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

Evaluating Weight Loss

Tips for evaluating weight loss:

  • State the % of weight loss and whether it was significant over 30, 90 or 180 days
  • Remember that many times residents may lose weight initially after the hospital due to receiving IVF during their stay.   So if they are eating 100% and have had a weight loss, this may be the cause.  Knowing their UBW can help to identify this.
  • Monitor for changes in edema
  • Assess for any declines in intake, socialization and look for increased lethargy
  • Note any medication changes (look for changes or additions of diuretics, thyroid and diabetic medications, and prednisone etc.)
  • Speak to staff and resident (or family member)
  • Investigate possible chewing or swallowing problems
  • Look for signs and symptoms of malnutrition and dehydration when speaking with the resident
  • Come up with a plan to stop the weight loss with the resident, family and/or nurse
  • Make recommendations that are appropriate for the individual resident
  • State when you will follow-up
  • Update the Resident Care Plan
  • On next visit: Check to see that the recommendations were written
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