Medical Nutrition Therapy Reference Pages

timer Asked: Jan 5th, 2018
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Question description

1. look at the rubric that I uploaded, and I already gave you the sample for the reference page, but different diseases should have different format.

2. NCM website link in the document, if you can not open it, let me know.

Medical Nutrition Therapy Reference Pages  Professor LaRose Advanced MNT  DIET4630 Your portfolio project is intended to be a useful resource for you to take from JWU into your internship and/or future work experiences. Part of designing a helpful resource is organizing a lot of the MNT we cover into reference pages. In your portfolio, you will be required to include MNT Reference Pages and additional resources (as listed) for each of the conditions listed below: • Refeeding Syndrome o See the blank sample Reference Page provided o Including NCM Conditions Critical Illness Refeeding Syndrome Copy and paste into a new document, be sure to include the proper citation for the NCM • ESRD (3 MNT Reference Pages) o Chronic Kidney Disease (CKD) o Hemodialysis (HD) o Peritoneal Dialysis (PD) o Including NCM Client Ed Renal CKD Stage 5 Nutrition Therapy Download Client Ed Check Tips, Food List, NCM Standard Menu Download PDF • Bariatric Surgery o Restrictive/Malabsorptive procedures can all be included on one MNT Reference Page o Including Sample Meal Plan Handout and Sample Portion Size Handout (I will do this) o NCM Client Ed Weight ManagementBariatric Surgery Vitamin/Mineral Supplements Download PDF o TOS Clinical Guidelines for the Bariatric Patient (in Ulearn) (I will do this) • Eating Disorders (2 MNT Reference Pages) o Anorexia Nervosa o Bulimia Nervosa o Including Sample AN Meal Plan Handout and Sample Oral Supplement Exchange Table (I will do this) • Cancer (2 MNT Reference Pages) o Cancer o Bone Marrow/Stem Cell Transplant (including GVHD) o Including the completed Cancer Chapter Worksheets (I will do this) o Seattle Cancer Care Alliance Diet Guidelines for BMT/PBSCT patients (appropriately formatted to ease of use) • Pressure Ulcers and Wounds o Medical Nutrition Therapy for Prevention and Treatment of Pressure Ulcers and Wounds o Including the completed SLM worksheets (I will do this) o A copy of the Braden Scale (I will do this) o NCM Client Ed Wounds Pressure Ulcers Nutrition Therapy Download Client Ed Check Tips, Food List, NCM Standard Menu Download PDF • Neurology o Rather than have a bunch of MNT Reference Pages, you are only required to have the completed Neurological Disorders Handouts (from the Neurology SLM) (I will do this) • HIV & AIDS LaRose, DIET4630 NOTE: Details for the final portfolio submission are included in the Portfolio Instructions. LaRose, DIET4630 Important!!!!! BUILDING MNT REFERENCE PAGES: • I have given you a sample MNT Reference Page on the following page to get you started. Different disease states will have different requirements so the MNT Reference Pages should be adjusted as needed to ensure that the MNT goals are all present. Again, these are for your reference- though there are minimum criteria (as below). MNT REFERENCE PAGE MINIMUM REQUIREMENTS: • On EACH MNT Reference Page, you must have the following (unless otherwise specified): o A brief definition or disease state overview o Any appropriate factors for estimating needs for kcals, protein, and fluid (there may be multiple that prove useful here) o Supplementation needs/considerations (vitamins, minerals, etc.) o Monitoring criteria (labs, weight, etc. including frequency of monitoring) ADDITIONAL CONSIDERATIONS: • These are intended to be useful for you so you should include what you think is meaningful while staying focused on the MNT needed. Things to include could be those in the list above could include: o Common diet order(s) o Diet restrictions o Common side effects of the condition(s) or treatment(s) with management suggestions for side effects o Patient/Family education needs/considerations o And more! REFERENCES: You may use your class notes, text, or other professional references to gather information for your MNT Reference Pages. I would recommend consulting the AND Nutrition Care Manual (available online) and the ASPEN Adult Nutrition Support Core (on reserve under my name in the library) at the very least. • If you find conflicting information, you should come and talk to me about it. Alternatively, you also may consider putting multiple viewpoints into your MNT Reference Pages since it may help you to make decisions later on. o Take a look at how I’ve organized your supplementation guidelines for the Pressure Ulcers and Wounds SLM. In this example, you’ll notice that ASPEN is far more specific (which is often more helpful as a clinician). • You may find it to be helpful to have citations for where your information is obtained (in case someone in your professional life asks you down the road). You’ll probably need something beyond ‘AMNT class notes’ to be really helpful. Citations are recommended, but it is optional for now so the format is up to you. LaRose, DIET4630 GRADING: • MNT Reference Pages will be graded as part of your final portfolio though they may be checked periodically during the term and counted as part of your class participation grade. o The MNT Reference Page for each condition is ‘due’ the class period after we cover the disease state. DO NOT fall behind with these. o You do not have to type them to have in class, but they will have to be typed prior to inclusion in your portfolio. • Keep in mind that you will be using the MNT Reference Pages as part of your Portfolio Test at the end of the term. It will be to your advantage to have complete worksheets submitted in your portfolio in advance of that assignment. All MNT Reference Pages are individual assignments. Plagiarism, sharing work with another student, and other forms of cheating are serious offenses and will be handled as such. Sample MNT Reference Page Refeeding Syndrome Definition: can be defined as the potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial refeeding Macronutrient Distribution Calories Protein 50%CHO 20-30%PRO 15-25%FAT Initial Advancement Goal Start at 20% basal energy needs No more than 50% of estimated energy needs 75% of nutrient needs Protein needs are calculated based on the nutrition assessment data related to disease, injury, or clinical/ nutrition status and range between 15% to 20% of total energy intake Fluid Supplementation Needs LaRose, DIET4630 Monitoring Criteria Monitored closely for electrolyte fluctuation and fluid overload. A review of baseline laboratory values, including glucose, magnesium, potassium, and phosphorus should be completed and any abnormalities corrected before initiating nutrition support, particularly PN. OTHER NOTES: References: NCM link: LaRose, DIET4630

