Steps of NCP
⚫ A – Nutrition Assessment
Nutrition Care Process (NCP)
Step 1: Nutrition Assessment
⚫ Screening and referral are typical entrance points into
the NCP
⚫ Assessment leads to determination that a nutrition
diagnosis/problem exists; it is possible that a nutrition
problem does not exist
Example: LTC resident on tube feeding; weight wnl and
stable, Albumin wnl, labs wnl, good skin integrity and
hydration status, feeding continues at recommended rate.
Nutrition Assessment, Monitoring and
Evaluation Comparative Standards
⚫ Estimated Energy Needs (formula)
⚫ Estimated Fat, Protein, and CHO needs
⚫ Estimated Fiber Needs (AI)
⚫ Estimated Fluid Needs (AI)
⚫ Estimated Vitamin and Mineral Needs (RDA…)
⚫ Recommended Body Weight /BMI/Growth (peds)
⚫ D – Nutrition Diagnosis
Problem, Etiology, Signs and Symptoms
⚫ I – Nutrition Intervention
⚫ M – Nutrition Monitoring
⚫ E – Evaluation
Through nutrition reassessment, dietetics practitioners
perform nutrition monitoring and evaluation to
determine if the nutrition intervention strategy is
working to resolve the nutrition diagnosis, its etiology,
and/or signs and symptoms
Nutrition Assessment Domains
⚫ Food/Nutrition-Related History: FH (diet hx, energy
intake, food and beverage intake, enteral and parenteral
intake, bioactive substance intake,
macronutrient/micronutrient intake, medication/supplement
use, knowledge/beliefs/attitudes/behavior, etc)
⚫ Anthropometric Measurements: AD
⚫ Biochemical Data, Medical Tests and Procedures: BD
⚫ Nutrition Focused Physical Findings: PD (appetite, edema,
taste alterations, swallowing difficulty, etc)
⚫ Client History: CH (personal hx, PMH, social hx)
Example: Food Intake
Indications: amount of food, types of food/meals; meal/snack
patterns, diet quality, food variety
Measurement methods: food intake records, 24-hour recall,
food frequency, MyPyramid Tracker
⚫ Typically used to monitor and evaluate change in the following
nutrition dx: excessive or inadequate oral food/bev intake,
underweight, overweight/obesity, limited access to food
⚫ Evaluation – comparison to goal or reference standard
⚫ 1) Goal: Pt currently eats ~10% of kcal from saturated fat Goal ↓
to <7% of daily kcal
⚫ 2) Reference standard: Pt’s current intake of fat not meeting
AHA criteria to consume <7% of kcal from sat. fat
 ??!
NCLEX Question

A 68-year-old client in the hospital with a chronic

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illness is 25% overweight. This client refuses to eat
vegetables and continues to ask for food to be
delivered from the local pizza restaurant. Which of
the following might this client be experiencing?

a. Protein-calorie malnutrition
b. Undernutrition
c. Overnutrition

??!
d. Both over and undernutrition

NCLEX Question
An obese client with an alteration in nutritional
status is being seen in the clinic for poor wound

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healing. To gain a more comprehensive picture of
this client's nutritional status, which of the
following tools can the nurse ask the client to
complete?

a. Food frequency questionnaire

b. Seven-day day food log
c. CAGE assessment

??!
d. Three- day diet recall

a. Food frequency questionnaire

Rationale: A food frequency questionnaire assesses intake

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of a variety of food groups on a daily, weekly, or longer
basis
What is the CAGE Assessment?
The CAGE questionnaire is a 4-question screening tool that
clinicians may use to help in the diagnosis of alcoholism.
CAGE is an acronym for the focus of the questions.
⚫ C – Cutting Down
⚫ A – Annoyance by Criticism
⚫ G – Guilty Feeling
⚫ E – Eye-openers

