BOOTCAMP EXAM

4 main areas of the “Code of Ethics”

1. Competence and professional development in practice (non-maleficence) — evidence-based practice

2. Integrity in personal and organizational behaviors and practices (autonomy) — conflicts of interest

3. Professionalism (Beneficence) — respect others

4. Social responsibility for local, regional, national, global nutrition and wellbeing (justice) — human rights, community, volunteering

7 standards of practice

Standard One: Demonstrating Ethics and Competence in Practice

Standard Two: Striving for Health Equity

Standard Three: Illustrating Quality in Practice

Standard Four: Demonstrating Leadership, Interprofessional Collaboration, and Management of Programs, Services, and Resources

Standard Five: Applying Research and Guidelines

Standard Six: Providing Effective Communications and Advocacy

Standard Seven: Providing Person/Population-Centered Nutrition Care

6 practice areas for RDN

Healthcare

Preventative care, wellness, lifestyle

Foodservice systems, culinary, retail

Military services, first responders, US public health services

Sustainable food and water systems

Education/Research

purpose of the nutrition care process (NCP)

Screening and referral system required for everyone

Outer ring: environmental factors, healthcare systems, social systems, economics, practice settings

Second ring: strengths the RD provides to patient/the NCP (Nutrition & Dietetics Knowledge, Collaboration, Skills & Competencies, Communication, Evidence-Based Practice, Critical Thinking, Documentation, & Code of Ethics)

ADIME

assessment, diagnosis, intervention, monitoring, & evaluation

nutrition diagnosis domains

intake (NI), clinical (NC), behavior-environmental (NB), other (NO)

nutrition intervention terminology

food and/or nutrient delivery (ND)

nutrition education (E)

nutrition counseling (C)

coordination of nutrition care (RC)

nutrition assessment terminology

food/nutrition-related history (FH)

anthropometric measurements (AD)

biochemical data, medical tests, and procedures (BD)

nutrition-focused physical findings (PD)

client history (CH)

comparative standards (CS)

nutrition assessment

obtain adequate info, verifying info, and interpreting data

reassessment addresses monitoring/evaluation parameters

nutrition diagnosis

PES statements (problem, etiology, signs/symptoms)

comes from nutrition assessment

• [Problem] related to [Etiology] as evidenced by [Signs and Symptoms]

Etiology should be fixable - no medical conditions

Nutrition care indicators (measureable)

• Food/Nutrient Intake

• Medication use

• Growth/Body composition

• Food/Nutrition related knowledge

• Attitudes/Behaviors

• Food access

• Physical activity

• Anthropometric data

• Lab values

• Physical findings (observed or reported)

• Personal and family medical history, social factors

nutrition intervention

2 steps: planning and implementation

directed at the etiology or cause of the problem

or directed at the signs/symptoms if RDN cannot help etiology

planning vs implementation

planning: prioritize diagnoses, confer with patient, set goals and determine expected outcomes, define specific nutrition intervention strategy, define time and frequency of care

implementation: communicate the plan of care, carry out the plan of care, continue data collection (monitor/evaluate)

nutrition monitoring & evaluation

monitor, measure, evaluate

monitor: review/measurement of selected nutrition care indicators

evaluate: systematic comparison of current findings with previous status

nutrition care outcomes: results of nutrition care directly related to nutrition diagnosis/goals

nutrition care indicators: markers that can be measured and evaluated to determine the effectiveness of nutrition care

nutrition care criteria

what data is compared to: reference standards, past data

nutrition prescription/goal: dietary intervention, behavior change

malnutrition definition

condition resulting from insufficient intake, impaired absorption, increased nutrient requirements, or altered nutrient utilization, often associated with inflammation, that leads to:

• Loss of muscle mass (with/without fat loss)

• Diminished physical or metabolic function

• Worse clinical outcomes

nutrition screening vs nutrition assessment

screening: required for everyone, identify at risk/not at risk for malnutrition

assessment: patients at risk for malnutrition, comprehensive full examination

guidelines for nutrition screening

inpatient: set by the Joint Commission; determined by hospital

outpatient: No set standards – patients rarely need nutrition screening

malnutrition screening tool (MST)

very open-ended questions — over diagnoses

based on 2 questions:

