Treating Alcohol Abuse A Collaborative Approach to Care
Treating Alcohol Abuse A Collaborative Approach to Care July 14, 2018 * Tex-CHIP Training Series Role of Nutrition & Lifestyle in Prevention/Management of Alcohol Abuse Understanding Provider Role in Treating Alcohol Abuse Registered Dietitians focus is on the nutrition diagnosis rather than medical or psychiatric diagnosis Nutrition diagnoses are written as a PES statement which identifies the nutrition Problem, its Etiology, and the Signs/
Symptoms which point to that problem Example: Underweight related to inadequate energy intake as evidenced by BMI of 14 and reported intake of <50% of estimated calorie needs. Understanding Provider Role in Treating Alcohol Abuse Interventions, goals, and evaluation methods are then tailored to the nutrition diagnosis Example: 1) Educated client on estimated calorie needs 2) Recommended prescription to PCP for oral nutrition supplement once daily to help meet estimated needs
Most PES statements in this population are surrounding energy balance, weight status and history, hydration status, and nutrient deficiencies Considerations when Interacting with Clients Cognitive Considerations: Impaired cognition makes accuracy or dietary recalls questionable Be aware of the emotional fragility of client and caregiver Scope of Practice Considerations: Redirect conversations to stay within bounds of RDs Scope of Practice Home Life Considerations:
Does client have a support system or enablers? Finances, available tools, & surrounding community play large roles in recovery Considerations when Interacting with Clients Anthropometric Considerations: Collect information on height, weight, weight history, and Body Mass Index Review recent and past lab values to identify any areas of concern (i.e. Liver disease, nutrient deficiencies, anemia, etc.) Conduct a Nutrition-Focused Physical Assessment to help identify malnutrition Nutrition Considerations:
Collect a 24-hour dietary recall from client and/or caregiver Include information on vitamin or oral nutrition supplement use Our Treatment Plan Healthcare Domain: Nutrition Provider: Dietitian Goals: a) Abstaining from alcohol Objective: Decrease in alcohol abuse as indicated by b) Energy and fluid balance by client report of: consuming foods and non-alcoholic (a) Reduction in frequency and volume of alcohol
consumption as compared to initial assessment and/or beverages that provides 90-110% of last follow-up estimated needs b) Improved nutrition status based on weight maintenance and energy and fluid intake meeting >75% of estimated needs c) Compliance with vitamin and nutrition supplement orders as prescribed by PCP and/or RD Interventions: a) Assist client with revisiting coping strategies to manage triggers of alcohol consumption
b) Educate client on estimated calorie and hydration and provide sample culturally-relevant menu plans that c) Micronutrient deficiencies corrected, meet clients needs particularly so that serum B-vitamin, iron, and potassium levels are within c) Recommend and/or order normal limits prescriptions for multivitamin and/or oral nutrition supplements d) Prevent further damage through dietary management as able (i.e. d) Offer dietary education on
liver disease, hypertension, anemia, management of complications of etc.) alcohol abuse as able Measuring Outcomes/ Success Weight maintenance or weight gain without increase in consumption of alcohol-containing beverages Increased reports of energy and fluid intake according to 24hour diet recall or food journal Reports of decreased alcohol intake Patient compliance with supplement use as prescribed Lab values show micronutrient levels improving or within normal limits
Communication from Counselors Helps gauge motivation and readiness to change Provides insight on support system and home life that I may not have received from assessment conversations Offers valuable information on progress being made, resources being sought, and emotional and mental state of client Often times, nutrition status is not top-of-mind for a client seeking or receiving care for alcohol abuse
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