Final Corrected HFN 446 Nutrition Care Process Module Vetted by DR R Kamuhu

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Final Corrected HFN 446 Nutrition Care Process module

vetted by Dr R Kamuhu
Food, Dietetics and Nutrition (Kenyatta University)
Studocu is not sponsored or endorsed by any college or university

Downloaded by Lukaku Vincent (vlukaku37@gmail.com)
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KENYATTA UNIVERSITY
DIGITAL SCHOOL OF VIRTUAL AND OPEN LEARNING
IN COLLABORATION WITH
SCHOOL OF PUBLIC HEALTH AND APPLIED HUMAN SCIENCES
DEPARTMENT: FOODS, NUTRITION & DIETETICS,

STRATEGIC PARTNERSHIPS FOR HIGHER EDUCATION
INNOVATION AND REFORM (SPHEIR),
THE ASSOCIATION OF COMMONWEALTH UNIVERSITIES (ACU) &
PARTNERSHIP FOR ENHANCED AND BLENDED LEARNING (PEBL)
HFN 446: NUTRITION CARE PROCESS

WRITTEN BY: Dr. Winfreda Maoga
VETTED BY:PEBL Quality Assurance Team Members

Dr. Regina Kamuhu
Licensed under a Creative Commons Attribution-Non Commercial-Share Alike 4.0 International

License

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INTRODUCTION
Welcome to the nutrition care process module. By the time you are in your fourth year, you have
covered many courses and learnt many aspect of nutrition which you are going to apply while
going through this module. The purpose of this module is to provide guidelines and expose you
the standards of practice for nutrition care. You will learn that the standards of nutrition practice
are represented by the four steps of the nutrition care process; nutrition assessment, nutrition
diagnosis, nutrition intervention and finally nutrition monitoring and evaluation. You will get to
learn that nutrition care process is a problem solving method that nutritionist follow to critically
think and make decisions when providing nutritional therapy or when addressing any nutrition
related problem so as to provide effective and high quality nutrition care.
In this module you will be introduced to the terminologies of nutrition care process, and then
you will learn on the nutrition care process model. You will further learn the specific steps of the
nutrition care process and this is quite interesting as it will enable you to apply your critical
thinking skills in decision making at every step. This will also enable you to understand and
appreciate the interrelationship and the connection of the four steps. Towards the end of the
module you will be conducting case studies at the health care facilities as you apply your learnt
skills in the standard practice of nutrition care. This is quite fulfilling as you get to translate your
knowledge into practice and help to solve client’s nutrition problem.
I hope that you will find this module relevant, appropriate and educative as you finalize you
nutrition course. I also hope that your mind will be stimulated so that you can critically think and
make appropriate decisions when solving nutrition related problems of individuals and specific
groups.

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HFN 446: NUTRITION CARE PROCESS

WEEK TOPIC
WEEK 1: DEFINITIONS AND CONCEPTS IN NUTRITION CARE PROCESS
WEEK 2: NUTRITION CARE PROCESS MODEL
WEEK 3: STEPS OF NUTRITION CARE PROCESS
WEEK 4: NUTRITION ASSESSMENT-STEP 1
WEEK 5: NUTRITION DIGNOSIS-STEP 2
WEEK 6: NUTRITION INTERVENTION-STEP 3
WEEK 7: NUTRITION MONITORING AND EVALUATION STEP 4
WEEK 8: PRACTICALS WITH CASE STUDIES FROM HEALTH FACILITIES
WEEK 11&13: CASE STUDY PRESENTATIONS
WEEK14: EXAMINATION
OVERVIEW OF THE COURSE
Week 0: Introduction (Your Context, Your Goals)
This lesson is intended to help you acclimatize to blended learning and to create a community of
learners who will motivate each other during the course. You will be required to introduce
yourself to your lecturer and colleagues either physically during a face to face session or even
online before other academic interactions start.
Week 1: Definitions and Concepts in Nutrition Care Process
In this first lesson, we lay the foundation for the entire course by defining the concept of
nutrition care process and other related terms. The purpose of this lesson is to enable you
understand fundamental concepts in nutrition care process.

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Week 2: Nutrition Care process Model

In this lesson, we explore the Nutrition Care Process Model by a graphic visualization of
interrelationship of the four steps of the Nutrition Care Process as well as internal and external
factors that impact application of the NCP.
Week 3: Steps of Nutrition Care Process
In this lesson, we introduce you to a roadmap of the Nutrition Care Process that consists of four
separate yet interconnected steps: The four steps are divided into two components: problem
identification and problem solving. This distinction is important for application purposes.
Week 4: Nutrition Assessment-Step 1
This lesson focuses on Nutrition Assessment, a Systematic process of obtaining and verifying
and interpreting data needed to identify a nutrition related-problem and the causes. It is a
continuous and dynamic process of data collection and analysis of the clients’ status.
Week 5: Nutrition Diagnosis Step 2
In this lesson, you will learn about the Nutrition diagnosis step, which entails the identification
and labeling that describes an actual occurrence, risk of, or potential for developing a nutritional
problem that the nutritionist/dietitian is responsible for treating. It is a critical step in the
Nutrition Care Process as it describes the problem which may already exist or may be at risk of
occurring
Week 6: Nutrition Intervention step 3
In this lesson, we learn about Nutrition Intervention and the two interrelated components:
planning and intervention typically directed toward resolving the nutrition diagnosis or the
nutrition etiology less often, it is directed at relieving signs and symptoms.
Week 7: Nutrition Monitoring and Evaluation step 4
In this lesson, we learn about the nutrition monitoring and evaluation which is used to determine
and measure the amount of progress made for a nutrition intervention and whether the nutrition
related goals/expected outcomes are being met.
Week 8 to Week 12: Practicals with Case Studies from Health Facilities

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These lessons are a culmination of all that you have been learning in previous lessons. The
lessons seek to put your new-found knowledge and skills into practice by exposing you to actual
cases at specific health facilities that require nutrition care. These lessons will therefore require
you to demonstrate what you have learnt by conducting case studies using the entire Nutrition
care process standards of practice.
Week 13&14: Examination
These two weeks bring together the work you have been doing to an end. This course unit will
be examined and will partially contribute to the award of the degree in the programme that you
are undertaking. We acknowledge that different universities across East Africa may have
different Semester dates. It is however anticipated that most Universities will have a minimum of
13 weeks’ semester. We have therefore placed examinations in the last two weeks but
Universities are allowed to go with their schedules. Your university examinations regulations will
apply.
MODULE LEARNING OUTCOMES
By the end of this module, you will be able to:
1. Acquire skills and knowledge necessary for providing nutrition care

2. Apply the Practical standard operating procedures and the steps in nutrition care process;
3. Apply the Nutrition care algorithms and critical thinking in the nutrition care process
4. Design and implement the nutrition care strategies; evaluation of client response and
progress.
COURSE DESCRIPTION
This is a Clinical Nutrition practice oriented course for final year students of Foods Nutrition and
Dietetics programme. The rationale of offering the course is to equip students with knowledge
and skills that can assist them process of application of the principles of nutrition and dietetics in
Nutrition care algorithms, critical thinking, and steps in the nutrition care process. The course
will also expose them to the Practical standard operating procedures in Nutrition Care in health
care settings.
COURSE REQUIREMENTS

