CNS cheat sheet

Energy values: carbohydrate 4 kcal/g, protein 4 kcal/g, fat 9 kcal/g, alcohol 7 kcal/g; fiber is estimated at roughly 2 kcal/g.

Adult AMDR: carbohydrate 45-65%, fat 20-35%, protein 10-35% of total energy intake.

Protein RDA for healthy adults is 0.8 g/kg/day; nitrogen balance equals nitrogen intake minus nitrogen losses, with 6.25 g protein per gram of nitrogen.

Nine essential amino acids: histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, valine.

Only two fatty acids are essential: linoleic acid (omega-6) and alpha-linolenic acid (omega-3).

Glycemic load = glycemic index x available carbohydrate (g) / 100.

Heme iron from animal tissue is absorbed better than non-heme iron; vitamin C enhances non-heme absorption, while phytates, tannins, and calcium inhibit it.

Fat-soluble vitamins A, D, E, and K require bile and dietary fat for absorption; water-soluble vitamins are the B complex and vitamin C.

Assessment framework is ABCD: anthropometric, biochemical, clinical, and dietary data, supplemented by client history and food/nutrition history.

BMI = weight (kg) / height (m)^2; overweight 25.0-29.9, obesity class I 30.0-34.9, class II 35.0-39.9, class III 40 or above.

Hamwi ideal body weight: men 106 lb for the first 5 ft plus 6 lb per inch; women 100 lb plus 5 lb per inch.

Percent weight change = (usual weight - current weight) / usual weight x 100; over 5% in 1 month or 10% in 6 months is clinically significant.

Albumin half-life is about 20 days (chronic status); prealbumin about 2 days (short-term), but both fall with inflammation and must be read alongside CRP.

Waist circumference signals increased cardiometabolic risk above 102 cm (40 in) in men and above 88 cm (35 in) in women.

Dietary intake methods include 24-hour recall, food frequency questionnaire, estimated or weighed food records, and direct observation.

24-hour urinary urea nitrogen estimates protein catabolism: protein intake approximately (UUN + 4) x 6.25 g when renal function is stable.

PES format: Problem (standardized diagnosis term), Etiology ('related to'), Signs/Symptoms ('as evidenced by').

Three diagnosis domains: intake (e.g., excessive oral intake), clinical (e.g., altered laboratory values), behavioral-environmental (e.g., limited access to food).

A nutrition diagnosis must be a problem the nutrition professional can independently prevent or resolve; medical diagnoses are not nutrition diagnoses.

The etiology drives intervention selection; the signs and symptoms become the monitoring and evaluation indicators.

Each PES statement contains one problem, one etiology, and one or more measurable signs or symptoms.

The diagnosis is documented in the ADIME note between assessment and intervention, and is revised when new data change the clinical picture.

Avoid vague labels such as 'poor nutrition'; use standardized terminology such as 'inadequate protein-energy intake'.

Energy needs are commonly estimated at 25-35 kcal/kg/day, with protein 1.0-1.5 g/kg/day in stress or catabolism and higher in major burns.

Fluid needs approximated as 30-35 mL/kg/day, or about 1 mL per kcal of energy expenditure.

Refeeding syndrome prevention: start at 10-20 kcal/kg, give thiamine before or with the first feeding, and check phosphorus, potassium, and magnesium daily.

Gastric feeding is preferred when the gut works and aspiration risk is low; post-pyloric feeding is chosen for gastroparesis or high aspiration risk.

Parenteral energy yields: dextrose 3.4 kcal/g, amino acids 4 kcal/g, lipid emulsions about 9-10 kcal/g.

Nutrition support is considered when intake has been inadequate for 7 or more days, or sooner if the patient is already malnourished.

Intervention categories: food and nutrient delivery, nutrition education, nutrition counseling, and coordination of nutrition care.

Diabetes MNT emphasizes consistent carbohydrate intake and carbohydrate counting distributed across meals and snacks.

In chronic kidney disease, individualize protein prescription and restrict sodium, potassium, and phosphorus according to laboratory values.

