NUR 102: Nutrition and Diet Therapy-

(Laboratory)
STUDENT ACTIVITY SHEET BS NURSING / SECOND YEAR
Session # 2

LESSON TITLE: NUTRITION CARE PLAN MAKING Materials:

Book, pen, notebook, and
LEARNING OUTCOMES: PowerPoint presentation
Upon completion of this lesson, the nursing student can:
References:
1. Discuss the four steps of Nutrition Care Process; Laboratory Manual for Allied Health: Maria
2. Identify the purpose of the four steps of Nutrition Care Lourdes Cruz-Caudal (2019) Basic Nutrition and
Process; and, Diet Therapy 2nd C&E Publishing, Inc.
3. Apply the proper assessment and collection of patient’s
data. https://www.ncpro.org/nutrition-care-process
4. Use Nutrition Care Process to providing high quality https://www.andeal.org/ncp
nutrition care.

LESSON PREVIEW/ REVIEW (10 minutes)

Let the students answer the following Metric conversions word problems:
1. 8 tbs. = _____cup 8. Tomas has two boxes to be shipped. One box weighs
2. 350°F = _____ °C 3 kg. The other box weighs 720 g. What is the combined
3. 12 ounces = _____ g weight of both boxes in grams?
4. 4 quarts = _____ gallon Answer: _____________
5. 1 pint = _____ fluid oz. 9. Tony made 14 L of lemonade for a party. His guests
6. Dakota has 4/10 kg of clay. He divides the clay to drank 9500 mL of the lemonade. How many milliliters of
make 8 equal-sized pots. How many grams of clay are in lemonade did Tony have left over?
each pot? Answer: _____________
Answer: _____________ 10. Noah made 12 kg of trail mix for his family's hiking
7. A birdbath contains ½ liter of water. A rainy day adds trip. His family ate 8,600 g of the trail mix on the hiking
a 215 ml more water to the birdbath. How many total trip. How many grams of trail mix did Noah have left?
milliliters of water are in the birdbath after it rained? Answer: ___________
Answer: _____________

MAIN LESSON (40 minutes)

The Nutrition Care Process (NCP)

❖ Nutrition Care Process (NCP) is a systematic approach to providing high quality nutrition care. The NCP
consists of four distinct, interrelated steps:
∙ Nutrition Assessment: The RDN collects and documents information such as food or nutrition-related
history; biochemical data, medical tests and procedures; anthropometric measurements,
nutrition-focused physical findings and client history.
∙ Nutrition Diagnosis: Data collected during the nutrition assessment guides the RDN in selection of the
appropriate nutrition diagnosis (i.e., naming the specific problem).
∙ Nutrition Intervention: The RDN then selects the nutrition intervention that will be directed to the root
cause (or etiology) of the nutrition problem and aimed at alleviating the signs and symptoms of the
diagnosis.

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 ∙ Nutrition Monitoring/Evaluation: The final step of the process is monitoring and evaluation, which the
RDN uses to determine if the client has achieved, or is making progress toward, the planned goals.

✔ Using the NCP does not mean that all clients get the same care.
✔ Use of a care process provides a framework for the RDN to individualize care, taking into account the
client’s needs and values and using the best evidence available to make decisions.
✔ Other disciplines in healthcare, including nursing, physical therapy and occupational therapy have adopted care
processes specific to their discipline.
✔ In 2003, the Academy's House of Delegates adopted the NCP to provide RDNs with a framework for critical
thinking and decision-making — leading to more efficient and effective care and greater recognition of the role
of RDNs in all care settings.

At first the Nutrition Care Process may seem like a linear approach; however, during the course of an interaction/
appointment with a client, the RDN will often complete the assessment and diagnosis steps, and may begin a
Nutrition Intervention when a client reveals another piece of new assessment data/information that will cause the
RDN to re assess, and re-diagnose and perhaps modify the plan that he/she had started discussing with the client.
Therefore, the Nutrition Care Process is represented as a circle in the Nutrition Care Model.

What is the Nutrition Care Process and Model?

❖ The Nutrition Care Process is a standardized model intended to guide RDNs in providing high quality nutrition
care.

NCP Step 1: Nutrition Assessment

❖ Purpose:
o Nutrition Assessment is a systematic approach to collect, classify, and synthesize important and relevant
data needed to identify nutrition-related problems and their causes.
o This step also includes reassessment for comparing and re-evaluating data from the previous interaction
to the next and collection of new data that may lead to new or revised nutrition diagnoses based on the
client’s status or situation It is an ongoing, dynamic process that involves initial data collection and
continual reassessment and analysis of the client’s* status compared to accepted standards,
recommendations, and/or goals.
o This contrasts with nutrition monitoring and evaluation where nutrition and dietetics practitioners use the
same data to determine changes in client behavior, nutritional status, and the efficacy of nutrition
intervention.
❖ Finding Nutrition Assessment Data:
o For individuals, data can come directly from the patient/client through interview, observation and
measurements, a health record, and the referring health care provider.
o For population groups, data from surveys, administrative data sets, and epidemiological or research
studies are used.