hand amputation %

0.7%

forearm amputation %

2.3%

entire arm amputation %

5%

foot amputation %

1.5%

below knee amputation %

6%

through knee amputation %

9%

above knee amputation %

15%

entire leg amputation %

16%

adjusted weight formula

[CBW - IBW] x 0.25 + IBW

weight change formula

[UBW - CBW] / UBW

significant weight loss chart

1 week = 1-2% significant; >2% severe

1 month = 5% significant; >5% severe

3 months = 7.5% significant; >7.5% severe

6 months = 10% significant; >10% severe

antihistamine

used for allergies; relieve cold, fever, allergy symptoms

take with water, if GI stress occurs, take with food

Do not eat apples, oranges, and grapefruit; do not take with juice

Avoid alcohol

Avoid sedatives or antidepressants

benadryl, allegra, claritin, zyrtec

analgestic/antipyretic

used for arthritis and pain; treats mild/moderate fever

for rapid relief, take on empty stomach

caffeine may increase rate absorption

avoid alcohol

tylenol, tempra

non-steroidal anti-inflammatory drugs

used for arthritis and pain; reduce pain, fever, and inflammation

take with food, water, or milk to decrease GI upset

may need to increase vitamin C, vitamin K, and folate

limit caffeine intake

limit or avoid select supplements—ones with coagulant effects

Avoid alcohol

aspirin, ibuprofen (motrin, advil), aleve, naprosyn

corticosteroids

used for arthritis and pain; relieve inflamed areas, reduce swelling/itching, allergies, rheumatoid arthritis, and other conditions

take with food or milk

limit grapefruit and other citrus fruits

decrease sodium intake

supplement calcium, vitamin D, K, A, C, or protein

limit caffeine intake

avoid alcohol

medrol, deltasone, orapred, prelone, cortef

narcotic analgesic

used for arthritis and pain; provide relief for moderate/severe pain

take with food or milk

avoid alcohol

codine combined with acetaminophen/tylenol, morphine/roxanol, ms contin

bronchodilators

used for asthma; treat symptoms of bronchial asthma, chronic bronchitis, and emphysema

take with food if GI issues present

high fat meals = better absorption

high CHO meals = decreased absorption

avoid caffeine and alcohol

slo-bid, theo-dur, uniphyl, ventolin, proventil, combivent, epinephrine/primatene mist

diuretics

used for CVD; help eliminate water, sodium, and chloride from the body

take on empty stomach since food reduces drug availability

take with food or milk if GI upset occurs

may cause loss of potassium, calcium, and magnesium - supplement

avoid natural licorice

potassium sparing: triamterene

potassium wasting: lasix

lasix/furosemide, dyazide, maxzide, hydrodiuril, dryenium, bumex, zaroxolyn

cholesterol lowering

used for CVD

take with food

do not eat grapefruit/citrus fruits

follow a low-cholesterol and low-fat diet

do not take with cordarone

Avoid alcohol

simvastatin

beta blockers

used for CVD; to decrease nerve impulses to blood vessels

take with food to increase bioavailability

do not have orange juice and avoid natural licorice

decrease calcium and sodium intake

take 2 hours before or 6 hours after calcium supplement or antacids

avoid alcohol

atenolol/tenormin, metoprolol/lopressor, propranolol/inderal, nadolol/corgard

nitrates

used for CVD; to relax blood vessels and lower demand for oxygen by the heart

take on an empty stomach with water

1 hour before meals or 2 hours after

avoid alcohol

isordil, sorbitate, nitro, nitrodur, transderm-nitro

angiotensin-converting enzyme (ACE) inhibitors

used for CVD; to relax blood vessels by preventing a vasoconstrictor (angiotensin II) from forming

take on empty stomach, 1 hour before meals, food decreases absorption

high fat meals decrease absorption

ensure adequate fluid intake

avoid salt, calcium, and natural licorice

captopril/capoten, enalapril/vasotec, lisinopril/prinivil, zestril, quinapril/accupril, moexipril/univasc

HMG-CoA reductase (AKA statins)

used for CVD; lowers cholesterol and reduce production rate of bad cholesterol (LDLs)

avoid grapefruit and other citrus fruits

lovastatin/mevacor should be taken with an evening meal to increase absorption

decrease dietary fat and cholesterol

avoid St. John’s wort supplement

avoid alcohol

atorvastatin/lipitor, fluvastatin/lescol, lovastatin, pitavastatin/livalo, pravastatin/pravachol, rosuvastatin/crestor, simvastatin/zocar

anticoagulants

used for CVD; prevent blood clot formation

limit foods with vitamin K, do not consume a lot of vitamin E or vitamin A (may prolong clotting time and increase bleeding risk)

