NFMNT Chapter 13 Apply Standard Nutrition Care

1. Nutrition Fundamentals and Medical
Nutrition Therapy
Apply Standard Nutrition Care
Corresponds with
LEARNING PLAN 13
Copyright 2016 Association of Nutrition and Foodservice
Professionals

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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