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MAXIMIZING CL INICAL OUT COME S BY MINIMIZING DIE T ARY DE F - - PowerPoint PPT Presentation

Sep 16, 2023 215 likes •329 views

MAXIMIZING CL INICAL OUT COME S BY MINIMIZING DIE T ARY DE F ICIE NCIE S: A MUL T IDISCIPL INARY APPROACH Appra ise a nd Asse ss the Nutritiona l & Die ta ry Ma na g e me nt of the Comple x L T C r e side nt fr om the nur

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SLIDE 1

MAXIMIZING CL INICAL OUT COME S BY MINIMIZING DIE T ARY DE F ICIE NCIE S: A MUL T IDISCIPL INARY APPROACH

Appra ise a nd Asse ss the Nutritiona l & Die ta ry Ma na g e me nt of the Comple x L T C r e side nt fr

  • m the nur

sing pe r spe c tive

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SLIDE 2

CMS RE GUL AT ORY GUIDE L INE S F OR L T C

Qua lity of L ife

F

  • 240 Qua lity o f L

ife

F

  • 241 Dig nity

F

  • 325 Nutritio n

F

  • 327 Hydra tio n

Re side nt Asse ssme nt

F

  • 272 Co mpre he nsive Asse ssme nt

Qua lity of Ca re

F

  • 314 Pre ssure Ulc e rs

F

  • 321 Na so g a stric T

ub e s

F

  • 322 Se rvic e s to Pre ve nt Aspira tio n

De nta l

F

  • 412 Nursing F

a c ilitie s De nta l Se rvic e s Die ta ry Se rvic e s

F

  • 363 Me nus a nd Nutritio na l

Ade q ua c y

F

  • 365 F
  • o d Me e ts I

ndividua l Ne e ds

F

  • 367 T

he ra pe utic Die ts

CASPE R Me tric s

Ce rtifie d And Surve y Pro vide r E nha nc e d Re po rts

MDS

Minimum Da ta Se t: Pro vide r/ Sta te / Na tio na l b e nc hma rks

Nursing Ho me Co mpa re

5 ST AR Nursing Ho me Qua lity Ra ting Syste m

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SLIDE 3

NE CE SSARY, MUL T IF ACE T E D… AND CHAL L E NGING F OR T HE MUL T IDISCIPL INARY T E AM

Coa lition of or g a niza tions a nd individua ls to c ha ng e the c ulture of a g ing a nd long te rm c a re

“Pe rson Ce nte re d Ca re ”

Pre mise o f pe rso n c e nte re d c a re a pplie s to a ll disc ipline s, e spe c ia lly nursing a nd die ta ry:

Re side nt should pa rta ke in :

  • Die ta ry a nd me a ltime de c isio ns
  • Who re side nt dine s with
  • Whic h fo o ds a re o ffe re d
  • Ho w fo o ds a re o ffe re d
  • Re side nt c ho ic e s stro ng ly influe nc e q ua lity o f c a re a nd q ua lity o f life , multidisc iplina ry te a m is

c ha lle ng e d to mitig a te po te ntia l risks, a sso c ia te d with tho se c ho ic e s

  • Pro viding c ho ic e s a re b a c ke d b y re se a rc h a nd CMS re g ula tio ns
  • Dining e xpe rie nc e is so c ia l b ut ye t c a n b e c ha lle ng ing b a se d o n o ur a g ing po pula tio n
  • Va st diffe re nc e s in the ne e ds o f o ur e lde rs
  • Ong o ing g o a l to de ve lo pme nt sta nda rds fo r dining pra c tic e whic h suppo rt individua lize d c a re

a nd se lf dire c te d living ve rsus tra ditio na l dia g no sis-fo c use d tre a tme nt

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SLIDE 4

T RANSIT IONS IN T RADIT IONAL L T C HOME S

Ma ny of our L T C home s ha ve tra nsforme d into Post Ac ute / L T C home s … . And now fa c ing the c ha lle ng e of ma na g ing short sta y pa tie nts a nd L T C re side nts in the ir home s… . T

  • o ma ny diffe re nc e s

 Re g ula r/ L

ib e ra lize d

 No Sa lt a dde d  2 Gm So dium  Co nsiste nt Ca rb o hydra te  He a rt He a lthy  L

ib e ra lize d Re na l

 Glute n F

re e

 Sma ll a nd la rg e po rtio ns  Dyspha g ia a dva nc e d  Dyspha g ia pure e  Cho ppe d/ g ro und me a ts  T

hic ke ne d liq uids:

  • T

hin

  • Ne c ta r-like
  • Ho ne y-like
  • Spo o n – thic k
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SLIDE 5

NURSING PE RSPE CT IVE KE Y: E ARL Y ASSE SSME NT AND IDE NT IF ICAT ION

Dise a se a nd func tiona l de c line c an affe c t an individuals ability to swallow, food or fluid; this inability c an r e sult in c hoking and/ or aspir ation

Diffic ulty with swa llowing or dyspha g ia c a n inc re a se the individua ls risk of :

  • Ma lnutritio n
  • De hydra tio n
  • Aspira tio n Pne umo nia
  • Unne c e ssa ry Ho spita liza tio n

