screening "Initiative" and what it determines. - *-Multidisciplinary effort on over 25 medical, dietary and ageing organizations—views all aspects of geriatric care* -DETERMINES: -DISEASE -EATING POORLY -TOOTH LOSS -ECONOMIC STATUS -REFERRAL TO SOCIAL SUPPORT -MULTIPLE MEDICATIONS -INVOLUNTARY WEIGHT LOSS -NEED ASSISTANCE TO CARE FOR SELF -ELDERLY "BEE" - *Basal energy expenditure- describes how much energy the body needs when it is at complete rest, calories need to maintain life breathing, brain function* -Expressed as calories -Harris- Benedict Equation -Cal/kgBW -Accounts for 2/3 of calorie needs How many calories in Carbohydrates are in one gram? - 4 calories per gram. How many calories in Fats are in one gram? - 9 calories per gram. How many calories of protein are in one gram? - 4 calories per gram. What information is included in MDS? - -Diagnosis -Co-morbidities -Mental and physical functional status -Sensory and physical impairments -Nutritional status and requirements -Special treatments or procedures mental and psychosocial status -Discharge potential -Dental condition -Activities potential -Drug therapy What is section "K" of an MDS? - *Oral Nutritional Status* - Oral problems -Ht and wt -Weight change -Nutritional problems -Nutritional approaches -Parenteral and enteral intake Resident Assessment Protocols - 2nd part of the Resident Assessment Instrument for residents assessed at a high risk level identified through the MDS - triggers How often is an Annual Reassessment done? - every 12 months and is more extensive. When was HIPPA developed? - April 2003 What is HIPPA? - *-federal law intended to protect the privacy of healthcare clients, while also standardizing exchange of healthcare information. Dictates the way patient information is handled. Must be kept "secure"* -PATIENT PRIVACY AND THE RIGHT TO KEEP PERSONAL AND MEDICAL INFORMATION CONFIDENTAL -SAFEGUARDING INFORMATION, SUCH AS COMPUTER FILES, FROM PHYICAL AND TECHNICAL HAZARDS -HIPPA requires that computer access is restricted and protected -Employees can discuss patient information in public areas -All documents must be shredded. -All documents, chart, progress notes must be handled in a way that public does not have access to it What is a Chain of Trust under HIPPA? - *institutions and related organizations have to exchange data must establish a chain of trust in that it transmit data only to other organizations that have committed to following HIPPA regulations* Do this by: -Examining where information vulnerable -Developing procedures for protecting information at each point Healthcare Team - -group of professionals each with unique training and expertise- contribute to the overall care Members of Healthcare Team - -Administrator (Nursing Home) -Dietician -Dietary Manager -Nurse -Occupational Therapist -Physician -Social Worker -Speech Pathologists Role of Administrator: - -Manages screening/assessment policies -Maintains staffing to maintain system -Support staff Role of Dietician: - -Responsible for all aspects of nutrition screening and assessment -Selects and sets up a nutrition -screening/assessment system -Monitors the screening system -Performs assessments -Develops nutrition care plan -Records assessments, recommendations and follow-up plans in medical chart -Alerts team members to any indicators needing their attention -Manages and trains dietary mangers and techs -Counseling -Monitors accuracy -Quality management Role of Dietary Manager: - -Interview pt for diet history -Nutrition screening/assessment -Calculates intake- calorie count -Implements diet plans -May document in medical records -Counsels basic diet restrictions -Evaluated effectiveness of nutrition care plans -Assists in maintaining nutrition care processes and quality improvement according to policies and procedures Role of Nurses: - -Assesses pt needs, develops, implements and monitors care plans -Direct patient care -Monitor pt intake, set up, determines and implements special needs- may require PT or OT -Assists with feedings -Records accurate and meaningful information regarding intake -May provide education Role of Occupational Therapist: - -Evaluates needs related to fine motor skills -Recommends assistive eating devices -Provide fine motor skill therapy Role of Physician: - -Evaluates medical conditions and diagnosis -Determines, executes, medical care and treatment -Bears complete medical and nutritional responsibility -Writes diet orders and approves protocols for stand orders -Orders all medications, treatments and consults -Collects and utilities information from team members Role of Social Worker: - -Evaluates social and supportive needs -Assists patients and family with decision making -Helps plan discharge -Helps family apply for supportive social services- home delivered meals. Home care -Provides counseling -Identifies resources Role of Speech Pathologist. - -Evaluates the chewing and swallowing function of residents -Recommends appropriate dyphagia therapy -Provides evaluation and therapy for speech related needs What must all members do? - -ASSESS NEEDS -DEVELOP PLAN -EVALUATE PLAN OF CARE -PROVIDE EDUCATION How do team members share information? - through medical records, patient care rounds, face to face communication. What are the medical chart sections? - -Admission assessment -Physician orders -Progress notes -Vital information -Consults -Lab results -Advance directives What is a care plan? - -*written plan for care. Identifies objectives for getting a patient into the best possible physical, mental, and social well being* -Meets nutritional needs by supplying all food groups What does CMS emphasize and what is the job of the staff? - -emphasizes patients right- including the right not to eat -It is the job of the staff to make nutritional choices available Resident Council - - committee composed of residents who provide feedback and suggestions about care- including dietary services Tray-line System - -trays move through an assembly line and workers place hot and cold foods on tray. -employee than distributes food to patient. -May be cook-chill Disadvantages of Tray-line System: - -Advanced preparation required -Last minute changes are difficult -Maintaining food temperatures -Difficult to manage -Challenges in customer satisfaction What is a well nourished adult in a moderate catabolic state's tolerance of starvation? - up to 14 days. What is a 60-70 years of age individual's tolerance of starvation? - no more than 10 days. What is a patient over 70 years tolerance of starvation? - no more than 7 days. When is it necessary for an implementation of nutrition support? - -Patient has been without nutrition for 5-7 days -duration of illness greater than 10 days -the patient is malnourished Enteral Nutrition - -the the provision of liquid formulas into the GI tract usually by tube Parenteral Nutrition - -the provision of formula via IV. Provided when nutrient needs cannot be met by enteral intake as a result of GI dysfunction What are the objectives of Nutritional Support? - -Do no harm -improve nutritional indices -prevent single and multiple nutrient deficiencies -promote organ integrity and function -ameliorate clinical manifestation of disease -favorably affect the disease process -positively influence client outcome Types of Enteral Formulas: - -blended formulas -polymeric formulas -elemental formulas -modular feeding components -specialty formulas If the GI tract is functional it should be... - *used.* Advantages of using GI tract: - -physiologically more natural, less expensive and nutritionally more complete -prevents bowel atrophy Indications of using GI tract: - -functioning GI tract -pre-operative and post-operative Routes of Administration for Enteral Feeding - -Naso-gastric tubes -PEG placements -Gastrostomy -esophagostomy -jejunostomy Methods of Delivery for Enteral Feeding - -Bolus -rapid administration -intermittent feedings -Continuous -Cyclic Enteral feeding Order: - -type of formula -type of tube -total volume and/or rate of feeding to be administered -type of feeding -number of feedings per day -other pertinent information Principles and Procedures for Enteral Feeding: - -easily digestible, almost isotonic and dispensed slowly -the higher the osmolality, the greater the possibility exists that the formula will be poorly tolerated -adequate fluid intake -gastric residuals Complications of Enteral Feeding: - diarrhea -hypersomolar -bacterial overgrowth or contamination -malnutrition -aspiration -clogging -underfeeding and overfeeding -hyperglycemia -re-feeding syndrome -formula-drug incompatibilities When to use Parenteral Nutrition and where it is infused - -use when GE is nonfunctioning -PN may be infused through peripheral veins or central veins Indications for Parenteral Nutrition - -the pt is unable to tolerate enteral feeding for seven to ten days -pt with trauma requiring multiple surgeries -prolonged bowel rest Routes for Total Parenteral Nutrition: - -PPN when PN is anticipated for a short period of time -if PN is anticipated for longer days, CPN is recommended Composition of Parenteral Solutions: - -kilocalories -carbohydrates -proteins -lipid emulsions -vitamins -electrolytes and trace minerals Principles and Procedures of Total Parenteral Solutions: - -Infusion rate must be constant and uninterrupted -uses a pump -complications -sepsis -hypoglycemia and hyperglycemia -lipid overload Method of Delivery for Parenteral Nutrition: - -Continuous. -Nutrition support team -Parenteral feeding order Nutrition Education: "RUMBAS" - *R*: relevant to the overall purpose of the lesson *U*: understandable- should make sense