This document discusses reviewing the effectiveness of nutrition care plans and managing professional communication. It covers evaluating care plans for individual client needs, identifying what client information needs to be shared, and participating in care conferences with the interdisciplinary team. The roles of various team members like the registered dietitian, nurse, and occupational therapist are also outlined.

1. Nutrition Fundamentals and Medical
Nutrition Therapy
Review Effectiveness of Nutrition Care and
Manage Professional Communication
Corresponds with
LEARNING PLAN 14
Copyright 2016 Association of Nutrition and Foodservice
Professionals

2. Objectives
 Applying Nutrition Data
» Identify the effectiveness of the nutrition care plan
» Evaluate care plans for individual needs
 Manage Professional Communication
» Identify what client information needs to be communicated
» Identify the need for client referrals
» Implement consultant recommendations as appropriate
» Honor client rights and confidentiality
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14

3. Objectives
 Participate in Client Care Conferences
» Prepare for client care conference
» Participate in a conference to identify client care concerns
» Work with the interdisciplinary team to develop solutions
» Implement goals and approaches with appropriate follow up
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14

4. Basics of Good Communication with
the Interdisciplinary Team
 Written
» Documentation in the medical record
» Email
 Verbal
» Be prepared during the care plan to provide facts about the
status of the client and progress made towards the goals of
the nutrition care plan
» Be prepared to respond to questions from the family
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14

5. Basics of Good Communication with
the Interdisciplinary Team
 Non-verbal
» Anticipate the questions and concerns of family members,
watch your own non-verbal cues
» Watch for clues that the family and IDT members are
following your reporting
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14

6. Overcoming Communication
Barriers
 Message quality
» Seek feedback by asking questions such as, “Would you like
to go through that again?”
» Try not to use jargon and explain if more clarity is needed
 Time
» “Free up” the time from other distractions (phone, pager,
other meetings)
 Conflict
» Don’t take conflict personally; remain professional
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14

7. The Interdisciplinary Team (IDT)
 Long-Term Care
Administrator
 Registered Dietitian
Nutritionist
 Certified Dietary Manager
 Nurse
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning
Plan 14
 Occupational Therapist
(OTR)
 Physician
 Social Worker
 Speech Pathologist

8. Role of the RDN in the IDT
 Assume primary responsibility and accountability
for nutrition screening and assessment and client
nutrition care planning. (This is why there should
be ongoing communication with the Registered
Dietitian Nutritionist)
 Select and set up a nutrition
screening/assessment system (in cooperation
with the nursing service and facility
administration); train facility staff as needed
 Monitor the screening system
 Perform nutritional assessments; may complete
the Resident Assessment Instrument (RAI) and
care plan
 Develop a care plan
.Nutrition Fundamentals and Medical Nutrition Therapy • Food Preferences and Customs • Learning Plan 1
 Record assessment findings, recommendations,
and follow-up plans in medical record and client
care plan.
 Alert other team members to any part of the
nutritional care plan needing their cooperation.
 Define the role of a Certified Dietary Manager in
clinical care and provide training.
 Provide nutrition counseling.
 Provide nutrition counseling.
 Monitor the accuracy of diet service.
 Participate in quality management.
 May participate in client care conferences
.

9. RDN Role in the IDT
Coordination of care: The Certified Dietary Manager and
the Registered Dietitian Nutritionist work closely together to
coordinate care. Depending on the facility, the RDN may
only be physically present on a monthly basis (or more
often)
 The CDM needs to have open lines of communication
with the RDN in order to effectively implement the
nutrition care plan. Any significant change in client status
should be referred and communicated within 24-48 hours
to ensure that quality care is provided.
Nutrition Fundamentals and Medical Nutrition Therapy • Food Preferences and Customs • Learning Plan 1

10. Brain Break
 Physician
 CDM
 Speech Therapist
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14
» Orders a diet and other
treatment that affects
nutritional status
» Conducts a diet history to
determine food preferences
and intolerances
» Recommends diet for a
possible swallowing disorder
For each IDT member, identify their role in the following scenario: A
new admission of a 105-year old woman with chronic UTIs, right-side
weakness from a stroke, and a 10 lb. weight loss in the past two weeks.

11. Brain Break
 Occupational Therapist
 Nurse
 Registered Dietitian
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14
» Helps client develop strength
and skills to feed herself
» Provides assistance at
mealtime, encourages client
to eat, distributes
medications; records client
food and fluid intake
» Develops nutrition care plan
For each IDT member, identify their role in the following scenario: A
new admission of a 105-year old woman with chronic UTIs, right-side
weakness from a stroke, and a 10 lb weight loss in the past two weeks.

