Instructions:

Please rate your experience / frequency (within the last year) using the following scale (check the appropriate boxes below):

  • 0 = No Experience / Observed Only
  • 1 = Limited Experience / Rarely Done (<6 times/year)
  • 2 = May Need Some Review / Occasionally Done (1 - 2 times/month)
  • 3 = Experienced / Frequently Done (daily or weekly)
    		•
    AGE OF PATIENTS CARED FOR
    Newborn/Neonate (birth to 30 days)
    Infant (1 month to 1 year)
    Toddler (1 year to 3 years)
    Preschooler (3 years to 5 years)
    School Age Child (5 years to 12 years)
    Adolescents (12 years to 18 years)
    Young Adults (18 years to 39 years)
    Middle Adults (39 years to 64 years)
    Older Adults (64 years to 79 years)
    Elderly Adults (over 79+ years)
    SKILLED ENVIRONMENTS
    Acute Care/ Hospital
    Managed Care
    SNF/ Long Term Care
    Home Health
    Outpatient
    Clinical Dietitian
    Community Dietician
    Management Dietician
    GENERAL DIETICIAN EXPERIENCE
    Written Communication Skills
    Verbal Communication Skills
    Basic Negotiation Skills
    Job Related Computer Skills
    Ability to Prioritize
    Ability to Critically Think in Overall Practice
    Show Cultural Competence/Sensitivity with all Clients
    Ability to Develop Nutrition Education
    Ability to Develop Meal and Nutrition Plans within Patient Budget
    Ability to Work Effectively in All Situations
    Ability to Assess, Plan, Implement and Evaluate Individual Patient Care Programs and Nutritional Guidelines
    Council Patients on Healthy Eating and Nutrition Issues
    Ensure Outcomes are Met within an Appropriate Length of Stay
    Coordinate and Monitor Nutritional Services
    Coding and Billing for Nutrition and Diatetics Services for Reimbursement
    Document All Client Encounters
    Knowledge of Nutrition and its Role in Diseases and Illnesses
    Patient and Family Education
    Knowledge and Development of Plan with Eating Disorders
    Determine energy requirements
    Determine protein requirements
    Determine fluid requirements
    Determine Electrolyte requirements
    Determine fat requirements
    Determine micronutrient requirements
    NUTRITION STATUS
    Clinical Malnutrition
    Poor Diet
    Eating Difficulties
    Marginal Malnutrition
    Metabolic Demands
    Nutrient Deficiencies
    Assess Fluid Status
    Kwashiorkor
    Marasmus
    Cachexia
    Protein Calorie Nutrition
    CONDITIONS AFFECTING NUTRITION
    Abdominal Wounds and Surgeries
    Abnormal Bleeding
    Acute MI
    Acute Renal Failure
    Alzheimer's Disease
    Anorexia Nervosa
    Aspiration
    Bulimia
    Cancer
    Chronic Diarrhea
    Coma
    Congenital Heart Defects
    Congestive Heart Failure
    COPD
    CVA
    Decubitus
    Diabetes
    Diabetic Ketoacidosis
    Draining Abscesses
    Draining Wounds
    Drug Overdose
    Dysphagia
    Elevated Cholesterol/Triglycerides
    End Stage Renal Disease
    Epiglottitis
    Excessive Alcohol Intake
    Extensive Burns
    Failure to Thrive
    Fever
    Fistulae
    Hemodialysis
    Hepatitis
    HIV/AIDS
    Homelessness/Limited Access to Food
    Hyperemesis
    Immune Disordres
    Infection
    Inflammatory Bowel Disease
    Liver Failure
    Low Blood Sugar
    Major Surgery
    Malabsorption Syndromes
    Mucositis
    Osteoporosis
    Pancreatitis
    Peritoneal Dialysis
    Pregnancy
    Protracted Emesis
    Radiation
    RDS
    Refeeding Syndrome
    Renal Transplants
    Sepsis
    Short Gut Syndrome
    Sickle Cell Anemia
    Status Asthmaticus
    Stomatitis
    Transplants
    Trauma
    Tuberculosis
    Vented Patient
    Wounds
    Morbid Obesity
    Post-Op Gastric Stapling/Gastric Bypass
    Depression
    MEDICATIONS AFFECTING NUTRITION
    Steroids
    Immunosuppressants
    Antineoplastics
    Insulin
    Diuretics
    Blood Thinners
    Laxatives
    MANAGING NUTRTION THERAPY
    Oral Diets
    Enteral Nutrition
    Parenteral Nutrition
    Writing Orders for Nutrition
    Intake and Output
    Fluid Balanace
    Calorie Counts
    Small Bowel Feeding Tubes
    Gastrostomy Tubes
    Jejunostomy Tubes
    Hyperalimentation