Nutrition: Was Malnutrition the Culprit?
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Nutrition:
Was Malnutrition the Culprit?
Forty to eighty five percent of patients
and nursing home residents experience protein-calorie
malnutrition, which promotes involuntary weight loss,
pressure wound development, poor wound healing and
other negative patient or resident outcomes. Because
malnutrition and many of its unintended consequences
can often be prevented, appropriate recognition and
management of malnutrition or the risk for malnutrition
is of primary importance in assessing the status of
patients and residents. An evaluation of the nutritional
assessment, care planning, interventions and monitoring
should be completed for each case involving malnutrition,
weight loss or pressure wounds. Janet McKee, a nutritional
expert, exposes the practices that lead to malnutrition.
This interactive webinar provides the knowledge to
determine when nutrition is a key issue in case evaluations
and screening a claim for merit.
This program will help you to:
- Identify the signs and symptoms of malnutrition
and the cascade of negative outcomes promoted by
malnutrition
- Identify the medical nutrition therapy documentation
required by the nutrition standards of care
- Determine when a nutrition expert may be needed
to help support your claims or defend your case
Evaluation
and Post-Test for CEUs (pdf) |
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Janet S.
McKee, MS RD CSG LD/N DAPWCA has been a registered
and licensed dietitian for over 25 years. Ms. McKee
is the president and owner of Nutritious Lifestyles,
Inc. Nutritious Lifestyles has a staff of 35 registered
dietitians and allied nutrition professionals that
offer nutrition consulting services to the health
care and foodservice industry in Florida, as well
as nationally. Ms. McKee is a nationally recognized
author, presenter, and nutrition liability expert.
Ms. McKee has provided consultation to healthcare
organizations and to legal professionals, including
attorneys, legal nurse consultants, educators, risk
managers, and insurance personnel, for over 15 years.
Ms. McKee has also spoken at numerous state and national
healthcare conferences. Ms. McKee’s special
topics of interest and expertise include the nutritional
care of adult, geriatric and bariatric patients and
residents, as well as nutritional therapy for the
prevention and treatment of protein-calorie malnutrition,
dehydration, and pressure ulcers.
Moderator: Patricia
Iyer is President of Med League Support Services,
Inc, established in 1989.
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Excerpt from
Feinsod, F. and Riggs, A, “Defending Long-Term
Care Facilities: Unraveling Clinical Outcomes from
the Natural History of Aging” in Patricia Iyer,
Editor) Nursing
Home Litigation: Investigation and Case Preparation,
Second Edition:
Weight loss and concomitant protein
calorie malnutrition have major implications for prognosis
as well as predispose individuals to pressure ulcer
risk, falls, and infections. Indeed, clinical outcomes
can be correlated with weight. Weight loss is a common
problem in frail, elderly residents in LTC facilities
and can evolve from a number of causes.
Nutritional health requires the
complex interaction of psychosocial, environmental,
medical, and functional systems. Identifying contributing
issues can be complex. This includes ensuring that
residents are served the correct diet (including consistency,
texture, temperature, and so on). In addition, residents
should be observed for ability to sequence eating
tasks. Demented residents may be overwhelmed by large
portions and do better with multiple small portions
at a time or throughout the day. Demented residents
may have to be followed with food as they ambulate
if they are unable to sit for meals. Unpleasant table
mates may discourage appetite. Other contributors
to weight loss, include medications that can alter
sense of taste and decrease appetite, alter swallowing
ability, increase confusion or sedation, cause nausea
or diarrhea, or increase movement disorders that interfere
with getting food to the mouth. Dental abscesses may
disrupt appetite by causing pain or malaise.
Chronic or acute pain, until adequately
treated, can markedly affect appetite. Treatable endocrine
etiologies should be considered such as thyroid dysfunction
or uncontrolled diabetes. Depression, dementia or
other psychiatric etiologies may also exert major
effects on eating.
Special and invasive procedures
can be disruptive to cognitively impaired residents
and should be carried out with family (or proxy) permission
and coordinated with resident (and/or proxy) expectations.
This includes speech therapy intervention as well
as modified barium swallows. PEG
tubes are ethically complex and benefit has not
been established in demented populations.
Decisions to use or not use such
interventions should be discussed with the resident
(and/or proxy) in detail and should not necessarily
be considered standard of care. (read
more)
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