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Nutrition Care ProcessKNH 406

RelationshipBetween

Patient/Client/Group

& Dietetics

Professional

-

Nutrition Diagnosis

Identify and label problem

Determine cause/contributing risk

factors

Cluster signs and symptoms/

defining characteristics

Nutrition Assessment

Obtain/collect timely and

appropriate data

Analyze/interpret with

evidence- based standards

Identify risk factors Use appropriate tools

and methods Involve

interdisciplinary

collaboration

Screening& Referral

System

Outcomes Management System

Monitor the success of the Nutrition Care

Process implementation

Evaluate the impact with aggregate data

Identify and analyze causes of less than

optimal performance and outcomes

Refine the use of the Nutrition Care

Process

ADA NUTRITION CARE PROCESS AND MODEL

Document

Nutrition Monitoring and

Evaluation

Monitor progress

Measure outcome indicators

Evaluate outcomes

Document

Nutrition Intervention

Plan nutrition intervention

Formulate goals and

determine a plan of action

Implement the nutrition intervention

Care is delivered and actions

are carried out

Document

Document

ADA’s Nutrition Care

Process Steps


Nutrition Diagnosis


Nutrition Monitoring and Evaluation

Nutrition Assessment (Definition)

“A systematic process of obtaining, verifying, and

interpreting data in order to make decisions about the

nature and cause of nutrition-related problems.”

Lacey and Pritchett, JADA 2003;103:1061-1072.

Nutrition Assessment Components

Gather data, considering

Compare to relevant standards

Identify possible problem areas

Nutrition Assessment: Critical Thinking

Observe

Determining appropriate data to collect

Selecting assessment tools

Distinguishing relevant from irrelevant data

Organizing data

Determining when problems require referral


Process Steps


Nutrition Diagnosis



Nutrition Diagnosis

Nutritional problem

Names and describes the problem

Problem may already exist, or may be at risk of occurring

Not a medical diagnosis

Nutrition Dx Domains: Intake

Defined as “actual problems related to intake of energy, nutrients, fluids, bioactive substances through oral diet or nutrition support (enteral or parenteral nutrition)

Class: Calorie energy balance

Class: Oral or nutrition support intake

Class: Fluid intake balance

Class: Bioactive substances balance

Class: Nutrient balance

Nutrition Dx Domains: Clinical

Defined as “nutritional findings/problems identified that relate to medical or physical conditions

Class: functional balance

Class: Biochemical balance

Class: weight balance

Nutrition Dx Domains:

Behavioral-Environmental

Defined as “nutritional findings/problems identified that

relate to knowledge, attitudes/beliefs, physical

environment, or access to food and food safety

Class: knowledge and beliefs

Class: physical activity, balance and function

Class: food safety and access

Nutrition Diagnosis Components

Problem

Etiology

Signs/Symptoms

Signs

Symptoms


Problem

Describes alterations in pt’s nutritional status

Diagnostic labels

Impaired

Altered

Inadequate/excessive

Inappropriate

Swallowing difficulty


Etiology

Related factors that contribute to problem

Identifies cause of the problem

Helps determine whether nutrition intervention will

improve problem

Linked to problem


Etiology

Excessive calorie intake related to regular consumption of

large portions of high-fat meals

Swallowing difficulty related to stroke


Signs/Symptoms

Evidence

Linked to etiology


Etiology

Excessive calorie intake “related to” regular consumption

of large portions of high-fat meals as evidenced by diet

history and weight status

Swallowing difficulty related to stroke as evidenced by

coughing following drinking of thin liquids

Nutrition Diagnosis

Excessive calorie intake

“related to” regular consumption of large portions of high-

fat meals

“as evidenced by” diet history & 12 lb wt gain over last 18

mo


Food, nutrition and nutrition-related

knowledge deficit R/T lack of education on

infant feeding practices as evidenced by infant

receiving bedtime juice in a bottle

Altered GI function R/T ileal resection as

evidenced by medical history and dumping

syndrome symptoms after meals


Nutrition Diagnosis Statement should be:

clear, concise

specific

related to one problem

accurate

based on reliable, accurate assessment data

Nutritional vs Medical Dx

Medical Diagnosis Nutritional Diagnosis

Diabetes

Trauma and closed

head injury

Liver failure

Nutritional vs Medical Dx

Medical Dx Nutritional Diagnosis

Obesity

Dependence mechanical

ventilation

Anorexia nervosa


Process Steps


Nutrition Diagnosis



Nutrition Intervention Definition

“Purposely-planned actions designed with the intent of changing a nutrition-related behavior, risk factor, environmental condition, or aspect of health status for an individual, a target group, or population at large.” –

Lacey and Pritchett, JADA 2003;103:1061-1072

Directed at the etiology or effects of a diagnosis

Intervention Objectives

Should be patient-centered

Must be achievable

Stated in behavioral terms

Pt and counselor must establish goals together

What will the patient do or achieve if objectives met


Problem 1: Involuntary weight loss

Objectives:

1.

2.


Problem 2: Inadequate protein-energy intake 2° poor appetite

Objectives:

1.

2.


Intervention translates assessment data

into strategies, activities, or

interventions that will enable the

patient or client to meet the

established objectives.

Interventions should be specific


Problem 1: Involuntary Weight loss

Intervention:

1.

2.

3.

4.


Problem 2: Inadequate protein-calorie intake 2° poor appetite

Intervention:

1.

2.

3.


Process Steps


Nutrition Diagnosis



Nutrition Monitoring & Evaluation

Components

Evaluate outcomes

Compare current findings

with previous status,

intervention goals, and/or

reference standards

What gets Measured?

Nutrition

Monitoring

and Evaluation

Types of Outcomes

End-result outcome

•Direct nutrition outcomes

•Clinical and health status outcomes

•Patient/client-centered outcomes

•Healthcare utilization

Intermediate-result outcome

Nutrition Goals and Objectives

Are necessary in order to evaluate

Should be achievable

Should be directly or indirectly related to nutrition care

NCP Example: Acute Care


Medical hx: 72 y.o. female admitted with decompensated CHF; heart failure team consulted; has been admitted with same dx x 2 in past month; meds: Lasix and Toprol; current diet order: 2 gram sodium; has lost 5 pounds in 24 hours since admission; Output > input by 2 liters

Nutrition history: has been told to weigh self daily but has no scale at home. Does not add salt to foods at the table. Noticed swollen face and extremities on day prior to admission. Day before admission ate canned soup for lunch and 3 slices of pizza for dinner; does not restrict fluids; has never received nutrition counseling

NCP Example: Acute CareNutrition Diagnosis

1.

2.

3.

4.



1.

2.

3.

4.


Monitoring and Evaluation

1.

2.

3.

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