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Nutrition Therapy and Pathophysiology | 3eNelms | Sucher | Lacey | Roth

Karen Lacey, MS, RD, CDUniversity of Wisconsin–Green Bay

The Nutrition Care Process

Chapter 2

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Improving Health Status through Nutrition Care

• Health status– Nutrition interventions

• Strategies and focus of care based on status of health

– Continuum of care • Totally healthy • Acute illness• Chronic disease or condition• Terminal illness

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Improving Nutritional Status through Nutrition Care

• Nutrition status– Human biology factors– Lifestyle factors– Food and nutrient factors– Environmental factors– System factors– See Table 2.1

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Factors Affecting Nutritional Status

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Purpose of Providing Nutrition Care

• What is the purpose of nutrition care?– To restore a state of nutritional balance by

influencing factors contributing to the imbalance

• R.D.s are highly qualified to do this

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The AND’s Standardized Nutrition Care Process

• What is the nutrition care process?– Systematic problem solving method– Four steps:

• Nutrition assessment• Nutrition diagnosis• Nutrition intervention• Nutrition monitoring and evaluation

– Includes a system of standardized nutrition language

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Standardized Nutrition Language

• Standardized language – Uniform terminology used to describe practice– Provides a common language for

documentation and communication• Nutrition diagnostic terminology • Nutrition assessment, monitoring and evaluation

terms• Nutrition intervention

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Use of the NCP to Improve Quality of Care

• Consistent structure and framework– Provides high quality care – Addresses

• Process of care (systematic and consistent steps of NCP)

• Content of care (evidence-based practice guides)– Guides critical thinking– See Figure 2.2

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Demonstrating Quality

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Critical Thinking Used in the Nutrition Care Process

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Big Picture of Nutrition Care: The Model

• Central core– Relationship between client and dietetics professional

• Individualized and client-focused• Outer rings

– Environmental factors impacting the client’s ability to receive and benefit from nutrition care

– Professional strengths of the dietitian• Supported by other systems

– Screening and referral systems– Outcomes management systems

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Four Steps of the Nutrition Care Process and Model

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Step 1: Nutrition Assessment

• Obtain and verify appropriate data– AND’s Evidence-Based Guides for Practice

• Cluster and organize assessment data– Food/nutrition-related history– Anthropometric measurements– Biochemical data, medical tests, and

procedures– Nutrition-focused physical findings– Client history

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Step 1: Nutrition Assessment (cont’d.)

• Evaluate data using reliable standards– Comparative standards domain– Scientifically valid– Formulate nutrition prescriptions

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Step 2: Nutrition Diagnosis

• Direct link between assessment and intervention

• Describes a problem for which nutrition-related activities provide the primary intervention– NOT a medical diagnosis

• Three domains– Intake, clinical, and behavioral-environmental

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Step 2: Nutrition Diagnosis (cont’d.)

• PES statements– Problem: Diagnostic label– Etiology: Factors related to cause or

existence of problem – Signs and symptoms: Defining characteristics

• Stated as “problem (P) related to etiology (E) as evidenced by signs and symptoms (S)”

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How is a PES Statement Created?

• Evaluate nutrition assessment – Find patterns and relationships among data and

causes• Identify the problem(s)

– Focus on those that can be treated by nutritional intervention

• Validate and confirm problem(s)– Use signs and symptoms

• Explore the etiology – Focus on a nutrition related causes

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How are PES Statements Evaluated?

• Problem– Can a dietetics practitioner impact it?

• Etiology– Is it the root cause?– Is there an intervention that can address it”

• Signs and symptoms– Can they be measured?– Are they sensitive to the intervention?

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Relationship of Nutrition Diagnosis to the Other Steps in NCP

• Links assessment to intervention• Uses data to quantify and qualify the

problem• Base outcome measures on signs and

symptoms• See Figure 2.4

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Other Steps of the NCP

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Steps of the NCP

• Step 3: Nutrition Intervention– Prioritize the nutrition diagnoses– Write the nutrition prescription– Set goals– Plan the intervention– Implement the intervention

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Step 4: Nutrition Monitoring & Evaluation

• Monitor progress– Monitor, measure and evaluate on a planned

schedule• Measure outcomes

– Nutrition, clinical and health status, patient/client centered, and health care utilization

• Evaluate outcomes– Create outcomes management system– Contribute to the body of evidence-based

research

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Documentation

• Standardized language• Relevant, accurate, and timely• Variety of formats are acceptable:

– SOAP– Focus notes– PIE– ADIM– Electronic Medical Records