Select monitoring indicators directly from the signs and symptoms named in the PES statement so evaluation tests the diagnosis.

Compare current status against the stated goals and reference standards, then classify the outcome as met, partially met, or not met.

Indicator quality criteria: relevant to the diagnosis, accurate, reliable, and feasible to collect repeatedly.

During refeeding, monitor phosphorus, potassium, and magnesium at least every 24 hours in the first week.

Reassessment frequency follows acuity: weekly or more often in acute care, less often in outpatient and community settings.

Weight trends must be interpreted with fluid status, since rapid changes usually reflect fluid shifts rather than tissue gain or loss.

Unmet goals trigger reassessment of the etiology and revision of the intervention, not simple repetition of the same plan.

Transtheoretical stages: precontemplation, contemplation, preparation, action, maintenance, and termination.

Motivational interviewing core skills (OARS): open-ended questions, affirmations, reflections, summaries; avoid the righting reflex.

Match the intervention to the stage: raise awareness in contemplation, build a concrete plan in preparation, support self-monitoring in action.

Teach-back confirms comprehension; plain-language materials should target roughly a 5th-6th grade reading level.

Health belief model constructs: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy.

Use trained interpreters and culturally adapted materials rather than relying on family members for interpretation.

SMART goals are specific, measurable, achievable, relevant, and time-bound.

Self-monitoring (food logs, symptom diaries, step counts) and stimulus control are core behavior-change techniques.

PICO frames a searchable question: Population, Intervention, Comparison, Outcome.

Evidence hierarchy: systematic reviews and meta-analyses of RCTs rank above single RCTs, cohort, case-control, case series, and expert opinion.

Sensitivity = TP/(TP+FN); specificity = TN/(TN+FP); positive and negative predictive values depend on disease prevalence.

Number needed to treat = 1 / absolute risk reduction.

Intention-to-treat analysis preserves randomization and limits attrition bias.

Common biases to appraise: selection, recall, measurement, publication, and confounding.

Statistical significance (p < 0.05) does not establish clinical significance; examine effect size and confidence intervals.

Relative risk is calculated in cohort studies; the odds ratio approximates it closely only when the outcome is rare.

Scope of practice defines legally and competently permitted activities; refer or consult when a task falls outside it.

ADIME and SOAP are standard note formats; documentation must be timely, dated, signed, and objective.

HIPAA governs protected health information; disclose only the minimum necessary for treatment, payment, or operations.

Informed consent requires capacity, disclosure of risks, benefits, and alternatives, voluntariness, and documentation.

Interdisciplinary collaboration requires clarifying roles with physicians, registered dietitians, nurses, and behavioral health providers.

Credentials require ongoing continuing education and renewal on the certifying board's stated cycle.

Records must support medical necessity: link the diagnosis, the intervention delivered, and the measured outcome.

Core principles: autonomy, beneficence, nonmaleficence, and justice.

Disclose conflicts of interest such as supplement-industry funding and decline gifts that could bias recommendations.

Respect informed refusal; document the discussion and offer alternatives without coercion.

Confidentiality may be breached only when required by law or to prevent serious harm.

Practice within demonstrated competence; refer rather than advise outside one's expertise.

Billing must reflect services actually delivered; upcoding and unbundling constitute fraud.

Accommodate religious, cultural, and ethical dietary practices when planning care and recommend only evidence-based supplements.

Break-even volume = fixed costs / (price per unit - variable cost per unit).

MNT CPT codes: 97802 initial assessment, 97803 reassessment and intervention, 97804 group session; each unit is 15 minutes.

Medicare Part B covers MNT for diabetes and renal disease (including post-transplant): 3 hours initial and 2 hours follow-up per calendar year.

Claims require ICD-10 diagnosis codes, CPT procedure codes, and a documented referral where payer rules demand it.

Fee setting must cover overhead (rent, staff, malpractice, software) plus a target margin.

Diversify revenue across insurance billing, private pay, group programs, corporate contracts, and telehealth.

Track payer mix, collection rate, no-show rate, and revenue per clinical hour as core business metrics.