12. IDT Basic Tasks
 Assess client needs
 Develop a plan of care
 Evaluate a plan of care
 Provide education to clients
 Involve the client and client’s family
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14

13. Gathering and Sharing Information
 The details for each of the IDT tasks may differ but the
overall objective is the same
» Work together to improve a client’s nutritional status
- To be effective
 Share information
 Communicate effectively
 Finally, the CDM determines if the nutrition care plan is
working; how do you know?
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14

14. Is the Nutrition Care Plan Working?
 Has the client’s ability to eat or eating skills improved,
declined, or stayed the same?
 Was any deterioration or lack of improvement avoidable
or unavoidable?
 If the client’s eating abilities have declined, is there
evidence that the decline was unavoidable?
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14

15. Is the Nutrition Care Plan Working?
 What risk factors for decline of eating skills did the facility
identify in the care plan?
 Is there sufficient staff time and assistance provided to
maintain eating abilities?
 Were CATs and the CAA process used to assess reasons
for decline, potential for decline, or lack of improvement?
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14

16. Is the Nutrition Care Plan Working?
 Were individual objectives of the plan of care periodically
evaluated and alternative approaches encouraged as
needed to maintain eating ability?
 Was the care plan driven by client’s strengths identified in
the comprehensive assessment?
 Was the care plan consistently implemented and closely
monitored?
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14

17. Hydration
 The facility must provide each client with sufficient fluid
intake to maintain proper hydration and health
 Water is one of six essential nutrients
 A common clinical concern in long-term care is
dehydration or lack of sufficient water in the body
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14

18. Brain Break
 What physical signs of dehydration would help you know
if a client was dehydrated?
» Sudden weight loss (5% or more of body weight)
» Sunken eyes
» Hollow cheekbones
» Dry, cracked lips
» Change in state of alertness
» Deep, gasping breathing
» Decrease in urinary output or dark urine
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14

19. Dehydration
 Risk factors
» Decreased sense of thirst
» Coma/decreased sensory ability
» Fluid loss due to diarrhea, fever, uncontrolled diabetes
» Fluid restriction secondary to renal dialysis
» Functional impairments that make it difficult to drink, reach
fluids, or communicate fluid needs
» Dementia – client forgets to drink or how to drink
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14

20. Edema
 Unhealthy water retention
 Edema is not a disease, but a symptom
 Can make heart and lungs work harder
 Fluid restriction may be ordered by MD
 Risk factors
» Visible swelling in legs, ankles, feet, abdomen
» Elevated blood pressure
» Sudden weight gain (> 5% body weight)
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14

21. Monitoring Diabetes
 Blood glucose monitoring
» Fasting blood sugar
 Measure glucose or ketones in urine
 Review of glycosylated hemoglobin (laboratory value)
 Check for symptoms that may indicate elevated glucose
» Thirst, excessive hunger, excessive urination
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14

22. Monitoring Diabetes
 Check for hypoglycemia
» Dizziness, shakiness, cool, clammy
 Work with RDN to ensure adequate nutrition coverage
throughout the day
 Consider a liberalized diet
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14

23. Weight Loss
 Review weight record
 Review laboratory values
 Review environmental factors
 Review progress notes for intake and output records
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning
Plan 14

24. Weight Loss
 Interview client, update preferences
 Observe at mealtime
» Swallowing
» Functional abilities
» Change in ability to communicate
 Initiate interventions to reverse weight loss as appropriate
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning
Plan 14

25. Brain Break
 List six reasons why weight loss might occur in long-term
care
 Examples:
» Dehydration
» Not enough time
» Adaptive equipment needed or not used
» Depression
» Cancer
» Ill-fitting dentures
» Unhappiness with table mates
» Food preferences not honored
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14

26. Pressure Ulcers
 Improvement of nutritional status is a key component of
resolving a pressure ulcer
 Consider
» Protein
» Fluid
» Caloric intake
 Have a process to record progress of healing and
interventions implemented and follow the process
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14

27. Brain Break
 What should be added to the following menu for a client
who has a Stage 3 pressure ulcer?
» Swiss Steak, Green Beans, Mashed Potatoes, Fruit Crisp
» Add whole milk to the Swiss steak gravy and to the mashed
potatoes to add calories and protein; add butter to the green
beans for added calories; add ice cream to the fruit crisp to
add calories, protein and fluid.
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14

28. Progress Notes
 Summarize how a client is responding to treatment
 Success in achieving goals identified in care plan
 Follow facility protocol for documentation in the progress
notes
» Specific
» Accurate
» Objective
» Concise
» Thorough
Nutrition Fundamentals and Medical Nutrition Therapy • Review Effectiveness of Nutrition Care • Learning Plan 14