Medical Nutrition Therapy
Medical Nutrition Therapy.PEIA Weight Management Encounters1MNT EncountersScheduled RD/Client MNT encounters:
Initial encounter: 60 minutes , month 2
Follow up encounters:60 minutes month 430 minutes month 660 minutes month 13
*If the participant is in Attempt 2 of the program, they will not receive the month 13 follow up encounter as Attempt 2 is 12 months in duration.MNT EncountersAdditional visits can be requested when needs arise by contacting the PEIA Weight Management Office
Considered on a case by case basis for approval
What may be approved?Changes in medical dxSignificant changes in nutrition related medsStruggling clientsInitial MNT Encounter60 minutesReview initial intake information to familiarize yourself with your client before contact.When scheduling first encounter, take the time to ask a few questions and get a feel for your client.Double check medical dxRequest they keep a food diary for a few days or fill out a food frequency questionnaire (can email it to them) to get a baseline intake to work from.Initial EncounterFollow the Nutrition Care Process
Nutrition Monitoring/EvaluationInitial EncounterClient Interview: basis of the nutrition assessmentUse your Motivational Interviewing skillsMI assists clients in gaining awareness of thoughts and feelings that are foundation of behavior.
Explores ambivalence; increases motivation for change
Put your client in the drivers seat. What are their personal goals and priorities? Initial EncounterInterviewing, continued:True power of change rests within the client.
Your job: to draw out the clients own motivation and skills for change- not to tell them what to do or why they should do it.
Lasting change more likely to occur when the client discovers their own reasons and determination for change.
Initial EncounterInterviewing, continuedPrinciplesExpress empathy- see the world through your clients eyesSupport Self-Efficacy- focus on previous successes and highlight skills and strengthsRoll with Resistance- dance rather than wrestle with your client; explore client concerns and invite them to examine new points of view; careful not to impose your own way of thinkingDevelop Discrepancy- help them discover where they are in relation to where they want to beInitial EncounterAssessmentEval ht, wt, wt history, BMI, WC, Biochemical data, Physical findings
Measure or estimate RMR (using Mifflin-St.Jeor at actual BW) and adjust for PA level. Estimate needs for wt loss of 1-2lb/wk.
Document clients food and nutrition hx- baseline diet hx/intake pattern, PA pattern, nutrition and health awareness, food availability and psychosocial or economic issues impacting nutrition therapy
Initial EncounterAssessment continued:Assess prescribed meds, OTC supplements and potential for interactions
Assess the clients knowledge base, motivation level and confidence/readiness to change diet and PA
Consider co-morbid conditions and need for incorporating other Nutrition Practice GuidelinesInitial EncounterNutrition DiagnosisList and prioritize the nutrition diagnosis (es) using a PES statement (Problem, Etiology, Signs/Symptoms)Most Common Dx for Weight Management:Excessive energy intake (NI-1.5)Excessive oral intake (food/bev) (NI-2.2)Inappropriate intake of fats (specify) (NI-5.6.3)Inappropriate intake of types of CHO (specify) (NI-5.8.3)Inadequate fiber intake (NI-5.8.5)Overweight/Obesity (NC-3.3)Initial EncounterMost common Nutrition Dx, continued
Food-Medication interaction (NC-2.3)Food and Nutrition related knowledge deficit (NB-1.1)Not ready for diet/lifestyle change (NB-1.3)Limited adherence to nutrition related recommendations (NB-1.6)Physical inactivity (NB-2.1)
Others may apply r/t co-morbid factorsInitial EncounterNutrition Intervention:Individualize the Nutrition PrescriptionWork with the client in establishing appropriate and reasonable interventions to address the etiology of their nutrition dx.Work with client on appropriate nutrition education/counseling and assist in selecting appropriate behavior therapy strategies (ie: self monitoring, stress management, stimulus control, contingency management, social support, etc) Initial EncounterIntervention continued:Have client assist in setting goals (measurable, reasonable/achievable, timed)
Indicate materials provided and resources given/used (ie: items from starter kit, web resources, on line trackers, etc .)
Indicate referrals made if anyInitial encounterMonitoring/Evaluation
Indicators to measure are determined by nutrition dx, etiology, s/s, as well as health care outcomes.
Identify nutrition care outcomes to be monitored and/or what they evaluate
On follow up should provide evidence that intervention is/is not changing behavior/statusFollow up Encounters30-60 minutes as assignedRe-interviewAssessment: Reassess anthropometrics, biochemical data, med changes.Obtain brief diet hx and eval clients adherence to diet plan/intervention strategiesDetermine adherence or barriers to learning or implementing behavioral changesCompare expected outcomes and goalsFollow up EncountersNutrition Dx
Based on initial encounter, progress and current goals, list and prioritize new or continued diagnosis (es)
Use PES statementsFollow up EncountersNutrition Intervention:Reinforce or modify nutrition prescription and assist client in setting behavioral goals focused on the etiology of the problem.
Reinforce/modify goals for PA and behavior therapy strategies as appropriate
Note materials provided, resources given/usedReferrals or requests for follow up labs prnFollow up EncountersMonitoring/Evaluation:Determine clients understanding of nutrition intervention
Any new indicators to monitor??
Compare nutrition care outcome indicators against specified standards- may establish your own comparison criteria as not all clients will be able to achieve goals established by a national standard-document progress or lack thereof
Resources to check outAcademy of Nutrition and Dietetics Adult Weight Management Evidence-Based Nutrition Practice Guidelines: www.evidencelibrary.comAcademy of Nutrition and Dietetics Adult Weight Management Tool KitAcademy of Nutrition and Dietetics Nutrition Care Manual section for Overweight and Obesity http://nutritioncaremanual.orgAcademy of Nutrition and Dietetics Nutrition Care Process and Standardized Language www.eatright.org/ncp Pocket Guide for IDNT: Standardized Language for The Nutrition Care Process (now in 4th ed.)MNT EncountersQuestions??Contact Information:
Cathy Shaw, RD, LDRD Program CoordinatorPEIA Weight Management Program304-293-6652Catherine.firstname.lastname@example.org