NUTRITION CARE

PROCESS
DIAGNOSIS, INTERVENTION, MONITORING AND EVALUATION
 Nutrition Nutrition
Assessment Diagnosis Nutrition
Care
Nutrition
Process
Nutrition
Intervention
Monitoring
and
Steps
Evaluation
 Nutrition Assessment

Nutrition Nutrition Diagnosis

Care
Process Nutrition Intervention
Steps
Nutrition Monitoring and
Evaluation
◦ Nutritional problem that the dietitian is
responsible for treating
◦ Names and describes the problem
◦ Problem may already exist, or may be
at risk of occurring Nutrition
◦ Not a medical diagnosis Diagnosis
◦ Type 2 diabetes = medical diagnosis
◦ Excessive carbohydrate intake
resulting in elevated blood glucose
levels = nutrition diagnosis.
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 Nutrition Dx
◦ Class: Oral or nutrition support intake Domains:
◦ Class: Fluid intake balance
Intake
◦ Class: Bioactive substances balance
◦ Class: Nutrient balance
 Defined as “nutritional findings/problems
identified that relate to medical or physical
conditions

Class: functional balance (change in physical

or mechanical functioning with nutritional
Nutrition Dx consequences)

Domains: Class: Biochemical balance: change in

capacity to metabolize nutrients as a result of
Clinical medications, surgery, or as indicated by altered
lab values

Class: weight balance: chronic weight or

changed weight status when compared with
usual or desired body weight
 Nutrition Dx Domains:
Behavioral-Environmental

Defined as “nutritional
findings/problems identified
that relate to knowledge,
attitudes/beliefs, physical
encironment, or access to
food and food safety
Class: physical
Class: knowledge and Class: food safety and
activity, balance and
beliefs access
function
 Problem (Diagnostic Label)

Etiology (Cause/contributing risk factors)

Nutrition
Signs/Symptoms (Defining characteristics)

Diagnosis •Signs = objective data = observable, measurable

changes

Components •Symptoms = subjective data = changes pt feels and

expresses
◦ Problem (Diagnostic Label)
◦ Describes alterations in patient’s

Nutrition
nutritional status
◦ Diagnostic labels

Diagnosis
◦ Impaired (nutrient utilization…)
◦ Altered (GI function…)
◦ Inadequate/excessive (calorie intake…)
◦ Inappropriate (intake of types of
Components
carbohydrate)
◦ Swallowing difficulty
◦ Etiology (Cause/Contributing Factors)
◦ Related factors that contribute to
problem
◦ Identifies cause of the problem
◦ Helps determine whether nutrition
Nutrition
intervention will improve problem
◦ Linked to problem by words “related
Diagnosis
to” (RT) Components
◦ Note: etiology may not always be
clear
◦ Etiology (Cause/Contributing Factors)
◦ Excessive calorie intake (problem)
related to regular consumption of
Nutrition
large portions of high-fat meals
(etiology)
Diagnosis
◦ Swallowing difficulty (problem)
related to stroke (etiology)
Components
 Nutrition
◦ Signs/Symptoms (Defining
characteristics)
◦ Evidence that problem exists Diagnosis
◦ Linked to etiology by words
“as evidenced by” Components
◦ Etiology (Cause/Contributing Factors)
◦ Excessive calorie intake (problem)
“related to” regular consumption of
large portions of high-fat meals
(etiology) as evidenced by diet
Nutrition
history and weight status Diagnosis
◦ Swallowing difficulty (problem)
related to stroke (etiology) as
Components
evidenced by coughing following
drinking of thin liquids (signs and
symptoms)
Nutrition Diagnosis
◦ Excessive calorie intake (P)
◦ “related to” regular consumption of large portions of high-
fat meals (E)
◦ “as evidenced by” diet history & 12 lb wt gain over last 18
mo (S & S)
◦ Food, nutrition and nutrition-related
knowledge deficit (P) R/T lack of education
on infant feeding practices (E) as evidenced
by infant receiving bedtime juice in a bottle
Nutrition
(S)
Diagnosis
Altered GI function (P) R/T ileal resection (E)
Components
◦
as evidenced by medical history and
dumping syndrome symptoms after meals
(S)
Nutrition Diagnosis Components