avoid supplements with coagulate properties

do not take with cordarone

warfarin/coumadin

antibiotics and antifungals

used for infections; treat infections caused by bacteria/fungi

take with a lot of water

talk to doctor if skin rashes/diarrhea occurs

antibacterial and penicillin

used for infections; treat infections caused by bacteria/fungi

take on empty stomach or 1 hour before or 2 hours after eating

if GI upset occurs, take with food

avoid guar gum and excessive vitamin K

penicillin, amoxicillin, ampicillin, omnipen

quinolones

used for infections; treat infections caused by bacteria/fungi

take on empty stomach or 1 hour before or 2 hours after meals

if GI upset occurs, take with food but not dairy/calcium-fortified products alone

increases caffeine effects

ciproflaxacin, levoflaxacin, olfoxacin, trovafloxacin

cephalosporins

used for infections; treat infections caused by bacteria/fungi

take on empty stomach unless GI upset occurs

take 1 hour before antacid supplement

cefactor, ceclor cd, cefradroxil, suprax, cefprozil/cefzil, cephalexin/keflex, keftab

macrolides

used for infections; treat infections caused by bacteria/fungi

take with food if GI upset occurs

Zmax should only be taken on an empty stomach

avoid taking with citrus foods/juices and carbonated drinks

zithromax/zmax, biaxin, erthyromycin

sulfonamides

used for infections; treat infections caused by bacteria/fungi

take with food and at least 8oz water

avoid alcohol

bactrim/septra

tetracyclines

used for infections; treat infections caused by bacteria/fungi

take on an empty stomach with 8oz of water

avoid taking with dairy products, antacids, and vitamin supplements containing iron — interfere with med effectiveness

nitromidazole

used for infections; treat infections caused by bacteria/fungi

may take with food to avoid GI upset, but food decreases absorption

avoid alcohol

metronidazole/flagyl

antifungals

used for infections

take with food to increase absorption

avoid grapefruit and related citrus

avoid alcohol

fluconazole/diflucan, ketoconazole/nizoral, itraconazole/sporanox

monoamine oxidase (MAO) inhibitors

used for mood disorders; treat depression, emotional and anxiety disorders

specific diet restrictions — follow physicians orders

tyramine foods/beverages may cause fatal BP increase

avoid alcohol

pheneizine/nardil, tranycypromine/parnate

anti-anxiety drugs

used for mood disorders; treat depression, emotional and anxiety disorders

may take with food to avoid GI upset

limit grapefruit/citrus consumption

limit caffeine — reverse effects

use caution with sedative herbal products (chamomile) and stimulants

avoid alcohol

lorazepan/ativan, diazepam/valium, alprazolam/xanax

antidepressant drugs

used for mood disorders; treat depression, emotional and anxiety disorders

can be taken with or without food

avoid alcohol

paxil, zoloft, prozac

stimulant

used for mood disorders

take with or without meals

limit caffeine and ensure adequate calcium intake

ritalin

depressant

used for mood disorders; sedative-hypnotic

do not take with food or immediately after a meal

ambien

histamine blockers

used for stomach issues; to relieve pain, promote healing, and prevent irritation from returning

can be taken with or without food with 8oz of water

a bland diet is recommended

take 2 hours before an iron or antacid supplement

may decrease iron and vitamin B12 absorption

limit caffeine and avoid alcohol

cimetidine/tagamet, famotidine/pepcid, ranitidine/zantac, nizatadine/axid

anticonvulsant/antiepileptic therapy

used for seizures

take with food or milk to decrease GI upset

avoid grapefruit or related citrus fruits, star fruits, or pomegranate juice

supplement calcium and vitamin D

avoid alcohol

tegretol/carbamazepine, equertro, carbatrol

BID

twice per day

AGA

appropriate for gestational age

AMS

altered mental status

B/L

bilateral

BM

breast milk or bowel movement

BMP

basic metabolic panel

CA

cancer

CAD

coronary artery disease

CBC

complete blood count

CHD

congenital heart disease

CHF

congestive heart failure

CMP

comprehensive metabolic panel

CP

cerebral palsy

CRF

chronic renal failure

CR

complete remission

CPAP

continuous positive airway pressure

CV

cardiovascular

CVL

central venous line

CXR

chest x-ray

DD

developmental delay

DHT

dobhoff tube

DM

diabetes mellitus

DVT

deep vein thrombosis

ESRD

end stage renal disease

ET or ETT

endotracheal tube

FEN/GI

fluids, electrolytes, nutrition/gastrointestinal

FTT

failure to thrive

GU

renal

HA

headache

HD

hemodialysis

HF

heart failure

HFV

high-frequency ventilator

HLD

hyperlipidemia

HN

head and neck

HMF

human milk fortifier

HPI

history of presenting illness

HT

height

HTN

hypertension

ID

infectious disease

IDM

infant of diabetic mother

IMV

intermittent mandatory ventilation