Topic 4: Helpful Resources for Students and Interns by Jessie Donaldson

          While working with my preceptor in a long-term care facility, I found several resources to be helpful to have on hand. These included a few handy pocket guides, a useful app on my phone, some evidence-based websites, and my go-to textbook. The resources a student or intern finds most helpful will depend on the environment they’re in and personal preferences, but I hope the list below of my own choices serves as a helpful starting point.

          Pocket Guides:

  • Pocket Guide to Nutrition Assessment
    • This is the guide I reached for most often. It is well organized and enabled me to quickly refresh my memory about aspects of nutrition assessment I’d learned, plus it went into detail about special considerations when dealing with specific conditions. For example, when calculating energy, protein, and fluid needs, there are sections that cover how to approach this with patients from various demographics and health histories.
  • Nutrition Focused Physical Exam (NFPE) Pocket Guide
    • Not all RDNs conduct full NFPEs. Depending upon the facility, it may only be feasible to rely on a pared-down version. Experienced RDNs are able to observe and assess a patient’s nutrition status by looking for physical features such as sunken orbitals or prominent clavicles. Whether doing a full exam or looking for easily observed features such as these, this is a helpful resource to guide interns through the process.
  • Pocket Guide to Spanish for the Nutrition Professional
    • Interns working in urban communities or in places with sizable Spanish-speaking populations may find this one particularly useful. While there’s no replacement for Spanish fluency, an intern with some degree of Spanish competency can better communicate with the dietetics-related vocabulary offered in this guide.
  • Various other pocket guides are available on medical nutrition therapy for specific conditions, such as diabetes, hypertension, and heart failure. Interns may wish to get the ones on conditions they see most frequently in their particular facility’s patient population.

*All of these pocket guides are available for purchase, in print or digital form, from the Academy of Nutrition and Dietetics (AND) website at www.eatrightstore.org. Student pricing is available to AND members.

          Apps/Websites:

  • eNCPT
    • This is the electronic Nutrition Care Process Terminology website, and it has been one of my most frequented sites throughout school. It hosts a wealth of information on the nutrition care process using the ADIME model. It’s a handy reference tool when looking up specific diagnoses, getting clarity on assessment criterium, and more. The “Reference Sheets” tab has much of this information in handy “cheat sheets”. As with the pocket guides, AND offers the eNCPT at a discounted price for students.
  • EAL
    • The AND Evidence Analysis Library is the first place many RDNs and interns look for the most current evidence-based guidelines in medical nutrition therapy. I find it easiest to navigate this site by going to the index and selecting the appropriate condition or topic, then navigating through the tabs on the left.
  • Nutriguides
    • Here’s a handy smartphone app that organizes everything from the EAL in a way that I find more intuitive than the EAL website. It’s easy to locate guidelines on many conditions and topics, and their clear ratings system is helpful in determining how strong the evidence is for each recommendation. I was also able to use it in a facility where the computers had restricted access, inhibiting my ability to use the EAL.
  • Canva
    • This app is accessible on any desktop or laptop computer, and is a great tool I’ve recently discovered. It isn’t nutrition-specific, but it is perfect for creating professional, aesthetically pleasing publications for nutrition education or school and internship assignments. Canva has an intuitive interface that allows the user to quickly create flyers, posters, presentations, social media posts, and more.

Books and Other Publications:

  • Krause’s Food & the Nutrition Care Process, by L. Kathleen Mahan and Janice L. Raymond
    • This was, hands-down, the most utilized textbook in my classes. It covers all of the topics found in the above-mentioned pocket guides and more, but in much more detail. While it was a bit hefty to lug into my facility every day, having it at home was a must. I’d recommend getting the most recent edition when possible.
  • Food Medication Interactions, by Zaneta M. Pronsky
    • This is the classic bible of medications and their food interactions. Learning the names and uses of every medication was one of the hardest parts of my clinical experience, so a resource like this is very helpful. Unfortunately, this book is now somewhat infamously out of print. If you’re lucky enough to have a copy from your classes, hold onto it! Otherwise, the best alternative may be to Google each medication and reference reliable websites like http://www.mayoclinic.org.