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This is a blended learning course that will utilize the flex model. This means that learning
materials and instructions will be given online and the lessons will be self-guided with the
lecturer being available briefly for face to face sessions and support and also on-site (online)
most of the time. Your lecturer will be meeting you face to face to introduce a lesson and put it
into perspective and you will actively participate in your search for knowledge by undertaking
several online activities. This means that some of the instructional hours of the course will be
delivered face to face while other lessons will be taught online through various learner and
lecturer activities. It is important for you to note that one instructional hour is equivalent to two
online hours. Three instructional hours will be needed per week. Out of these, one will be used
for face to face contact with your lecturer (also referred as e-moderator in the online activities)
while the other two instructional hours (translating to four online hours) will be used for online
activities otherwise referred to as e-tivities in the lessons. You are advised to follow the topic
flow-chart given so that you cover at least a lesson every week.
You will be required to participate and interact online with your peers and the e-moderator
who in this case is your lecturer. Guidelines for the online activities (which we shall keep
referring to as e-tivities) will be provided whenever there is an e-tivity. Please note that since
the online e-tivities are part of the learning process, they may be graded at the discretion of
your e-moderator. Such grading will however be communicated in the e-tivity guidelines and
feedback given as soon as possible after the e-tivity. The e-tivities will include but will not be
limited to online assessment quizzes, assignments and discussions. There are also assessment
questions that you can attempt at the end of every lesson to test your understanding of the
lesson. The answers to all the assessment questions are at the end of the module. All the
resource that has been used in this module in form of books are available under the resources
section after the answers to the questions.
ASSESSMENT
It is important to note that the module has embedded certain learner formative assessment
feedback tools that will enable you gauge your own learning progress. The tools include online
collaborative discussions forums that focus on team learning and personal mastery and will
therefore provide you with peer feedback, lecturer assessment and self- reflection. You will also

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be required to do one major assignment/ case study that is meant to assess the application of the
skills and knowledge gained during the course. The case study score in combination with scores
for e-tivities (where graded) will account for 30% of your final examination score with the
remaining 70% coming from a face to face sit-in final written examination that will be guided by
your university examination policy and procedures.
I wish you the very best of experiences in this course.

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TABLE OF CONTENTS
Week 0: Introduction (Your Context, Your Goals) 3

Week 1: Definitions and Concepts in Nutrition Care Process................................................................3
COURSE DESCRIPTION.................................................................................................................................5
LESSON 1: CONCEPTS IN NUTRITION CARE PROCESS.................................................................................11
1.0 Introduction.....................................................................................................................................11
1.1 Lesson Learning Outcomes.............................................................................................................11
1.2.1 E-tivity -concepts of Nutrition Care Process.................................................................................12
1.3 Assessment Questions......................................................................................................................13
1.4 E-Refrences.....................................................................................................................................13
LESSON 2:NUTRITION CARE PROCESS MODEL...........................................................................................14
2.0 Introduction.....................................................................................................................................14
2.1 Learning outcomes..........................................................................................................................14
2.2.1 E-tivity...............................................................................................................................................16
2.3Assessment Questions......................................................................................................................17
2.4 E-References....................................................................................................................................17
LESSON 3STEPS OF NUTRITION CARE PROCESS.........................................................................................18
3.0 Introduction.....................................................................................................................................18
3.1 Learning Outcomes..........................................................................................................................18
E-tivity 3.2.1..........................................................................................................................................20
3.4 E-References....................................................................................................................................21
LESSON 4: NUTRITION ASSESSMENT-STEP 1..............................................................................................22
4.0 Introduction.....................................................................................................................................22
Lesson Learning Outcomes...................................................................................................................22
4.2.1 E-tivity- concepts of Nutrition Assessment...................................................................................26
Assessment Questions...........................................................................................................................27
4.4E-References....................................................................................................................................27

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LESSON 5: NUTRITION DIGNOSIS-STEP 2.....................................................................................28

5.0 Introduction.....................................................................................................................................28
E-tivity5.2.1 ..........................................................................................................................................33
5.4 E-Refrences.....................................................................................................................................33
LESSON 6:NUTRITION INTERVENTION-STEP..............................................................................................35
6.1: Introduction....................................................................................................................................35
6.2: Lesson Learning Outcomes............................................................................................................35
6.2.1 E-tivity-…………………………………………………………………………………………………………………………………….38
E-References.........................................................................................................................................39
LESSON 7:NUTRITION MONITORING AND EVALUATION-STEP...................................................................40
7.1 Introduction.....................................................................................................................................40
7.2.1 E-TIVITY.....................................................................................................................................43
7.3 Assessment Questions.....................................................................................................................43
7.4 E-References....................................................................................................................................43
LESSON 8 to 12:PRACTICALS WITH CASE STUDIES FROM HEALTH FACILITIES............................................45
8.1 NUTRITION CASE STUDY PRESENTATION OUTLINE...........................................................45
II. DISCUSSION OF PATIENT CASE STUDY...................................................................................46
PRESENTATION DIRECTIONS:.........................................................................................................48
ANSWERS TO LESSON ASSESSMENT QUESTIONS.........................................................................................1
Core E-References.....................................................................................................................................55

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LESSON 1
CONCEPTS IN NUTRITION CARE PROCESS
1.0 Introduction
Nutrition care process is a systematic problem-solving method that nutrition and dietetics
professionals use to think critically and make decisions that address practice-related problems. It
is a standardized model intended to guide nutrition and dietetic professionals, in providing high
quality nutrition care. The nutrition care process (NCP) is a systematic method that nutrition and
dietetics practitioners and professionals use to provide nutrition care. The Nutrition Care Process
is a systematic method to providing high-quality nutrition care. The Nutrition Care Process
(NCP) is designed to improve the consistency and quality of individualized care for
patients/clients or groups and the predictability of the patient/client outcomes. It is not intended
to standardize nutrition care for each patient/client, but to establish a standardized process for
providing care. Use of the NCP does not mean that all clients get the same care; the process
provides a framework for the RDN to customize care, taking into account the client's needs and
values and using the best evidence available to make decisions. Other disciplines in healthcare,
including nurses, physical therapists and occupational therapists have adopted care processes
specific to their discipline. There are various terms that will be commonly used in this course and
it is important that you understand them.
1.1 Lesson Learning Outcomes
By the end of this lesson, you will be able
1. To define nutrition care process
2. To state the purpose of nutrition care process
3. To explain the basic concepts in nutrition care process
1.1.1 Purpose of the Nutrition care process:
 Improve the consistency and quality of individualized patient/client care and the
predictability of the patient/client outcomes.
 Provide a standardized language that allows nutrition practice to be more measurable
 Creates a format that enables the process to generate quantitative and qualitative data
that can be analyzed and interpreted; and
 Serves as the structure to validate nutrition care and showing how the nutrition care that
was provided does what it intends to do.
1.2.2 The concepts of Nutrition Care Process
To lay the groundwork and facilitate a clear definition of Nutrition Care Process, key terms were
developed. These definitions provide a frame of reference for the specific components and their
functions.
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Nutrition care process: Is a systematic approach of providing nutrition care based on a

series of set standards
Process: A series of connected steps or actions to achieve an outcome and/or any activity or
set of activities that transforms inputs to outputs.
Process Approach: A the systematic identification and management of activities and the
interactions between activities. A process approach emphasizes the importance of the
following:
1. Understanding and meeting requirements;
2. Determining if the process adds value;
3. Determining process performance and effectiveness; and
4. Using objective measurement for continual improvement of the process
Critical Thinking: An analytical reasoning process in which ideas are developed and
evaluated. It involves conceptualization, rational thinking, creative thinking, consulting and
autonomous thinking. It integrates facts, informed opinions, active listening and
observations. It is also a reasoning process in which ideas are produced and evaluated. It is
defined as “transcending the boundaries of formal education to explore a problem and form
a hypothesis and a defensible conclusion”. The use of critical thinking provides a unique
strength that health care professionals bring to the Nutrition Care Process. Further
characteristics of critical thinking include the ability to do the following:
a. conceptualize;
b. think rationally;
c. think creatively;
d. be inquiring; and
e. think autonomously
Decision Making: A critical process for choosing the best action to meet a desired goal.
Problem Solving: A process of problem identification, solution design, implementation and
evaluation of results. The process includes the following:
a. problem identification;
b. solution formation;
c. implementation; and
d. Evaluation of the results.
Collaboration: A process by which several individuals or groups with shared concerns are
united to address an identified problem or need, leading to the accomplishment of what each
could not do separately.
1.2.1 E-tivity -concepts of Nutrition Care Process

