Nutrition and Medical Nutrition Therapy
Nutrition and Medical Nutrition Therapy
The CDRE nutrition domain tests whether you can move from nutrition screening to a documented nutrition diagnosis and implement safe, evidence-informed interventions across the lifecycle and in common chronic conditions. Expect items on the Nutrition Care Process, anthropometric and biochemical interpretation, diet modifications, and enteral/parenteral basics.
Core rules and concepts
- Use the Nutrition Care Process: Assessment, Diagnosis (PES statement: Problem, Etiology, Signs/Symptoms), Intervention, and Monitoring/Evaluation. Screening is a brief risk triage, not a full assessment.
- Collect the five assessment domains: anthropometric, biochemical, clinical, dietary intake, and environmental/social.
- Estimate energy from kcal/kg or predictive equations; adjust for activity, stress, and weight goals. Protein needs rise with catabolism, wounds, and dialysis.
- Match the diet order to the condition: carbohydrate consistency or counting for diabetes; sodium and DASH patterns for hypertension; potassium/phosphorus control in CKD; texture-modified diets using IDDSI levels for dysphagia.
- Document the intervention, goal, and timeframe; monitor with objective measures, not just "patient tolerated."
Worked example
A 70 kg adult with a healing pressure injury needs about 30 kcal/kg = 2,100 kcal/day and 1.2–1.5 g protein/kg = 84–105 g/day. If a standard formula provides 1.0 kcal/mL and 40 g protein/L, 2,100 mL supplies 2,100 kcal and 84 g protein. Check free-water needs and flush volume; a 2,100 mL formula at 80% water gives 1,680 mL water, so add flushes if ordered. Reassess weight, intake, and wound status weekly.
Traps
Using serum albumin alone to diagnose malnutrition (it reflects inflammation); applying obesity kcal/kg to actual body weight without clinical judgment; writing a diet order without a measurable goal; and ignoring swallowing safety or cultural food preferences.