Mod 9 Pt1: Medical Nutrition Therapy: Malnutrition & Weight Management

Individualized nutrition care used to prevent, manage, or treat health conditions?

Medical Nutrition Therapy (MNT)

MNT: Based on patient’s ____________________________________

nutrition status, medical history, needs, and goals

MNT: Uses _________________ to address specific health concerns and improve clinical outcomes

nutrition interventions

MNT: Commonly provided by a ___________________ in collaboration with the healthcare

registered dietitian nutritionist

MNT: Ex) _____________________ for a patient with malnutrition

Improving energy and protein intake

MNT: Ex) Supporting _________________ for weight management

sustainable eating habits

MNT: Ex) Adjusting ______________ to meet changing medical needs

nutrition strategies

What are all the components of the nutrition care process (NCP)?

Nutrition assessment, nutrition diagnosis, nutrition intervention, and monitoring and evaluation

NCP: Collect information about dietary intake, weight history, symptoms, and clinical status?

Nutrition assessment

NCP: Identify the specific nutrition problem that requires attention?

Nutrition diagnosis

NCP: Develop and implement an individualized nutrition plan?

Nutrition intervention

NCP: Assess progress and determine whether interventions are effective?

Monitoring and evaluation

The Nurses Role in Nutrition Care: _________ food intake, appetite, and changes in weight

monitor

The Nurses Role in Nutrition Care: Recognize signs and symptoms of ______________

inadequate nutrition

The Nurses Role in Nutrition Care: Identify factors that ________________, such as nausea, pain, fatigue, or swallowing difficulties

interfere with eating

The Nurses Role in Nutrition Care: Reinforce _______________ and the established care plan

nutrition education

The Nurses Role in Nutrition Care: Monitor _________________ including wound healing and lab. results

relevant clinical findings

The Nurses Role in Nutrition Care: Communicate ____________ to the RDN and healthcare provider

nutrition concerns

Imbalance between nutritional needs and the intake or utilization of nutrients?

Malnutrition

Malnutrition: Can involve ____________ energy, protein, or other essential nutrients

inadequate

Malnutrition: may occur in patients across the _____________

body-weight spectrum

Malnutrition: Can result from inadequate intake, illness, _________ nutritional needs or impaired absorption

increased

Malnutrition: May _________ to muscle loss, impaired immune function, delayed wound healing or poor recovery

contribute

Malnutrition: _______________ helps guide appropriate nutrition intervention

Early identification

Risk Factors for Malnutrition: Poor appetite, nausea, vomiting, or early satiety?

Reduced intake

Risk Factors for Malnutrition: Acute illness, infection, cancer, or chronic disease?

Medical conditions

Risk Factors for Malnutrition: Trauma, surgery, burns, or wound healing?

Increased needs

Risk Factors for Malnutrition: Gastrointestinal disorders that interfere with nutrient absorption?

Impaired digestion or absorption

Risk Factors for Malnutrition: Difficulty chewing, swallowing, shopping, or preparing meals?

Functional limitations

Risk Factors for Malnutrition: Depression, cognitive impairment, social isolation, or food insecurity?

Psychosocial factors

Risk Factors for Malnutrition: Changes in appetite, physical function, and ability to access or prepare food?

Older adulthood

Manifestations for Malnutrition: Unintentional _____________

weight loss

Manifestations for Malnutrition: Reduced _____________________

muscle mass and subcutaneous fat

Manifestations for Malnutrition: Muscle weakness and __________ physical function

reduced

Manifestations for Malnutrition: _____ appetite or persistently inadequate food intake

poor

Manifestations for Malnutrition: ____________ and decreased ability to perform daily activities

fatigue

Manifestations for Malnutrition: __________ wound healing and increased vulnerability to complications

delayed

Manifestations for Malnutrition: Possible _________ that may obscure weight loss

edema

Manifestations for Malnutrition: Signs may be subtle and require assessment of __________________

multiple findings

Nutrition Screening & Assessment: Recent weight loss, usual weight, and changes over time?

Weight history

Nutrition Screening & Assessment: Amount consumed, appetite, and duration of inadequate intake?

Dietary intake

Nutrition Screening & Assessment: Muscle loss, fat loss, edema, and functional changes?

Physical findings

Nutrition Screening & Assessment: Nausea, vomiting, diarrhea, constipation or swallowing difficulties?

Symptoms

Nutrition Screening & Assessment: What are the other 3 things to know?

Medical history, functional and social factors, and screening tools

Clinical Criteria for Diagnosing Malnutrition: What are the two used?

Phenotypic and etiologic criteria

Clinical Criteria for Diagnosing Malnutrition: At least one required + unintentional weight loss + low BMI + reduced muscle mass?

Phenotypic criteria

Clinical Criteria for Diagnosing Malnutrition: Phenotypic criteria - More than 5% within the past 6 months + More than 10% over a period longer than 6 months?

Unintentional weight loss

Clinical Criteria for Diagnosing Malnutrition: Phenotypic criteria - Less than 20 kg/m2 for adults under age 70 + less than 22 kg/m2 for adults age 70 and older?

Low BMI

Clinical Criteria for Diagnosing Malnutrition: At least one required + reduced intake or assimilation + inflammation or disease burdern?

Etiologic criteria

Clinical Criteria for Diagnosing Malnutrition: Etiologic criteria - Inadequate food intake or impaired nutrient absorption?

Reduced intake or assimilation

Clinical Criteria for Diagnosing Malnutrition: Etiologic criteria - Acute illness, injury, or chronic disease associated with inflammation?

