Treating Alcohol Abuse A Collaborative Approach to Care - PowerPoint Presentation

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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 Dietitian’s 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

, it’s

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:

Educated client on estimated calorie needs

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 RD’s 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

Objective

:

Decrease in alcohol abuse

as indicated by client report of:

Reduction in

frequency and volume of alcohol consumption as compared to initial assessment and/or last follow-up

Improved nutrition status based on weight maintenance and energy and fluid intake meeting >75% of estimated needs

Compliance with

vitamin and nutrition

supplement orders as

prescribed by PCP and/or RD

Goals

:

Abstaining

from alcohol

Energy and fluid balance by consuming

foods and non-alcoholic beverages

that

provides 90-110% of estimated needs

Micronutrient

deficiencies corrected, particularly so that serum B-vitamin, iron, and potassium levels are within normal limits

Prevent further damage through dietary management as able (i.e. liver disease, hypertension, anemia, etc.)

Interventions

:

Assist

client with revisiting coping strategies to manage triggers of alcohol consumption

Educate client on estimated calorie

and hydration and provide sample culturally-relevant menu plans that meet client’s needs

Recommend and/or order prescriptions for multivitamin and/or oral nutrition supplements

Offer dietary education on management of complications of 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 24-hour 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 changeProvides 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