I MPORT ANT to I de ntify Dyspha g ia – Swa llo wing Co nc e rns

Nursing 's E a rly Asse ssme nt a nd Ide ntific a tion of Dyspha g ia or a ny swa llowing c onc e rns will:

  • Ma inta in nutritio na l re q uire me nts
  • Pro te c t the a irwa y during swa llo wing
  • Pre ve nting a ny a dditio na l c o mplic a tio ns
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SLIDE 6

ROL E OF NURSING ST AF F

Nursing sta ff a re ofte n the first pe rsons to r e c og nize the sig ns a nd symptoms of dyspha g ia . Norma l re sponse to dyspha g ia is c oug hing , a bnorma l is sile nc e

Nursing sta ff re c og nizing the c linic a l signs of aspir ation is c r itic al

  • F

e ve r

  • Sho rtne ss o f bre a th
  • We a kne ss
  • Co ug hing
  • T

hic k, c o lo re d sputum

Nursing Asse ssme nt

  • Re vie w o f Re side nt histo ry/ c ha rt to ide ntify risk fa c to rs/ unde rlying c o nditio ns fo r dyspha g ia
  • Ne uro musc ula r dise a se
  • He a d a nd Ne c k Ca nc e r
  • Bra in Ca nc e r / Me ta sta tic Ca nc e r
  • Ora l He a lth / Po o r o ra l c a re / Physio lo g ic al c ha ng e s
  • Me dic a tio ns –po lypha rma c y
  • Pulmo na ry issue s/ Pne umo nia
  • De me ntia
  • Stro ke
  • Ag ing
  • UT

I

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SLIDE 7

ROL E OF NURSING ST AF F

Nur sing Physic al Asse ssme nt

Re vie w o f re side nts:

Ab ility to ma na g e fo o d –

  • b se rva tio n during me a ls,

me dic a tio n pa sse s

Swa llo wing func tio n

Po sitio ning

Che st a nd Ce rvic a l Ausc ulta tio n

L e ve ls o f a wa re ne ss- Co g nitio n

Airwa y pro te c tio n

Nursing Asse ssme nt/ Inte rvie w

Ask a nd/ o r o b se rve

 F

  • o d stic king

 Cha ng e s in ta ste  Co ug h with fo o d o r liq uids b e fo re ,

during o r a fte r swa llo wing

 Co ug hing b e twe e n me a ls  Ac ute o r c hro nic we ig ht lo ss  E

xc e ssive o ra l se c re tio ns

 Cha ng e s o r ina b ility to ma na g e spe c ific

te xture s o f fo o ds

 So c ia l c ha ng e s re la te d to dining  F

a mily re c o g nitio n

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SLIDE 8

ROL E OF NURSING … . IN NUT RIT IONAL AND DIE T ARY MANAGE ME NT

Nur sing sta ff a r e ke y in the imple me nta tion of :

  • Ma na g ing c o mpe nsa to ry stra te g ie s, whic h a re

individua lize d fo r e ac h re side nt

  • Re info rc ing a ppro a c h to nutritio n/ hydra tio n
  • T

e c hniq ue s

  • Po sitio ning
  • Minimizing distra c tio ns
  • Re info rc ing re side nt re c e ive d re c o mme nde d die t/

liq uid le ve ls

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SLIDE 9

ROL E OF NURSING ST AF F

( Continue d )

Nursing sta ff a re ke y in the imple me nta tion of :

Co mmunic a tio n o f c ha ng e s/ info rma tio n to the physic ia n, sta ff, fa mily a nd

  • the r c a re pa rtne rs

Me thods of tube fe e ding s:

  • F

lush

  • Bo lus F

e e ding s

  • Co ntinuo us F

e e ding s

  • T
  • le ra nc e / I

nto le ra nc e to fe e ding

  • Mo tility/ dysmo tility
  • Sto ma

Ide ntifying the ne e d for a re fe rra l / e va lua tion by SL P

  • Nursing re info rc e s the re ha b ilita tio n o f e a c h sta g e in swa llo w a s dire c te d b y

SL P

  • Spe c ific po sitio ning during o ra l inta ke
  • Supe rvisio n
  • Cue ing
  • Assista nc e
  • Spe c ia l e q uipme nt a va ila b le during me a ls
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SLIDE 10

MUL T IDISCIPL INARY APPROACH

Alo ng with the c urre nt tre nds o f po pula tio n a g ing , c hro nic c ha ng e s in mo rb idity, func tio na l impa irme nt o f he a lth, pro g re ssive c o mple xity o f c a re c o nte nt, the e lo ng a tio n o f the c a ring pe rio d a nd the c o nse q ue nc e s o f the se tre nds, o ur wo rld o f lo ng -te rm c a re ha s b e c o me mo re c ha lle ng ing tha n e ve r. Nursing is just o ne o f the ma ny c a re pro vide rs tha t ma ke a diffe re nc e in the live s o f o ur e lde rs. Our ro le is va st b ut ma na g ing the nutritio na l a nd die ta ry ne e ds o f o ur e lde rs is CRI T I CAL