Inflammation or disease burden

MNT for Malnutrition: Identify and address the __________ of inadequate nutrition

underlying cause

MNT for Malnutrition: Establish _______________ energy, protein, and fluid goals based on clinical needs

individualized

MNT for Malnutrition: Encourage ______________ that provide adequate energy and protein

nutrient-dense foods

MNT for Malnutrition: Offer _____________ meals and snacks with appropriate

small, frequent

MNT for Malnutrition: Provide __________________ when food intake is insufficient

oral nutrition supplements

MNT for Malnutrition: Address _________ including pain, nausea, swallowing difficulties, and feeding assistance needs

barriers to eating

MNT for Malnutrition: Consider __________ when oral intake is inadequate or unsafe and the gastrointestinal tract can be used

enteral nutrition

MNT for Malnutrition: Consider ______________ when nutrition needs cannot be met adequately through gastrointestinal tract and it is clinically indicated

parenteral nutrition

Monitoring Treatment Response: Monitor ________________ of meals or supplements

food intake and tolerance

Monitoring Treatment Response: Track __________ while considering fluid status

weight trends

Monitoring Treatment Response: ________ muscle strength, functional status, and physical findings

Assess

Monitoring Treatment Response: Monitor ____________, electrolytes and hydration status

Relevant lab. values

Monitoring Treatment Response: Evaluate ___________ when applicable

wound healing and recovery

Monitoring Treatment Response: Monitor for ___________, including refeeding syndrome in at risk patients

complications

Monitoring Treatment Response: Reassess _____________ and modify interventions as needed

nutrition goals

Potentially life-threatening metabolic complications following the reintroduction of nutrition after prolonged inadequate intake or severe malnutrition?

Refeeding syndrome

Refeeding Syndrome: ______________ stimulates insulin release, shifting electrolytes into cells

carbohydrate intake

Refeeding Syndrome: Key electrolyte changes?

Hypophosphatemia, hypokalemia, and hypomagnesemia

Refeeding Syndrome: Hypophosphatemia, hypokalemia, and hypomagnesemia- May cause what?

cardiac arrhythmias, respiratory weakness, fluid imbalance, and neurologic complications

Refeeding Syndrome: Patients with severe malnutrition or prolonged minimal intake are at ____________

increased risk

Refeeding Syndrome: ____________ requires identifying at-risk patients, careful nutrition advancement, and appropriate monitoring

prevention

Malnutrition, Wound Healing, and Pressure Injuries: ____________ the metabolic demands of tissue repair

energy supports

Malnutrition, Wound Healing, and Pressure Injuries: Protein provides amino acids needed for ___________________

tissue formation and repair

Malnutrition, Wound Healing, and Pressure Injuries: _____________ and other micronutrients support normal healing processes

Vitamin C, Zinc

Malnutrition, Wound Healing, and Pressure Injuries: Inadequate intake can contribute to ________________________

muscle loss and delayed wound healing

Malnutrition, Wound Healing, and Pressure Injuries: ______________ is multifactorial and includes immobility, pressure, moisture, and impaired tissue perfusion

pressure injury risk

Malnutrition, Wound Healing, and Pressure Injuries: Nutrition assessment should be incorporated into the ________ for patients with wounds or pressure injuries

care plan

Understanding Body Weight Regulation: Energy obtained from foods and beverages?

Energy intake

Understanding Body Weight Regulation: basal metabolic rate + physical activity and exercise + thermic effect of food?

Energy expenditure

Understanding Body Weight Regulation: _______________ in energy balance influence body weight

Long term changes

Understanding Body Weight Regulation: Genetics, hormones, age, and medical conditions influence ______________

weight regulation

Understanding Body Weight Regulation: Meds, sleep, stress, environment, and food access can affect _____________________

eating patterns and energy expenditure

Understanding Body Weight Regulation: ______________ is complex and varies among individuals

body weight regulation

Factors That Influence Body Weight: What are all the factors?

Biological, medical, behavioral, environmental, and psychosocial factors

Factors That Influence Body Weight: genetics, appetite regulation, hormones, and metabolic adaptation?

Biological factors

Factors That Influence Body Weight: Endocrine conditions, chronic illness, and meds?

Medical factors

Factors That Influence Body Weight: Eating patterns, physical activity, sleep, and stress management?

Behavioral factors

Factors That Influence Body Weight: Food availability, work schedules, neighborhood resources, and opportunities for physical activity?

Environmental factors

Factors That Influence Body Weight: Mental health, social support, and past experiences with dieting?

Psychosocial factors

Factors That Influence Body Weight: ____________ may interact to influence weight over time

Multiple factors

Assessing Weight Status & Health Risk: Weight in kilograms divided by height in meters squared?

Body mass index

Assessing Weight Status & Health Risk: Less than 18.5 kg/m2?

Underweight

Assessing Weight Status & Health Risk: 18.5-24.9 kg/m2?

Healthy weight

Assessing Weight Status & Health Risk: 25.0-29.9 kg/m2?

Overweight

Assessing Weight Status & Health Risk: 30.0 kg/m2 or greater?

Obese

Assessing Weight Status & Health Risk: Screening tool, not a direct measure of body fat or overall health?

BMI

Assessing Weight Status & Health Risk: __________ weight history and unintentional weight changes

consider

Assessing Weight Status & Health Risk: ___________________ may help assess central adiposity

waist circumference

Assessing Weight Status & Health Risk: Evaluate other _____________, including blood pressure, blood glucose, and lipid levels

health indicators