Tutor Answer

School: UCLA


Medical Nutrition Therapy Reference Pages

Refeeding Syndrome
Described as a serious imbalance of fluids as well as the electrolytes especially in malnourished
persons who are experiencing metabolic anomalies and who are being submitted to re-feeding.
This process is carried out either eternally orally or parenterally. It is therefore closely related to
mortality and morbidity. Clinical presentation includes anomalies in glucose metabolism, critical
fluid imbalance, hypomagnesaemia, hypokalaemia, hypophosphataemia in some instances
thiamine will be a classical feature.
Appropriate factors
Patients with renal failure will present with high levels of serum electrolyte hence a slow
response in the refeeding interventions. Maintenance of safe serum glucose levels will be
difficult for patients who are experiencing final stage of liver disease since they will be having
exhausted glycogen stores. Due to the inadequate supply of insulin in diabetic patients, the
refeeding process is critically delayed since the electrolytes and glucose are not driven in the
cells hence assisting in nutritional support.
Supplementation Needs
At the lower limit potassium should be given at 3.5 significantly low at 3.0 and for critical
patients at 2.2
Phosphates should be given at 0.8 at significantly low levels 0.5 and critical patients at 0.35
Magnesium low limit should be at least 0.7 for significantly low patients 0.5 and critical patients
Monitoring criteria

Daily monitoring of blood levels of magnesium, phosphates are to be measured on a daily basis,
hence adjusted as feeding progresses. Fluid imbalance should be closely assessed clinically
inclusive of glucose levels
Chronic Kidney Disease
Also referred to as chronic renal failure, chronic kidney disease refers to all degrees of reduced
renal functionalities. Hence due to the diminished rate of filtering excess wastes and fluid
retention of these wastes causes toxicity in the body system. Causative factors include diabetes
type 1&2, hypertension, obstruction of the urinary tract, recurrent pyelonephiritis, vesicouteretal,
interstitial nephritis and Glomerulonephritis.
Appropriate Factors for Estimating Needs
CKD is initially managed through the control of blood pressure this should be between 140/90
mmHg recommended pressure and 130/80 mmHg suggested pressure. Control of diabetes
mellitus acts as a control in the progression of CKD and reduces the chances of cardiovascular
morbidity. Patients who have developed should constantly undergo lipid testing which assist in
medication compatibility. Patients with CKD have been found to experiences low metabolism
rate with regard to phosphates and calcium’s. Laboratory tests are recommended very four
Supplementation needs
Diets that are low in potassium are highly recommended K > 5.5 mEq/L.
Phosphorus levels should be at 3 to 5 mg/dl.

Daily sodium intake should be at 2g per day as a pharmacotherapy it assist in the regulation of
blood pressure
Monitoring criteria
Occurrence of Albuminuria at ≥ 30mg/24hrs through a urinalysis test, this includes investigation
of urine composition; presence of sediments. Tubular disorder indicated by electrolytes. Imaging

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Outstanding Job!!!!

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