Nutrition
Diagnosis
clear, concise specific
Statement should
be:

based on
accurate –
related to one reliable,
related to one
problem accurate
etiology
assessment data
Nutritional vs Medical Dx
Medical Diagnosis Nutritional Diagnosis

Diabetes Excessive CHO intake r/t visits to Coldstone

Creamery as evidenced by diet hx and high hs
blood glucose

Trauma and closed Increased energy needs r/t multiple trauma as

head injury evidenced by results of indirect calorimetry

Liver failure Altered gastrointestinal function r/t cirrhosis of the

liver as evidenced by steatorrhea and growth
failure
Nutrition Care Process Steps
◦ Nutrition Assessment
◦ Nutrition Diagnosis
◦ Nutrition Intervention
◦ Nutrition Monitoring and Evaluation
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
Should be patient-centered
◦ Must be achievable
◦ Stated in behavioral terms, quantifiable

◦
terms
Pt and counselor must establish goals
Intervention
together
◦ may involve other members of
Objectives
health care team
◦ What will the patient do or achieve if
objectives met
◦ Problem 1: Involuntary weight loss
◦ Objectives:
◦ 1. Pt will stop losing wt and
begin to gain wt slowly, to a target Intervention
wt of 145#
◦ 2. Pt will modify his diet to
Objectives
increase intake to meet calorie and
protein needs
Nutrition Intervention
◦ 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:
—What? —When?
—Where? —How?
Nutrition Intervention
◦ Problem 1: Involuntary Weight loss
◦ Intervention:
◦ Pt will try to eat three meals a day plus bedtime snack
◦ Pt will include at least one nutrient-dense supplement per day in his diet
◦ Pt will increase energy intake to 1800 kcal per day, complete 3-day food
record for analysis of adequacy
Nutrition Care Process Steps
◦ Nutrition Assessment
◦ Nutrition Diagnosis
◦ Nutrition Intervention
◦ Nutrition Monitoring and Evaluation
Nutrition Monitoring & Evaluation
Components
Evaluate outcomes
Compare current findings with previous status,
intervention goals, and/or reference standards
Nutrition Goals and Objectives
◦ Are necessary in order to evaluate the effectiveness of
nutrition care
◦ Should be achievable and based on scientific evidence
◦ Should be directly or indirectly related to nutrition care
NCP Example: Acute
Care
Nutrition Assessment
◦ 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
Nutrition Diagnosis
◦ Excessive sodium intake r/t frequent use of
canned soups and restaurant foods as
evidenced by diet history
◦ Knowledge deficit r/t no previous nutrition
education as evidenced by frequent use of NCP Example:
high sodium convenience foods and inability
to name high sodium foods Acute Care
◦ Excess fluid intake r/t dietary indiscretions as
evidenced by diet hx and current fluid status
◦ Self-monitoring deficit r/t lack of access to
scale as evidenced by patient self report
NCP Example: Acute
Care
Nutrition Intervention
◦ Excessive sodium intake: Patient will attend Senior Feeding
site that provides low sodium meals; Patient will implement
survival skills low sodium diet principles and attend heart
failure diet program in heart failure clinic
◦ Self-monitoring deficit: Patient will obtain free home scale
from CHF case manager; will limit fluids to 2 liters/day per
instructions in Heart Failure Clinic if adherence to low sodium
diet does not achieve appropriate fluid balance
NCP Example: Acute
Care
Monitoring and Evaluation
◦ Patient will weigh self daily and keep log; report to heart
failure case manager if weight ↑ 2 lb in 24 hours
◦ Patient will bring 3 day diet record to heart failure clinic for
review by dietitian
◦ Heart failure case manager will track hospital readmissions
over 12 months
THANK YOU!!