Numbering, sequencing 1.2.1
Title concepts of Nutrition Care Process
Purpose The purpose of this E-tivity is to enable you understand
the concepts of nutrition care process
Brief summary of overall Watch the video in the following link and define the
work concepts of nutrition care process.
https://www.youtube.com/watch?v=yD6UF3ogn_U
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Spark
Individual Task Briefly explain the concepts of nutrition care process

Interaction begins Post your explanations on the concepts of nutrition care
process in discussion forum 1.2.1
E- moderator interventions 1 Ensure that learners are focused on the contents and
context of discussion.
2 Stimulate further learning on high risk factors
3 Provide feedback on the learning progress.
Schedule time This activity should take one hour

Next Nutrition care process model
1.3 Assessment Questions

Which of the following is not the Purpose of the Nutrition care process?
A. Improve the consistency and quality of individualized patient/client care and the
predictability of the patient/client outcomes.
B. Provide a standardized language that allows nutrition practice to be more measurable
C. Creates a format that enables the process to generate quantitative and qualitative data
that can be analyzed and interpreted; and
D. Collecting data
1.4 E-Refrences
1. https://www.elsevier.com/books/krauses-food-and-the-nutrition-care-process/mahan/978-0-
323-34075-5
2. .http://nak.or.ke/wp-content/uploads/2017/12/KENYA-NATIONAL-CLINICAL-NUTRITION-AND-
DIETETICS-REFERENCE-MANUAL.pdf
3. https://scalingupnutrition.org/wp-content/uploads/2013/10/Kenya-National-Nutrition-Action-
Plan-2012-2017-final.pdf
4. . http://nak.or.ke/wp-content/uploads/2017/12/NATIONAL-GUIDELINES-FOR-HEALTHY-DIETS-
AND-PHYSICAL-ACTIVITY-2017-NEW-EDIT.pdf
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LESSON 2
NUTRITION CARE PROCESS MODEL
2.0 Introduction
The Nutrition Care Model is a graphic visualization that illustrates the steps of the Nutrition Care
Process as well as internal and external factors that impact application of the NCP. The central
component of the Model is the relationship of the target client or group and the RDN. One of two
outer rings represents the skills and abilities of the RDN along with application of evidence-
based practice, application of the Code of Ethics, and knowledge of the RDN. The second of two
outer rings represents environmental factors such as healthcare systems, socioeconomics and
practice settings that impact the ability of the target group or client to benefit from RDN services.
Screening and referral and outcomes management are also components of the model.
2.1 Learning outcomes

By the end of this lesson you will be able;
1. To identify the components of the nutrition care process model
2. To explain the interrelations of the components of the nutrition care process model
2.3 Nutrition Care Process Model (NCPM)
The Nutrition Care Process Model (NCPM) describes the NCP by presenting the workflow of
professionals in diverse individual and population care delivery settings. It illustrates the steps of
the Nutrition Care Process as well as internal and external factors that impact application of the
NCP. Implementation of the NCPM has been associated with several advantages, including
 Use of a common frame work for nutrition care and research,

 Promotion of critical thinking,
 More-focused nutrition care documentation,
 Increasedacknowledgement of the value of nutrition care by other health care
professionals,
 Improved application of evidence-based guidelines
The American Dietetic Association (ADA developed a nutrition care process model (Fig1…).
The model shows the steps and systems of the Nutrition Care Process. The model is intended to
depict the relationship with which all of these components overlap, interact, and move in a
dynamic manner to provide the best quality nutrition care possible. Below is a figure showing the
nutrition care process model
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The model consists of four quadrants around the core which represents the four steps of the
nutrition care process. The model describes the context in which the nutritionist/dietitian works
and the environment in which care is delivered and which supports care delivery.
Central to the model is the relationship between the nutritionist/dietitian professionals and the
patient/client/group. This relationship is influenced by characteristics of both the client/group
and the nutritionist/dietitian, along with the nutrition/dietetic knowledge, skills & competencies,
critical thinking, collaboration, communication, evidence based practice and code of ethics the
nutritionist/dietitian possesses and uses to develop this relationship.
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The outer ring, describes the strategic and policy environment in which care is delivered. This
context of practice includes the healthcare system and practice settings, social systems, and
economics, in which the practice of all health professionals is embedded. The 4 quadrants around
the core represent the four steps of the nutrition care process
Potential audiences for the NCPM include practitioners, educators and students, professional
credentialing agencies ,health system accrediting agencies ,health care funding
organizations, payers, and clients. The NCPM is updated approximately every 5 years, which
aligns with other Academy resources such as Evidence-Based Nutrition Practice Guidelines. This
ensures that the NCPM reflects current practice. The current NCPM update highlights three
themes that emerged as a result of the consensus process: use of concise language in the NCPM,
promotion of professionals ’responsibility for outcomes management, and support for people
centered care (PCC).
2.2.1 E-tivity
Title Nutrition Care Process Model(NCPM)
Purpose The purpose of this E-tivity is to enable you identify the
components of the nutrition care process model and
explain the interrelations of the components of the
Brief summary of overall https://images.app.goo.gl/SsUCwyiL1nBnVQ596

work
Spark
Individual Task Describe the interrelations of the components of the

Interaction begins 1. Post your answers in discussion forum 2.2.1

2. Read posted work from 2 colleagues
3. Post one comment on their work and give constructive
criticism
E- moderator interventions 1. Ensure that learners are focused on the contents and
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2. Stimulate further learning on high risk factors

3. Provide feedback on the learning progress
Next Nutrition care process steps
2.3Assessment Questions
Which of the following is not an advantage of Implementation of the NCPM has been associated
with several advantages, including
A. Use of a common frame work for nutrition care and research,

B. Tool for research
C. More-focused nutrition care documentation,
D. Increased acknowledgement of the value of nutrition care by other health care
professionals,
2.4 E-References
323-34075-5
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LESSON 3
STEPS OF NUTRITION CARE PROCESS
3.0 Introduction
The NCP is a roadmap and consists of four separate yet interconnected steps: Nutrition
Assessment and Reassessment, Nutrition Diagnosis, Nutrition Intervention, and Nutrition
Monitoring and Evaluation. The four steps are divided into two components: problem
identification and problem solving. This distinction is important for application purposes.
Problem identification includes Nutrition Assessment and Reassessment (Step 1), and Nutrition
Diagnosis (Step2). Problem solving includes Nutrition Intervention (Step 3), and Nutrition
Monitoring and Evaluation (Step 4).
3.1 Learning Outcomes

By the end of this lesson you will be able to;
1. State and describe the four steps of the nutrition care process
2. Explain the nutrition care process algorithm
3.3Steps of Nutrition Care Process
In the last lesson, you learnt about the nutrition care process model. The 4 quadrants around the
core of the nutrition care process model represent the four steps of the nutrition care process.
Each step is important to complete before advancing to the next step. In practice, as new in-
formation becomes available, professional revisit previous steps of the NCP to reassess,
update/change nutrition diagnoses, adapt/adjust interventions, and/or modify goals and monitor
outcomes. Monitoring and evaluation data from the prior client interaction (or visit) is data that
begins the reassessment of the subsequent interaction.
Nutrition Assessment: A systematic process of obtaining, verifying, and interpreting data in

order to make decisions about the nature and cause of nutrition-related problems.
Nutrition Diagnosis, defined as:
a. Actual problems related to intake of energy, nutrients, fluids, bioactive substances
through oral diet or nutrition support (Enteral or parenteral nutrition)
b. Nutritional findings/problems identified that relate to medical or physical
conditions
c. Nutritional findings/problems identified that relate to knowledge, attitudes/beliefs,
physical environment, or access to food and food safety
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Nutrition Intervention: 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.
Nutrition Monitoring and Evaluation: use of selected outcome indicators (markers) that
are relevant to the patient defined needs, nutrition diagnosis, nutrition goals, and disease
state.
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Each of the steps is preceded by the word nutrition. This was a conscious decision to make the
Nutrition Care Process unique and specific to nutrition/dietetics professionals. Figure3.1 below
shows the nutrition care process algorithm.
Even though each step builds on the previous one, the process is not linear. Critical thinking and
problem solving will frequently require that nutrition/dietetics professionals revisit previous
steps to reassess, add, or revise nutrition diagnoses; modify intervention strategies; and/or
evaluate additional outcomes
E-tivity 3.2.1
Title Nutrition Care Process Steps
Purpose The purpose of this E-tivity is to enable you understand the
of the stepsnutrition care process and Explain the nutrition care
process algorithm
Brief summary of overall Follow the links below and study the steps nutrition care
work process
https://images.app.goo.gl/ofHzzg6nDDQMQsoL6
https://alhamdulilahlead.blogspot.mx/?book=032334075X
Spark
Individual Task Describe the steps of nutrition care process and Explain the
nutrition care process algorithm
Interaction begins Post your answers in discussion forum 3.2.1