NCLEX Question
A client comes into the clinic for a routine
examination. The nurse measures this client's weight at
231 pounds. Previously this client weighed 247
pounds. Which of the following can the nurse
accurately document about this assessment finding?
a. Nothing.
b. The client has lost 6.9 percent of his weight.
??!
c. The client has a health condition causing weight
loss.
d. The client has lost 6.5 percent of his weight
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Step 2: Nutrition Diagnosis
1. Problem (Diagnostic Label) such as, Excessive oral
food/beverage intake (NI-2.2)
2. Etiology (Cause/Contributing Factor) such as,
related to lack of food planning, purchasing, and
preparation skills
3. Signs/Symptoms defining characteristics) such as,
as evidenced by BMI of 32, intake of high
caloric-density foods/beverages at meals and snacks.
⚫ 247-231= 16 pounds
⚫ 16punds/247= 0.0647777 or 0.065
⚫ 0.065x 100= 6.5%
⚫ Unhealthy Weight Loss
⚫ Doctors recommend a weight loss rate of 1 – 2 pounds or
0.45kg – 0.9kg per week. Losing more than that per week
typically ranks as unhealthy weight loss.
NCLEX Question
The nurse calculates a client's body mass index as
being 25.2. According to the Classification of Body
Mass Index in Adults, which of the following can the
nurse accurately document about this finding?
a. This client is overweight.
b. This client is mildly malnourished.
c. This client is of normal weight.
d. This client is obese.
Nutrition Diagnosis - Domains
⚫ Intake (NI) – actual problems related to intake of
energy, nutrients, fluids, bioactive substances through
oral diet or nutrition support
⚫ Clinical (NC) – Nutritional finding/problems
identified that relate to medical or physical conditions
⚫ Behavioral – Environmental (NB) – Nutritional
findings/problems identified that related to knowledge,
attitudes/beliefs, physical environment, access to food,
or food safety
 Nutrition Dx: Problem, Etiology, Signs and
Symptoms
⚫ Inadequate energy intake
(NI-2.1) related to
decreased ability to consume
sufficient energy due to
ESRD and dialysis as
evidenced by significant ⚫ Self-feeding difficulty
weight loss of 5% in past
month, and lack of interest
in food
⚫ Involuntary weight gain
(NC-3.4) related to
antipsychotic
medication as evidenced
by increase weight of
11% in 6 months.
(NB-2.6) related to
impaired cognitive
ability as evidenced by
weight loss of 6% in last
month and dropping
cups and food from
utensil.
Step 3: Nutrition Intervention
⚫ Involves planning and implementation
Planning
Prioritizing the nutrition diagnoses, setting goals and
defining the intervention strategy and
Detailing the nutrition prescription (states pt/client’s
recommended dietary intake of energy, nutrients, etc)
Using the ADA’s evidence-based practice guidelines
Setting goals that are measurable, achievable and
time-defined
Implementation – carrying out and
communicating the plan of care

Nutrition Intervention – 4 categories

Food and/or Nutrient
Delivery
⚫ Individualized approach
for food/nutrient provision
such as meals, snacks,
supplements
Nutrition Education
⚫ Instruct a pt/client in a
skill or to impart
knowledge to help them
manage or modify food
choices and eating
behavior to maintain or
improve health
Nutrition Intervention
Nutrition Counseling
⚫ Direct the nutrition intervention at the etiology of the
⚫ Collaborative problem or at the signs and symptoms if the etiology
counselor-patient cannot be changed by the dietetics practitioner.
relationship, to set
priorities, establish goals Assessment Diagnosis Intervention Monitoring & Eval
and create action plans for
self-care to treat
Coordination an
of Nutrition
existing condition and Problem Etiology Signs & Symptoms
Care
promote health ⚫ Nutrition interventions are intended to eliminate or
diminish the nutrition diagnosis, or to reduce signs and
⚫ Referral to or coordination symptoms of the nutrition diagnosis.
of nutrition care with other
health care providers,
agencies etc. to assist in
managing nutrition related
problems

Step 4: Monitoring and Evaluation Monitoring and Evaluation

Food/Nutrition –Related Biochemical Data, Medical
Hx Outcomes
⚫ Determine the amount of progress made and whether Tests & Procedure Outcomes
goals/expected outcomes are being met ⚫ Food and nutrient
⚫ Lab data and tests
intake, supplement
intake, physical activity,
Follow-up monitoring of the signs and symptoms is food availability, etc.
used to determine the impact of the nutrition
intervention on the etiology /signs and symptoms of Nutrition-Focused Physical Anthropometric
the problem. Finding Outcomes Measurement Outcomes
⚫ Physical appearance, ⚫ Height, weight, BMI,
swallow function, growth pattern, weight
appetite hx
Nutrition Care Process (NCP)

Prepared by Sandy Sarcona, MS,

RD