Terminology for nutrition assessment is organized in five domains (categories):

Food/Nutrition-Related>knowledge/beliefs, >body mass index electrolytes, glucose) >muscle and fat
History >food and supplies (BMI), and tests (e.g., wasting,
availability, >physical >growth pattern gastric emptying time, >swallow function,
>Food and nutrient activity, indices/percentile resting appetite, and affect
intake, >food and >nutrition quality of life ranks, and metabolic rate) Client History
nutrient Anthropometric >weight history Nutrition-Focused
administration, Measurements Biochemical Data, Physical Findings
>medication, Medical Tests, and >Personal history,
>complementary/alterna >Height, Procedures >Physical >medical/health/family
ti ve medicine use, >weight, >Lab data (e.g., appearance, history, treatments and

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>complementary/altern ative medicine use, and >social history

Use of Nutrition Assessment Data:

Nutrition assessment data, or indicators, are compared to reference standards, recommendations, or goals. These norms
and standards may be national, institutional, or regulatory. Nutrition assessment findings are then communicated in
nutrition diagnosis (problem) statements and nutrition intervention goal setting.

Critical thinking skills:

•Determining important and relevant data to collect
•Determining the need for additional information
•Selecting assessment tools and procedures that match the situation
•Applying assessment tools in valid and reliable ways
•Validating the data

NCP Step 2: Nutrition Diagnosis

Purpose:
o Nutrition Diagnosis is a nutrition and dietetics practitioner’s identification and labeling of an existing nutrition
problem(s) that the practitioner is responsible for treating.
o Nutrition diagnoses (e.g., inconsistent carbohydrate intake) are different from medical diagnoses (eg, diabetes).

Determining a Nutrition Diagnosis:

Nutrition and dietetics practitioners use standard nutrition diagnostic terminology to label the client’s nutrition diagnosis(es)
through organized nutrition assessment data that are clustered for comparison with defining characteristics list on the
reference sheets. The eNCPT provides a reference sheet for each nutrition diagnosis that includes its definition, possible
etiology/causes, and common signs or symptoms identified in the Nutrition Assessment step.

Terminology for Nutrition Diagnosis is organized in three domains (categories):

(P) Problem or Nutrition Diagnosis Data or indicators used to determine
Factors Linked to the nutrition the client's nutrition diagnosis.
Term Describes alterations in the diagnosis term by the words “related
client’s nutritional status. to.” Linked to the etiology by the words
(E) Etiologic Cause/Contributing Risk (S) Signs/Symptoms “as evidenced by.”
No nutrition diagnosis at this time (NO-1.1) may be documented if the assessment indicates that no nutrition problem
exists to justify a nutrition intervention.

Guidelines for Writing a Clear PES Statement:

When writing the PES statement, nutrition and dietetics practitioners can ask a series of questions that help clarify the
nutrition diagnosis(es).

Critical thinking skills:

P – Can the nutrition and dietetics practitioner resolve or improve the client's nutrition diagnosis? When all things are
equal and there is a choice between stating a PES statement using two nutrition diagnoses from different domains,
consider the Intake nutrition diagnosis as the one more specific to the role of the RD/RDN.
E – Evaluate whether the etiology for each problem is the specific “root cause” that can be addressed with a nutrition
intervention. If addressing the etiology cannot resolve the problem, can the RD/RDN intervention at least lessen the signs
and symptoms?

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 S – Will measuring the signs and symptoms indicate if the problem is resolved or improved? Are the signs and symptoms
specific enough to monitor (measure/evaluate changes) and communicate resolution or improvement of a nutrition
diagnosis?
PES Overall – Do the nutrition assessment data support the nutrition diagnosis, etiology, and signs and symptoms?

Critical Thinking Skills

•Finding patterns and relationships among the data and possible causes
•Making inferences•Stating each problem clearly and singularly
•Ruling in or ruling out specific diagnoses
•Identifying an etiology for each problem that may be resolved, lessened, or managed by the intervention(s)
•Identifying signs and symptoms that are measurable or their change may be tracked
•Prioritizing identified problems

NCP Step 3: Nutrition Intervention

Definition:
A nutrition intervention is a purposely planned action(s) designed with the intent of changing a:
o nutrition-related behaviour, o risk factor, o aspect of health status to resolve or o improve the
o environmental condition, or identified nutrition diagnosis(es) or o nutrition problem(s).
Nutrition interventions are selected and tailored to the client needs by planning and implementing appropriate
interventions.