E- moderator interventions 1. Ensure that learners are focused on the contents and
Next Nutrition Assessments
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Which of the following is not a definition of Nutrition Diagnosis?
A. Actual problems related to intake of energy, nutrients, fluids, bioactive substances
through oral diet or nutrition support (Enteral or parenteral nutrition)
B. Nutritional findings/problems identified that relate to medical or physical
conditions
C. A systematic process of obtaining, verifying, and interpreting
D. Nutritional findings/problems identified that relate to knowledge, attitudes/beliefs,
3.4 E-References
323-34075-5
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LESSON 4
NUTRITION ASSESSMENT-STEP 1
4.0 Introduction
Nutrition Assessment is a systematic approach to collect, classify and synthesize important and
relevant data from clients (where “client” refers to individual and population). This step also
includes Reassessment, which additionally includes collection of new data, and comparing and
re-evaluating data from the previous interaction to the next. Nutrition Assessment is an ongoing,
dynamic process that involves initial data collection as well as continual reassessment and
analysis of the client’s status compared with accepted standards, recommendations, and/or goals.
A Systematic process of obtaining and verifying and interpreting data needed to identify a
nutrition related-problem and the causes. It is a continuous and dynamic process of data
collection and analysis of the clients’ status.
Lesson Learning Outcomes

By the end of this lesson, you will be able;
1. Define nutrition assessment
2. Explain the types of nutrition assessments data
3. Describe the five domains in the terminology of nutrition assessment
4.3 The concepts of Nutrition Assessment
Nutrition screening: Nutrition screening nutrition screening is a quick process aimed at

identifying/detecting individuals who are malnourished or at risk and those who need further
assessment. Nutrition screening should ideally be done at first contact in a health care setting as
part of vital signs by any healthcare provider or at first contact with a nutritionist. Components of
nutrition screening most screening tools address four basic questions;❖recent weight loss; ❖
recent food intake; ❖current body mass index; ❖ severity of disease. Used to quickly identify
clients who are at higher risk and will require urgent nutrition care. Screening precedes
assessment.
Nutrition Assessment: Nutrition Assessment is a systematic approach to collect, classifies, and

synthesizes important and relevant data needed to identify nutrition-related problems and their
causes. 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
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compared to accepted standards, recommendations, and/or goals. 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: For individuals, data can come directly from the
patient/client through interview, observation and measurements, a health record, and the referring
health care provider. 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 Anthropometric Biochemical Nutrition- Client History

History Measurements Data, Medical Focused
Tests, and Physical
Procedures Findings
(Clinical)
Food and nutrient intake, Height, weight, Lab data (e.g., Physical Personal
food and nutrient body mass index, electrolytes, appearance, history,
administration, growth pattern glucose) and muscle and fat medical/health/f
medication, indices/percentile tests (eg, wasting, amily history,
complementary/alternative ranks and weight gastric swallowing treatments and
medicine use, history, MUAC, emptying function, complementary/
knowledge/beliefs, food WHR, WC time, resting appetite, alternative
and supplies availability, metabolic rate blood medicine use,
physical activity, nutrition pressure, body and social
quality of life temperature, history
GFR
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
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 Documentation
Sources /Methods of data collection: For individual assessments: Interviews, observations,

measurements, medical records. For population groups: Surveys, administrative data sets,
epidemiological study
Term selection and Organization: The taxonomy or classification system guides the nutrition
and dietetics practitioner to logical terminology selection. The terms for Nutrition Assessment
and Nutrition Monitoring and Evaluation are combined because the data points are the same or
related; however, the data purpose and use are distinct in these two steps of the Nutrition Care
Process.*Client refers to individuals, groups, populations, supportive individuals, and structures.
TYPE of Data ASSESSMENTS

Anthropometric Weight Length and Height Circumference Measurements Waist Circumference
Hip Circumference Mid upper arm Circumference (MUAC) Head Circumference
Biochemical Blood-glucose, Hemoglobin levels, blood lipids
Serum albumin: Low concentration is associated with increased incidence of medical

complications .Plasma albumin levels do not increase in stressed patients until the
inflammation remits even with feeding. It is important to consider the cause, rather than the
low albumin levels as a key determinant for morbidity and mortality.
Serum prealbumin:- levels decrease with inflammation, malignancy, protein wasting diseases
of the intestines or kidneys and zinc deficiency. In some cases of nephritic syndrome, the levels
are increased. The levels are maintained in uncomplicated malnutrition but decreased in
healthy patients who have undergone recent stress or trauma. Serum levels are not greatly
affected by mild liver or kidney disease rather by chronic disease that destroy organs and
therefore makes PAB unreliable marker for protein status.
C-Reactive protein: Useful to predict when the hyper metabolic state reduces. It reflects any
type of inflammation. It increases within the first 4-6 hours. Once the levels start reducing, this
is an indicator that the patient is going to anabolic state and nutrition therapy can be beneficial.
Creatinine: - Decreased in those with PEM and increased in renal disease.
Creatinine height index: This is a measure of skeletal and lean body mass. It is determined by
measuring a 24 hour urinary creatinine excretion in relationship to the patient’s height while
the patient is consuming a creatinine and creatinine free diet. It is not reliable for patients
without the ideal weight. It is affected by medical conditions like renal failure, sepsis, trauma,
exercise and steroid therapy
Blood Urea nitrogen (BUN): Increased in those with renal disease and excessive protein
catabolism, decreased in those with negative nitrogen balance and liver failure.
Immunocomptence:-Useful in determining extent of inadequate nutrition and disease Also
useful in allergies. The Most accurate evidence of malnutrition in older patients is
hypocholesterolemia and hypoalbuminaemia. Generally, there is no gold standard for
evaluating nutrition status. Different assessments can be combined to improve accuracy and
ensure appropriate interventions
Clinical. physical examination, presence of complication
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Dietary Dietary intake, eating habits, etc

assessment
Functional Ability to undertake activities of daily living e.g. eating, walking
ability
Social- Livelihood, Income
Economic
Other ▪ Bioelectric Impendence analysis(BIA)
assessments ▪ Body Cell Mass(BCM)
▪ Extracellular Mass(EM)
▪ Fat Free Mass(FFM)
▪ Fat Mass(FM)
▪ Dual Energy X-ray Absorptiometry(DEXA)
▪ Ultrasound
▪ Magnetic resonance Imaging
▪ Total Body Water
▪ Handgrip Dynamometry
▪ Underwater Weighing
NOTE: For Non Ambulatory Patients Height measurements consider: Total Arm length, Arm
spam, and Demi Span and Knee height
4.2.1 E-tivity- concepts of Nutrition Assessment

Numbering, 4.2.1
sequencing
Title Nutrition assessment
Purpose The purpose of this E-tivity is to enable you Explain the types of
nutrition assessments data and describe the five domains in the
terminology of nutrition assessment
Brief summary Follow the links below and study the steps nutrition care process
of overall work
https://www.youtube.com/watch?v=mq35L3v5GvI
Spark
Individual Task 1.Describe the types of data in nutritional assessment

