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High Risk Nutrition Care Plan Guidelines 3

Risk 211 Elevated Blood Lead Levels

Women (all categories): >5 µg/dl Infants: >5 µg/dl Children: >3.5 µg/dl

Assessment, counseling, and referral guidelines: • Complete nutritional assessment according to WIC protocol. • Assess diet. Especially note intake of calcium and iron rich foods as well as any low iron levels (iron deficiency). • Inquire about inappropriate nutrition practices, such as ingesting non-food items (pica) and a child’s hand-to-mouth activity (contact with dust, dirt, paint, etc.). • Follow the Blood Lead Test Screening and Referral guidance in Section 3.5 of the WIC Procedure Manual which includes providing ADPH-FHS 285e/s “Make Good Food Choices to Help Prevent Lead Poisoning.”

Documentation: • Check “High Risk Education” on the Nutrition Education screen under Nutrition Education Topics and enter “Elevated Blood Lead” under Topic Status. • Document any specific details regarding the nutritional assessment and the nutrition care plan in the Nutrition Assessment field on the Care Plan Summary. This includes documentation of diagnosis from the HCP (health care provider).

Recommendations for the WIC CPA: • Learn about and reinforce the health care team’s plan of care and encourage participants/caregivers to keep all appointments and take any prescribed supplements as directed. • Emphasize the importance of adequate calcium and iron intake in the diet. Adequate consumption of both calcium and iron, which compete with lead for intestinal absorption, have been found to decrease lead absorption. • Encourage any prescribed supplements, such as iron and/or prenatal vitamins. Adequate calcium intake during pregnancy may reduce maternal bone resorption and reduce the mobilization of lead stored in the bone into the blood. • Encourage initiation or continuation of breastfeeding, except for women with a blood lead level of >40 µg/dl.

Risk 302 Gestational Diabetes (Prenatal)

Gestational diabetes mellitus (GDM) is defined as any degree of glucose/carbohydrate intolerance with onset or first recognition during pregnancy.