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

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