Determining a nutrition intervention:

The nutrition diagnosis and its etiology drive the selection of a nutrition intervention. The nutrition intervention is typically
directed toward resolving the nutrition diagnosis(es) by altering or eliminating the nutrition etiology(ies). Less often, it is
directed at relieving the signs and symptoms of the nutrition problem or problems. Nutrition intervention goals, ideally,
developed collaboratively with the client, provide the basis for monitoring progress and measuring outcomes.

Terminology for Nutrition Intervention is organized in five domains (categories):

Food and/or Nutrition Education Nutrition Care
Nutrient Delivery Counselling Coordination of Nutrition Population Based Nutrition Action
Customized approach nutrition, and relationship, to establish promote health nutrition related
for food/nutrient physical activity food, nutrition and Consultation with, problems
provision choices and physical activity referral to, or Interventions
Instruct or train a client behavior to maintain or priorities, goals, and coordination of designed to improve
in a skill or to impart improve health action plans that nutrition care with other the nutritional well being
knowledge to help A supportive process, acknowledge and foster health care providers, of a population.
clients characterized by a responsibility for institutions, or agencies
voluntarily manage or collaborative self-care to treat an that can assist in
modify food, counselor-client existing condition and treating or managing

Use of Nutrition Intervention Terminology:

Nutrition intervention is accomplished in two distinct and interrelated steps: planning and implementing.

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 Planning the nutrition intervention involves:
•Prioritizing nutrition interventions based on urgency, impact, and available resources
•Collaborating with the client to identify goals of the intervention for each diagnosis
•Writing a nutrition prescription based on a client’s customized recommended dietary intake of energy and/or selected
food or nutrients based on current reference standards and dietary guidelines and a client’s health condition and nutrition
diagnosis
•Selecting specific nutrition intervention strategies that are focused on the etiology of the problem and that are known to
be effective based on best current knowledge and evidence
•Defining the time and frequency of care, including intensity, duration, and follow-up.

Implementation is the action phase and involves:

•Collaborating with the client to carry out the plan of care
•Communicating the nutrition care plan
•Modifying the plan of care as needed
•Following up and verifying that the plan is being implemented
•Revising strategies based on changes in condition or response to intervention

Critical thinking skills:

• Setting goals and prioritizing
• Defining the nutrition prescription or basic plan
• Making interdisciplinary connections
• Initiating behavioral and other nutrition interventions
• Matching nutrition intervention strategies with client needs, nutrition diagnosis(es), and values •
Choosing from among alternatives to determine a course of action
• Specifying the time and frequency of care

NCP Step 4: Nutrition Monitoring and Evaluation

Definition:
The purpose of nutrition monitoring and evaluation is to
o determine and measure the amount of progress made for the nutrition intervention and
o whether the nutrition related goals/expected outcomes are being met.
o The aim is to promote more uniformity within the dietetics profession in assessing the effectiveness of nutrition
intervention.
o Nutrition Monitoring and Evaluation identifies outcomes/indicators relevant to the diagnosis and nutrition
intervention plans and goals.
During the first interaction, appropriate outcomes/indicators are selected to be monitored and evaluated at the next
interaction. During subsequent interactions, these outcomes/indicators are used to demonstrate the amount of progress
made and whether the goals or expected outcomes are being met. Factors to consider when selecting indicators are the
medical diagnosis, health care outcomes, client goals, nutrition quality management goals, practice setting, client
population, and disease state and/or severity.

Terminology for Nutrition Monitoring and Evaluation is organized in four domains (categories)**:
Food/Nutrition-Related History medicine use, index (BMI), growth pattern glucose) and tests (e.g.,
Outcomes knowledge/beliefs, food and indices/percentile ranks, and gastric emptying time, resting
supplies availability, physical weight history metabolic rate)
Food and nutrient intake, food activity, nutrition quality of life Biochemical Data, Medical Nutrition-Focused Physical
and nutrient administration, Anthropometric Measurement Tests, and Procedure Finding Outcomes
medication, Outcomes Outcomes
complementary/alternative Height, weight, body mass Lab data (e.g., electrolytes, Physical appearance, muscle

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 and fat wasting, swallow function, appetite, and affect.

Collection and Use of Nutrition Monitoring and Evaluation Outcome Data:

This step consists of three components:
✔ monitoring, measuring, and evaluating the changes in nutrition care indicators.
✔ Practitioners monitor by providing evidence that the nutrition intervention is or is not changing the client’s behavior
or status.
✔ They measure outcomes by gathering data for outcomes/indicators.
✔ Finally, nutrition and dietetics practitioners compare the current findings with previous status, nutrition intervention
goals, and/or reference standards and evaluate the overall impact of the nutrition intervention on the client’s
nutrition diagnosis(es) and health outcomes.
✔ The use of standardized indicators and criteria increases the validity and reliability of outcome data collection,
communication, an aggregation of data for reporting outcomes of the nutrition and dietetics practitioner’s
interventions.
Critical thinking skills:
•Using appropriate reference standards for comparison
•Defining where client is in terms of expected outcomes
•Explaining variance from expected outcomes
•Determining factors that help or hinder progress
•Deciding between discharge or continued care