15 easy ways to increase calories in LTC

  1. Mix 4oz ice cream with chocolate milk
  2. Mix 4oz Magic Cup with 8oz whole milk or Ensure Plus
  3. Extra cottage cheese at a meal (can be puréed also)
  4. Add 30 mL liquid protein to 4oz juice
  5. 1oz peanut butter with toast or English Muffin each morning
  6. Give whole milk q meal
  7. Mix peach yogurt with whole milk and magic cup
  8. Hot chocolate made with whole milk or Lactaid
  9. Coffee mixed with vanilla or chocolate ice cream plus milk or supplement
  10. Greek yogurt at breakfast
  11. Cereal and milk for a bedtime snack
  12. Ice cream sandwiches
  13. Fortified foods at each meal: cereal, soup, potato
  14. Extra creamer for cereal with brown sugar and butter
  15. Serve cream soups daily

Ace your LTC/Clinical Rotation

I am a RDN with over 25 years of experience in LTC. Over the past few years, I have been working with students as a preceptor. This led me to create four nutrition presentations that have proven to be helpful to student dietitians and diet technicians. In fact, I have recently updated the videos as a result of some feedback from over 200 students. One had commented, “I wished I had seen your videos at the start of my internship.” In addition, I have written an e-Book that students can purchase for practical information on completing nutrition assessments. Sample patients are included. Overall, these resources are designed to give the student practical advice on how to complete nutrition assessments and plans based on current nutrition scientific evidence.

Sample nutrition note for a resident with a decline in meal intake

5/20/17-Resident has experienced a decline in meal intake the past week r/t UTI with ABT therapy.  She denies any difficulty chewing or swallowing. Currently eating 25-50% of meals, which is down from her usual 50-100%. Weight taken on 5/3/17 was 136# and was stable between 133-138# for 180 days.  IBW is 100#. BS range from 125-200.  Labs-5/18/17: Na 146H; K 3.7; Cl 110; Hgb 11.2L; Hct 38L; BUN 25H; Creat 1.0; GFR >60; Glu 137H. Skin is intact. Needs:  1545-1854 Kcals (BWx25-30) and 49-62 grams of protein (BWx.8-1.0) and 1854 mL in 24 hours (BWx30); Meals provide approx. 700-800 Kcals and 22-27 grams of protein.  Would benefit from nutrition supplement.  Spoke with resident and she agreed to try our Diet House supplement.

Nutrition Diagnosis: Inadequate meal intake related to recent infection and ABT therapy as evidenced by leaving 50% or more of meals

Recommend: 1) 120 mL SF House Supplement tid-following each meal. 2) Weekly weights 3) Encourage fluids-give an extra 120 mL q shift. Follow prn.

This is an excerpt from: The Top Fifty Questions from Student RDNs about Long-Term Care, an e-book created by Doreen Rodo, M.Ed, RDN

$6.99 Kindle Edition on Amazon

https://www.amazon.com/Fifty-Questions-Student-about-Long-Term-ebook/dp/B07SMZHTQ3

#aceyourLTCrotation

NutriGuide app

Working in long term care for over twenty-five years has been rewarding as well as challenging.  I’m actually amazed at how many things have changed since I began. When I started out, I felt that there were no clear guidelines for providing nutrition therapy.  It seemed as though most dietitians were doing their own thing.  This made it very confusing for many of us.  Fortunately, The Academy of Nutrition and Dietetics (A.N.D) realized this and launched its Evidence Analysis Library (EAL) in 2004. Academy members reviewed many studies to come up with practice guidelines for dietitians (RDN’S) and Diet Technicians (DTR’S).  The outcomes of the evidence-based reviews were labeled as Strong, Fair, Weak, Consensus, and Insufficient Evidence. (1) It is a great tool for nutrition professionals who want to make sound nutritional recommendations.  To make the process easier for RDN’s, the Academy of Nutrition and Dietetics developed a “NutriGuides Mobile” app in 2013 to provide further information. (2) Since today’s world is highly mobile and many students and RDN’s likely have smart-phones, the “NutriGuides” app is an essential tool for practicing utilizing evidenced-based guidelines.

1. Academy of Nutrition and Dietetics (AND). Evidence Analysis Library (EAL).  http://www.eatrightpro.org/resources/research/applied-practice/evidence-analysis-library Accessed April 9, 2019. 

2. Academy of Nutrition and Dietetics (AND).  NutriGuides Mobile.  

http://www.eatrightstore.org/product/0F87E78B-4F5F-4F27-BDBD-0803429FC63E Accessed April 9, 2019.

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