2.
Interaction 1. Indicate the normal levels and cut off points for the different
begins indicators described in the preceding table
Post your answers in discussion forum 4.2.1
E- moderator 1. Ensure that learners are focused on the contents and context of
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interventions discussion.
Next Nutrition care process steps
Assessment Questions
1. Which of the following Methods of data collection is not appropriate for individual
assessments: \
A. Surveys
B. Interviews
C. Observations
D. Biochemical data
4.4E-References
1. https://www.elsevier.com/books/krauses-food-and-the-nutrition-care-process/mahan/978-
0-323-34075-5
2. .http://nak.or.ke/wp-content/uploads/2017/12/KENYA-NATIONAL-CLINICAL-NUTRITION-
AND-DIETETICS-REFERENCE-MANUAL.pdf
3. https://scalingupnutrition.org/wp-content/uploads/2013/10/Kenya-National-Nutrition-
Action-Plan-2012-2017-final.pdf
4. . http://nak.or.ke/wp-content/uploads/2017/12/NATIONAL-GUIDELINES-FOR-HEALTHY-
DIETS-AND-PHYSICAL-ACTIVITY-2017-NEW-EDIT.pdf
5. 2017. The Academy of Nutrition and Dietetics. JOURNAL OF THE ACADEMY OF

NUTRITION AND DIETETIC
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LESSON 5
NUTRITION DIGNOSIS-STEP 2
5.0 Introduction
Nutrition diagnosis is the identification and labeling that describes an actual occurrence, risk of,
or potential for developing a nutritional problem that the nutritionist/dietitian is responsible for
treating. It names and describes the problem which may already exist or may be at risk of
occurring. Description and purpose Nutrition Diagnosis is nutrition and dietetics professional’s
identification and labeling of an existing nutrition problem that he or she is responsible for
treating.

By the end of this lesson, you will be able to;
1. Describe the components of nutrition diagnosis

2. Develop clear Nutrition diagnosis statements for various cases
5.2.1The concepts of Nutrition Diagnosis
Nutrition Diagnosis
Nutrition Diagnosis is nutrition and dietetics practitioner’s identification and labeling of an
existing nutrition problem(s) that the practitioner is responsible for treating. Nutrition diagnosis
is the process of identifying the specific nutrition problem that a dietician or a nutritionistis
responsible for treating/resolving based on the nutrition assessment data. Nutrition diagnoses are
different from medical diagnoses; the nutrition diagnosis should be specific to the role of a
dietician or nutritionist.
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. Food and nutrition
professionals use nutrition assessment data to identify and label the patients’ nutrition diagnosis
using standard nutrition diagnostic terminology.
There are three domains of nutrition diagnosis
Domain 1: 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
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• Class: Nutrient balance

Domain 2: Clinical
Defined as “nutritional findings/problems identified that relate to medical or physical conditions
• Class: functional balance (change in physical or mechanical functioning with nutritional
consequences)
• Class: Biochemical balance: change in capacity to metabolize nutrients as a result of
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
Domain 3: Behavioral
Defined as “nutritional findings/problems identified that relate to knowledge, attitudes/beliefs,
• Class: knowledge and beliefs
• Class: physical activity, balance and function
• Class: food safety and access
Three domains /categories by which nutrition diagnosis is organized

Intake Clinical Behavioral-Environment
Too much or too little of a food or Nutritional problems Knowledge, attitudes, beliefs,
nutrient compared to actual or that relate to medical or physical environment, access to
estimated needs physical conditions food or food safety
Documenting/Communicating a Nutrition Diagnosis:

Nutrition and dietetics practitioners write a PES (Problem, Etiology, Signs and Symptoms)
statement to describe each problem, the root causes and the assessment data that provide
evidence for the nutrition diagnosis(es). The format for each PES statement is “[Nutrition
diagnosis term (problem)] related to [etiology] as evidenced by [signs/symptoms].”
(P)Problemor Nutrition (E) Etiology (S) Signs/Symptoms

DiagnosisTerm Data or indicators used to
Cause/Contributing Risk Factors determine theclient's nutrition
Describes alterations in the diagnosis.
client’s nutritional status Linked to the nutrition diagnosis
term by the words “related to.” Linked to the etiology by the
words “asevidenced by.”
Nutrition diagnosis components

There are three components in a nutrition diagnosis problem;
1. Problem (Diagnostic Label)
2. Etiology (Cause/contributing risk factors)
3. Signs/Symptoms (Defining characteristics)
– Signs = objective data = observable, measurable changes
– Symptoms = subjective data = changes pt feels and expresses
Problem (Diagnostic Label)
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– Describes alterations in pt’s nutritional status

– Diagnostic labels
• Impaired (nutrient utilization…)
• Altered (GI function…)
• Inadequate/excessive (calorie intake…)
• Inappropriate (intake of types of carbohydrate)
• Swallowing difficulty
Etiology (Cause/Contributing Factors)
– Related factors that contribute to problem
– Identifies cause of the problem
– Helps determine whether nutrition intervention will improve problem
– Linked to problem by words “related to” (RT)
– Note: etiology may not always be clear
Example
– Excessive calorie intake (problem) related to regular consumption of large
portions of high-fat meals (etiology)
– Swallowing difficulty (problem) related to stroke (etiology)
Signs/Symptoms (Defining characteristics)

– Evidence that problem exists
– Linked to etiology by words “as evidenced by”
– Excessive calorie intake (problem) “related to” regular consumption of large
portions of high-fat meals (etiology) as evidenced by diet history and weight
status
– Swallowing difficulty (problem) related to stroke (etiology) as evidenced by
coughing following drinking of thin liquids (signs and symptoms)
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).
1. Is it nutrition diagnosis or a medical diagnosis? E.g “increased nutrient needs versus fever
or altered GIT function”.
2. Does the nutrition assessment data support the nutrition diagnosis, etiology, and signs and
symptoms?
3. Is the diagnosis specific to the role of a dietician or nutritionist?
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?
Nutrition Diagnosis Statement should be:

• clear, concise
• specific
• related to one problem
• accurate – related to one etiology
• based on reliable, accurate assessment data
Example
• Excessive calorie intake (P) “related to” regular consumption of large portions of high-fat
meals (E) “as evidenced by” diet history & 10kg 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 (S)
• Altered GI function (P) R/T ileal resection (E) as evidenced by medical history and
dumping syndrome symptoms after meals (S)
Differences between medical and nutrition diagnosis
Medical Diagnosis Nutritional Diagnosis
Diabetes Excessive calorie intake (P) “related to” regular

consumption of large portions of high-fat meals (E) “as
evidenced by” diet history & 10kg wt gain over last 18 mo
(S & S)
Excessive energy intake r/t lack of access to healthy food

choices (restaurant eating) as evidenced by diet history and
BMI of 35.
CA esophagus Swallowing difficulty (problem) related to CA esophagus
(etiology) as evidenced by coughing following drinking of
thin liquids (signs and symptoms)
Liver failure Altered gastrointestinal function r/t cirrhosis of the liver as

evidenced by steatorrhea and growth failure
Dependence mechanical Excessive energy intake r/t high volume Parental Nutrition
ventilation as evidenced by Respiratory Quotient >1
Anorexia nervosa Undesirable food choices r/t history of anorexia nervosa

and self-limiting behavior as evidenced by diet history and
weight loss of 5 kg in the last one month
Table 5.2 Nutrition Diagnosis matrix