CHECK FOR UNDERSTANDING (10 minutes)

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed.
You are given 15 minutes for this activity:

Multiple Choice
1. The statement from the previous question "Inadequate energy intake related to decreased dietary intake while
receiving radiation to head and neck as evidenced by 15# weight loss during last 2 months due to consumption of
1000 kcal/day less than estimated needs" is known as
a. nutrition diagnosis statement d. PES statement
b. medical diagnosis statement e. a and d
c. b and c
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_______________________________________________________________________________________________

2. The nutrition care process begins

a. when patient/client/group has been identified at nutritional risk
b. when a patient/client/group needs further assistance to achieve or maintain nutrition and health goals
c. when nutrition goals are met
d. A and B
e. A and C

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ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_______________________________________________________________________________________________

3. The nutrition care process ends

a. when patient/client/group has been identified at nutritional risk
b. when a patient/client/group needs further assistance to achieve or maintain nutrition and health goals
c. when nutrition goals are met
d. A and B
e. A and C
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_______________________________________________________________________________________________

4. What is the correct order of the steps in the Nutrition Care Process?
a. Assessment, Intervention, Monitoring and Outcomes Evaluation, Diagnosis
b. Diagnosis, Assessment, Intervention, Monitoring and Outcomes Evaluation
c. Intervention, Assessment, Diagnosis, Monitoring and Outcomes Evaluation
d. Assessment, Diagnosis, Intervention, Monitoring and Outcomes Evaluation
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_______________________________________________________________________________________________

5. You recommend to your client that he lower the amount of sodium in his diet and discuss which foods are sources
of sodium. You and the client then go through his diet, identify the foods that he is consuming that are high in
sodium and generate a list of alternative foods that he is willing to substitute for the high-sodium foods. Which
step of the nutrition care process are you performing?
a. Assessment c. Diagnosis
b. Intervention d. Monitoring and Outcomes Assessment
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_______________________________________________________________________________________________

6. The NCP challenges the dietitian to:

a. learn more terminology c. provide standardized care
b. utilize critical thinking skills d. develop the PES statement
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_______________________________________________________________________________________________

7. ____ is the examination of the body using the sense of touch.

a. ​Percussion c. Palpation
b. Auscultation d. Inspection
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

8. A patient has developed a pressure wound from lying in bed. This information should be documented in which
part of ADIME charting? ​
a. ​Assessment c. Diagnosis

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 b. ​Intervention d. Monitoring e. Evaluation
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

9. The "I" in ADIME charting stands for: ​

a. ​ideal. c. ​impaired.
b. identification. d. intervention e. interaction
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_______________________________________________________________________________________________

10. Which describes a function of the patient's medical chart? ​

a. Communicating information between medical professionals and the public
b. Evaluating medical care for the client's family
c. Upholding the Joint Commission's standards
d. Keeping a record of what has been done for the patient
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided. This will be done for 15 minutes.
1. ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________
2. ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________
3. ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________
4. ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________
5. ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________
6. ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________
7. ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________
8. ANSWER: ________

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RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________
9. ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________
10. ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________

LESSON WRAP-UP (15 minutes)

Teacher directs the student to mark (encircle) their place in the work tracker which is simply a visual to help students track
how much work they have accomplished and how much work there is left to do. This tracker will be part of the student
activity sheet.

You are done with the session! Let’s track your progress.

AL Activity: Case Study

Create 5 groups in the class with 5 members. Case study will be provided and to be solved by each group by doing a
simple NCP. Each group will present their answers after 10 minutes of preparation.

Impaired Renal Function Case Study

Anthropometrics: Biochemical Data:

Age: 24 yrs. old Glucose: 205
Ht.: 5 ft. 0 in. -- 60 in. -- 152.4 cm -- 2.32 m2 BUN: 80
Wt.: 140 lbs. -- 63.6 kg Cholesterol: 443
Gender: Female TG: 300
BMI: 27.4 (overweight) HbA1C: 8.2 H
GFR: 28 ml/min

Impaired Renal Function Case Study: Dietary Intake Assessment

Breakfast: PM Snack:
-Fried egg -25 potato chips
-Fried bacon -1 can Coke
-Fried potatoes
-Toast w/ butter Dinner:
Lunch: -3 tacos made w/ ground beef, onion, tomatoes, lettuce
-2 tamales w/ chili con carne & flour tortillas -Coke
-Fry bread
-1 can Coke HS Snack: -Peanut butter & crackers

Q: What recommendations can we suggest for her to improve her dietary choices?
Make a Nutrition Care Process or plan for the patient.

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