Component Action Point
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Data Organized assessment data that is clustered for comparison with defining
sources/tools for characteristics of suspected diagnoses as listed in diagnosis reference sheets
diagnosis
Nutrition The Nutrition Diagnosis is expressed using nutrition diagnostic terms and
Diagnosis the etiologies, signs, and symptoms that have been identified in the
components reference sheets describing each diagnosis. There are three distinct parts to
a nutrition diagnostic statement;
 The Nutrition Diagnosis describes alterations in a client’s status
 Etiology is a factor gathered during the Nutrition Assessment that
contributes to the existence or the maintenance of pathophysiological,
psychosocial, situational, developmental, cultural, and/or
environmental problems
 The etiology is preceded by the words “related to”
 Identifying the etiology will lead to the selection of a nutrition
intervention aimed at resolving the underlying cause of the nutrition
problem whenever possible
 Signs/symptoms (defining characteristics) The defining characteristics
are a cluster of signs and symptoms that provide evidence that a
Nutrition Diagnosis exists
 The signs and symptoms are preceded by the words “as evidenced by”
 Signs are the observations of a trained professional
 Symptoms are changes reported by the client Nutrition diagnostic
statement
Nutrition A well-written nutrition diagnostic statement should be:

diagnostic ▪ Clear and concise
statement ▪ Specific to a client
▪ Limited to a single client problem
▪ Accurately related to 1 etiology; and
▪ Based on signs and symptoms from the assessment data
Critical thinking ▪ Finding patterns and relationships among the data and possible causes
▪ Making inferences
▪ Stating the problem clearly and singularly
▪ Ruling in/ruling out specific diagnoses
▪ Identifying an etiology 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
Determination for Because the Nutrition Diagnosis names and describes the problem, the
continuation of determination for problem-solving follows the Nutrition Diagnosis step. If a
care professional does not identify a Nutrition Diagnosis or the potential exists for a
Nutrition Diagnosis to develop, a professional may determine an appropriate
method and interval for continuation of care
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E-tivity5.2.1 concepts of Nutrition Diagnosis

Numbering, 5.2.1
sequencing
Title Nutrition Diagnosis
Purpose The purpose of this E-tivity is to enable you describe the
components of nutrition diagnosis and practice developing clear
Nutrition diagnosis statements for various cases
Brief summary of Follow the links below and learn on how to develop clear
overall work Nutrition diagnosis statements for various cases study the steps
nutrition care process https://youtu.be/jmF12JYPgoQ
Spark
Individual Task 1.Explain the characteristics of a good diagnostic statement

2. Develop clear Nutrition diagnosis statements for 1 case
Interaction begins 1 Post your answer in the discussion forum 5.2.1

2 Read posted work from 2 colleagues
3 Post at least one comment on their work and give constructive
criticism
E- moderator 1. Ensure that learners are focused on the contents and context of
interventions
discussion.
Next Nutrition interventions
Which one of the following is not a nutritional diagnosis
A. Swallowing difficulty (problem) related to CA esophagus (etiology) as evidenced by
coughing following drinking of thin liquids (signs and symptoms
B. Altered gastrointestinal function r/t cirrhosis of the liver as evidenced by steatorrhea and
growth failure
C. Diabetes mellitus type 2
D. Excessive energy intake r/t high volume Parental Nutrition as evidenced by Respiratory
Quotient >1
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5.4 E-Refrences
1. https://www.elsevier.com/books/krauses-food-and-the-nutrition-care-process/mahan/978-
0-323-34075-5
2. .http://nak.or.ke/wp-content/uploads/2017/12/KENYA-NATIONAL-CLINICAL-NUTRITION-
AND-DIETETICS-REFERENCE-MANUAL.pdf
3. https://scalingupnutrition.org/wp-content/uploads/2013/10/Kenya-National-Nutrition-
Action-Plan-2012-2017-final.pdf
4. . http://nak.or.ke/wp-content/uploads/2017/12/NATIONAL-GUIDELINES-FOR-HEALTHY-
DIETS-AND-PHYSICAL-ACTIVITY-2017-NEW-EDIT.pdf
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LESSON 6
NUTRITION INTERVENTION-STEP
6.1: Introduction
Nutrition Intervention is a purposefully planned action(s) designed with the intent of
changing a nutrition-related behavior, risk factor, environmental condition, or aspect of
health status. Nutrition Intervention consists of two interrelated components: planning and
intervention. The Nutrition Intervention is typically directed toward resolving the nutrition
diagnosis or the nutrition etiology less often, it is directed at relieving signs and symptoms.
6.2: Lesson Learning Outcomes

1. Explain the terminology concepts of nutrition

interventions
2. Describe the stages of conducting a nutrition
intervention
6.2.1: The concepts of Nutrition Intervention
Definition:A nutrition intervention is a purposely planned action(s) designed with the

intent of changing a nutrition-related behavior, risk factor, environmental condition, or
aspect of health status to resolve or improve the identified nutrition diagnosis (es) or
nutrition problem(s). Nutrition interventions are selected and tailored to the client needs
by planning and implementing appropriate interventions.
Component Action point

Data sources/tools ▪ Current research literature ▪ Results of outcome management studies or
for Interventions quality improvement projects ▪ Existing clinical guidelines
Nutrition Planning
Intervention ▪ Prioritize interventions based on urgency, influence, and available
components resources
▪ Write a nutrition prescription based on a client’s individualized
recommended dietary intake of energy and/or selected foods or nutrients
based on current reference standards and dietary guidelines and a client’s
health condition and nutrition diagnosis
▪ Collaborate with the client to identify goals of the intervention for each
diagnosis
▪ Select specific 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
▪ Define time and frequency or care, including intensity, duration, and
follow-up
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Implementation
▪ Collaborate with the client to carry out the plan of care ▪ Communicate
the plan of nutrition care ▪ Modify the plan of care as needed ▪ Follow-up
and verify that the plan is being implemented ▪ Revise strategies based on
changes in condition or response to intervention.
Critical thinking Setting goals and prioritizing
▪ Defining the nutrition prescription or basic plan
▪ Making interdisciplinary connections
▪ Matching intervention strategies with client needs, nutrition diagnoses,
and values
▪ Choosing from among alternatives to determine a course of action
▪ Specifying the time and frequency of care.
Determination for If a client has met intervention goals or is not at this time able/ready to
continuation of care make needed changes, the professional may discharge the client from this
episode of care as part of the planned intervention.
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.. Terminology for Nutrition Intervention is organized in five
domains (categories):
Food and/or Nutrition Nutrition Counseling Coordination Population Based

Nutrient Education of Nutrition Nutrition Action.
Delivery Care
Customized A formal process A supportive process, Consultation Interventions
approach for to instruct or train characterized by a with, referral designed to
food/nutrient a client in a skill or collaborative to, or improve the
provision to impart counselor-client coordination nutritional well-
Or knowledge to help relationship, to of nutrition being of a
Individualized clients voluntarily establish food, care with other population.
approach for manage or modify nutrition and physical health care
food/nutrient food, nutrition, and activity priorities, providers,
provision physical activity goals, and action institutions, or
choices and plans that agencies that
behavior to acknowledge and can assist in
maintain or foster responsibility treating or
improve health for self-care to treat managing
an existing condition nutrition-
and promote health related
problems
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Stages of Nutrition intervention
Nutrition intervention is accomplished in different and interrelated steps:
 Formulation of goals,
 Planning
 Implementing.
Formulation of goals:
Nutrition intervention goals, ideally, developed collaboratively with the client; provide
the basis for monitoring progress and measuring outcomes
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 include:
• Setting goals and prioritizing
• Defining the nutrition prescription or basic plan
• Making interdisciplinary connections
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• 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
6.2.1 E-tivity-Concepts of Nutrition Intervention

Numbering, 6.2.1
sequencing
Title Nutrition Diagnosis
Purpose The purpose of this E-tivity is to enable you Explain the
terminology concepts of nutrition interventions and describe the
stages of conducting a nutrition intervention
Brief summary of Follow the links below and learn on how to develop an appropriate
overall work Nutrition interventions
Spark
Individual Task 1. Explain the terminology concepts of nutrition interventions

2. Describe the stages of conducting a nutrition intervention
Interaction begins Post your answers in the discussion forum 6.2.1

E- moderator 1. Ensure that learners are focused on the contents and context
interventions
of discussion.
Next Nutrition Monitoring and Evaluation
1. Which of the following steps is not a process of Nutrition Intervention?
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A. Formulation of goals
B. Assessing the problem
C. Planning
D. Implementing
E-References
1. https://www.elsevier.com/books/krauses-food-and-the-nutrition-care-process/mahan/978-0-323-
34075-5
3. https://scalingupnutrition.org/wp-content/uploads/2013/10/Kenya-National-Nutrition-Action-Plan-
2012-2017-final.pdf
4. . http://nak.or.ke/wp-content/uploads/2017/12/NATIONAL-GUIDELINES-FOR-HEALTHY-DIETS-AND-
PHYSICAL-ACTIVITY-2017-NEW-EDIT.pdf
5. 2017. The Academy of Nutrition and Dietetics. JOURNAL OF THE ACADEMY OF NUTRITION AND
DIETETICS
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LESSON 7
NUTRITION MONITORING AND EVALUATION-STEP
7.1 Introduction
The purpose of nutrition monitoring and evaluation is to determine and measure the amount of
progress made for the nutrition intervention and whether the nutrition related goals/expected
outcomes are being met. 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
goals or expected outcomes are being met. Nutrition monitoring and evaluation identifies
outcomes/indicators relevant to the nutrition diagnosis and intervention plans and goals.

1. Explain the concepts of Monitoring and Evaluation
2. Identify and the outcome indicators to be used for nutrition monitoring and evaluation
7.2.1The concepts of Nutrition and Evaluation
Nutrition Monitoring: This the continuous review and measurement of the patient status at a scheduled
follows up point with regard to the nutrition diagnosis, intervention plans/goals and outcomes. Aims at
determining the degree to which progress is being made.
Evaluation: This is the Systematic comparison of current findings with previous status, intervention
goals or reference standards. The aim is to determine the extent to which goals or desired outcomes of
nutrition care are being met. Compare current findings with previous status, intervention goals, and/or
reference standards
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Nutrition
Monitoring
and Evaluation
What is monitored?
Direct nutrition outcomes e.g. weight gain

Clinical and health status outcomes
Patient/client-centered outcomes
Healthcare utilization
End-result outcome
Examples of outcome measured
1. Examples of direct nutrition outcomes -the client’s behavior change, food or nutrient intake
changes, improved nutritional status, or knowledge gained.
2. Clinical and health status outcomes include laboratory values, weight, blood pressure, risk factor
profile changes, signs and symptoms, clinical status, infections, and other complications.
3. Patient/client-centered outcomes include quality of life measures, satisfaction, self-efficacy, self-

management, and the client’s functional ability.
4. Healthcare utilization and cost outcomes include items such as medication changes, special
procedures, planned/unplanned clinic visits, preventable hospitalizations, length of
hospitalization, or the prevention or delay of nursing home admission.
5. We also measure this data for immediate results-- in the short term such as the first visit with the
client, as well as measure long-term results, such as the end of our MNT visit with the client or
year 2 follow-up visit
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
Nutrition
Monitoring and
Evaluation
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Data Sources/Tools  Patient records

 Anthropometric measurements, laboratory tests,
 Patient (or guardian) interviews/surveys
 telephone follow-up
 Reference guides and other evidence-based sources
 Data collection forms, spreadsheets
Monitoring progress  Check patient understanding and compliance with plan;
 Determine if the intervention is being implemented as prescribed;
 Provide evidence that the plan/intervention strategy is or is not changing patient behavior or
status;
 Identify other positive or negative outcomes;
 Gather information indicating reasons for lack of progress; and
 Support conclusions with evidence.
Measuring and  Select outcome indicators that are relevant to the nutrition diagnosis or signs or symptoms,
Evaluating Outcomes nutrition goals, medical diagnosis, and outcomes and quality management goals.
 Use standardized indicators to:
o Increase the validity and reliability of measurements of change; and
o Facilitate electronic charting, coding, and outcomes measurement
 Compare current findings with previous status, intervention goals, and/or reference standards
Critical Thinking  Selecting appropriate indicators/measures;
 Using appropriate reference standard for comparison;
 Defining where patient/client/group is now in terms of expected outcomes;
 Explaining variance from expected outcomes;
 Determining factors that help or hinder progress; and
 Deciding between discharge or continuation of nutrition care
Documentation of  Date and time;

Assessment  Specific indicators measured and results;
 Progress toward goals (incremental small change can be significant therefore use of a Likert type
scale may be more descriptive than a “met” or “not met” goal evaluation tool);
 Factors facilitating or hampering progress;
 Other positive or negative outcomes; and
 Future plans for nutrition care, monitoring, and follow up or discharge.
Determination for  Based on the findings, a decision to actively continue care or discharge the patient from nutrition
Continuation of Care care (when necessary and appropriate nutrition care is completed or no further change is expected
at this time).
 If nutrition care is to be continued, the nutrition care process cycles back as necessary to
assessment, diagnosis, and/or intervention for additional assessment, refinement of the diagnosis
and adjustment and/or reinforcement of the plan.
 If care does not continue, the patient may still be monitored for a change in status and reentry to
nutrition care at a later date.
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7.2.1 E-TIVITY
Numbering, 7.2.1
sequencing
Title Nutrition Monitoring and Evaluation
Purpose The purpose of this E-tivity is to enable you Explain the concepts of
Monitoring and Evaluation and Identify and the outcome indicators to
be used for nutrition monitoring and evaluation
Brief summary of Follow the links below and learn on how to Identify and the
overall work outcome indicators to be used for nutrition monitoring and
evaluation
Spark
Individual Task Outline the outcome indicator used in M&E.

Interaction begins Post your answers in the discussion forum 7.2.1
Read posted work from 2 colleagues
Post at least one comment on their work and give constructive
criticism
E- moderator 1. Ensure that learners are focused on the contents and context
interventions
of discussion.
Next Nutrition care process Case studies
7.3 Assessment Questions

The following are Examples of outcome measured in monitoring and evaluation, state true or false
against each.
1. Examples of direct nutrition outcomes -the client’s behavior change, food or nutrient intake
changes, improved nutritional status, or knowledge gained.
2. Clinical and health status outcomes include laboratory values, weight, blood pressure, risk factor
profile changes, signs and symptoms, clinical status, infections, and other complications.
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3. Patient/client-centered outcomes include quality of life measures, satisfaction, self-efficacy, self-

management, and the client’s functional ability.
4. Healthcare utilization and cost outcomes include items such as medication changes, special
procedures, planned/unplanned clinic visits, preventable hospitalizations, length of
hospitalization, or the prevention or delay of nursing home admission.
7.4 E-References
1. https://www.elsevier.com/books/krauses-food-and-the-nutrition-care-process/mahan/978-0-323-
34075-5
3. https://scalingupnutrition.org/wp-content/uploads/2013/10/Kenya-National-Nutrition-Action-Plan-
2012-2017-final.pdf
4. . http://nak.or.ke/wp-content/uploads/2017/12/NATIONAL-GUIDELINES-FOR-HEALTHY-DIETS-AND-
PHYSICAL-ACTIVITY-2017-NEW-EDIT.pdf
5. 2017. The Academy of Nutrition and Dietetics. JOURNAL OF THE ACADEMY OF NUTRITION AND
DIETETICS
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LESSON 8 to 12:
PRACTICALS WITH CASE STUDIES FROM HEALTH FACILITIES
8.1 NUTRITION CASE STUDY PRESENTATION OUTLINE

I. REVIEW OF MEDICAL LITERATURE
A. Pathophysiology
1. Define disease and explain the primary disease process
2. Discuss usual etiology or occurrence of disease; give morbidity and mortality statistics if
available.
3. Prognosis - discusses prognosis for disease and prognosis for patient
4. Summarize symptoms of disease and correlate with symptoms documented in case study
patient’s medical record.
5. Identify significant lab values: discuss lab abnormalities associated with the disease and
correlate labs of patient with normal lab values.
6. Treatment – discuss usual surgical/medical treatment for the disease and the treatment planned
for or completed by the patient (include procedure, purpose, outcome, pictures if available)
7. Medications – discuss pertinent medications prescribed for the primary diagnosis
B. Nutritional implications of the disease
1. Discuss rationale for dietary modifications and recommended diet order; discuss how dietary
modification is an intervention strategy for the disease.
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II. DISCUSSION OF PATIENT CASE STUDY

A. Nutrition Assessment Data
1. Client History
Personal History – present general information about the patient: use initials to identify patient,
specify age, gender, race, and ethnicity, if appropriate. Remember HIPAA when reporting age.
Health History & Surgical Treatment – patient, family medical/health history; history of
surgical treatment
Social History – Housing, economic, psychological, religion or religious preferences,

occupation, geography, and stress background of patient as it relates to primary diagnosis;
social/medical support
2. Anthropometrics – Height, weight, weight changes, BMI, IBW %, etc
3. Biochemical data, medical tests, & procedures - correlate labs, medical tests/procedures of
patient with normal values
4. Nutrition-Focused Physical Findings – present significant findings from physical exam and
other related data.
5. Food/Nutrition Related History Food/Nutrient Intake - include diet history with typical
diet followed at home, average intake, diet order at admission, and oral intake since admission,
etc. Medications & herbal supplements – those taken at home and hospital; possible interactions
Knowledge/beliefs/attitudes - related to food and nutrition Behavior – related to food and health
Access to food and related supplies Physical Activity History
6. Comparative Standards (may be mixed in throughout other assessment information) –

estimated energy/protein needs, weight standards, etc
7. Secondary diagnoses for this admission; other medical problems listed
8. Briefly review hospital course
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B. Nutrition Diagnosis
1. Using standardized language determines appropriate nutrition diagnoses and include as a PES
statement. You will need at least one. Be sure to use NCP terminology.
C. Nutrition Intervention
1. Nutrition Prescription – What was your “prescription” or the overall recommendations for the
patient? Include the patient’s individualized recommendations for energy, specific foods or
nutrients, based on current reference standards and guidelines and the patient’s health condition
and nutrition diagnosis.
2. Describe and justify (cite references/evidence that supports and/or validates) the intervention
strategies used, proposed, and/or recommended. Discuss and compare any differences you find
between what was done and what is recommended for the nutrition diagnosis and/or disease
state. Include items such as:
a. Food and/or nutrient delivery modifications or recommendations
b. Nutrition education– describes educational encounters; discuss patient’s knowledge and

readiness to learn new information; what is the predicted adherence to the diet therapy.
c. Coordination of care – discuss other professionals, institutions, or agencies that you

collaborated and/or coordinated with and/or referred to during the patient’s nutrition care; discuss
any discharge planning and transfer of nutrition care from one level or location of care to
another.
3. List goals that are patient-focused, measurable, achievable, and time-defined.
4. Identify factors or influences that may prevent the intervention strategies from being
successful
a. Influences on food intake (i.e. swallowing problems, NPO for tests, etc)
b. Ability to meet nutrition prescription
c. Touch on any social, economic, psychological influences that might influence outcomes.
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D. Nutrition Monitoring and Evaluation
1. List specific indicators/measures that were or could have been monitored/evaluated to

determine the progress of the patient. These should link back to the signs and symptom of the
nutrition diagnoses and/or intervention goals.
III. SUMMARY:
A. Summarize the prognosis of the patient and the effectiveness of the nutrition care plan.
B. Discuss realistic/practical applications and recommendations for future practice based on the
research reviewed for the case study.
C. What would you do differently the next time you worked with a patient in a similar situation?
PRESENTATION DIRECTIONS:
 Prepare a PowerPoint presentation as outlined above. Make sure you avoid using any patient-
identifying information protected by HIPAA.
 To cover the material adequately, presentations should be 40-50 minutes with an additional 5-
10 minutes planned for questions.
 Include in-text citations on the appropriate slides, as well as a reference list at the end of the
presentation.
At least one reference cited needs to come from evidence-based guidelines, systematic reviews,
and/or scientific literature.
 With the help of your preceptor, schedule the presentation, at the convenience of the clinical
facility staff, no later than the final day of the clinicals.
Faculty advisor/Lecturer, clinical dietitians (and/or other medical team members as

appropriate) should be invited to attend and participate.
 Provide copies of your PowerPoint slides and a list of your references to all those attending
the presentation.
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 As possible, the primary clinical preceptor should attend and complete the Nutrition Case
Study Presentation Evaluation; however, another clinical dietitian may complete the evaluation
as needed.  Save a copy of your PowerPoint slides and the completed evaluation as a PDF and
submit to the faculty academic advisor/Lecturer for assessment.
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Nutrition care process Example
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 2.3kg 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 and sausage 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 high
sodium convenience foods and inability to name high sodium foods
• 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
Objectives
• Patient will stop high sodium intake
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
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
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ANSWERS TO LESSON ASSESSMENT QUESTIONS
1.3 D
2.3 B
3.3 C
4.3 A
5.3 C
6.3 B
7.3
1. TRUE
2. TRUE
3. TRUE
4. TRUE
______________________________________________________________________________
Core E-References
1. .https://www.elsevier.com/books/krauses-food-and-the-nutrition-care-process/mahan/978-0-
323-34075-5
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Final Corrected HFN 446 Nutrition Care Process module

Studocu is not sponsored or endorsed by any college or university

SCHOOL OF PUBLIC HEALTH AND APPLIED HUMAN SCIENCES

DEPARTMENT: FOODS, NUTRITION & DIETETICS,

INNOVATION AND REFORM (SPHEIR),

THE ASSOCIATION OF COMMONWEALTH UNIVERSITIES (ACU) &

PARTNERSHIP FOR ENHANCED AND BLENDED LEARNING (PEBL)

HFN 446: NUTRITION CARE PROCESS

VETTED BY:PEBL Quality Assurance Team Members

Licensed under a Creative Commons Attribution-Non Commercial-Share Alike 4.0 International

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HFN 446: NUTRITION CARE PROCESS

WEEK 1: DEFINITIONS AND CONCEPTS IN NUTRITION CARE PROCESS

WEEK 2: NUTRITION CARE PROCESS MODEL

WEEK 3: STEPS OF NUTRITION CARE PROCESS

WEEK 4: NUTRITION ASSESSMENT-STEP 1

WEEK 5: NUTRITION DIGNOSIS-STEP 2

WEEK 6: NUTRITION INTERVENTION-STEP 3

WEEK 7: NUTRITION MONITORING AND EVALUATION STEP 4

WEEK 8: PRACTICALS WITH CASE STUDIES FROM HEALTH FACILITIES

WEEK 9: PRACTICALS WITH CASE STUDIES FROM HEALTH FACILITIES

WEEK 10: PRACTICALS WITH CASE STUDIES FROM HEALTH FACILITIES

WEEK 11&13: CASE STUDY PRESENTATIONS

OVERVIEW OF THE COURSE

Week 0: Introduction (Your Context, Your Goals)

Week 1: Definitions and Concepts in Nutrition Care Process

understand fundamental concepts in nutrition care process.

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Week 2: Nutrition Care process Model

Week 4: Nutrition Assessment-Step 1

Week 5: Nutrition Diagnosis Step 2

Week 7: Nutrition Monitoring and Evaluation step 4

related goals/expected outcomes are being met.

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Week 13&14: Examination

MODULE LEARNING OUTCOMES

By the end of this module, you will be able to:

1. Acquire skills and knowledge necessary for providing nutrition care

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I wish you the very best of experiences in this course.

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Week 0: Introduction (Your Context, Your Goals) 3

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LESSON 5: NUTRITION DIGNOSIS-STEP 2.....................................................................................28

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CONCEPTS IN NUTRITION CARE PROCESS

1.1.1 Purpose of the Nutrition care process:

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Nutrition care process: Is a systematic approach of providing nutrition care based on a

1.2.1 E-tivity -concepts of Nutrition Care Process

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Individual Task Briefly explain the concepts of nutrition care process

Schedule time This activity should take one hour

1.3 Assessment Questions