Relationship Between

Patient/Client/Group & Dietetics

Professional

-

Nutrition Diagnosis Identify and label problem Determine cause/contributing risk

factors Cluster signs and symptoms/

defining characteristics

Nutrition Assessment Obtain/collect timely and

appropriate data Analyze/interpret with

evidence - based standards

Identify risk factors Use appropriate tools

and methods Involve

interdisciplinary collaboration

Screening & Referral System

Outcomes Management Sys tem

Monitor the success of the Nutrition Care Process implementation

Evaluate the impact with aggregate data Identify and analyze causes of less than

optimal performance and outcomes Refine the use of the Nutrition Care

Process

ADA NUTRITION CARE PROCESS AND MODEL

Document

Nutrition Monitoring and Evaluation Monitor progress Measure outcome indicators Evaluate outcomes Document

Nutrition Intervention Plan nutrition intervention

Formulate goals and determine a plan of action

Implement the nutrition intervention Care is delivered and actions

are carried out Document

Document

Nutrition Assessment Nutrition Diagnosis Nutrition Intervention Nutrition Monitoring and

Evaluation

“A systematic process of obtaining, verifying, and interpreting data in order to make decisions about the nature and cause of nutrition-related problems.”› Lacey and Pritchett, JADA 2003;103:1061-

1072.

Gather data, considering Compare to relevant standards Identify possible problem areas

Observe › Verbal and nonverbal cues

Determining appropriate data to collect› Only key information to be recorded

Selecting assessment tools Distinguishing relevant from irrelevant data Organizing data to relate to the nutrition

problem Determining when problems require referral

Nutrition Assessment Nutrition Diagnosis Nutrition Intervention Nutrition Monitoring and

Evaluation

Nutritional problem Names and describes the problem Problem may already exist, or may be at

risk of occurring Not a medical diagnosis

Defined as “actual problems related to intake of energy, nutrients, fluids, bioactive substances through oral diet or nutrition support (enteral or parenteral nutrition)

Class1: Calorie energy balance Class2: Oral or nutrition support intake Class3: Fluid intake balance Class4: Bioactive substances balance Class5: Nutrient balance

Defined as “nutritional findings/problems identified that relate to medical or physical conditions

Class1: functional balance Class2: biochemical balance Class3: weight balance

Defined as “nutritional findings/problems identified that relate to knowledge, attitudes/beliefs, physical environment, or access to food and food safety

Class1: knowledge and beliefs Class2: physical activity, balance and

function Class3: food safety and access

Problem Etiology Signs/Symptoms

› Signs › Symptoms

Problem › Describes alterations in pt’s nutritional

status› Diagnostic labels

Impaired Altered Inadequate/excessive Inappropriate Swallowing difficulty

Etiology › Related factors that contribute to

problem› Identifies cause of the problem› Helps determine whether nutrition

intervention will improve problem› Linked to problem

Etiology › Excessive calorie intake related to regular

consumption of large portions of high-fat meals

› Swallowing difficulty related to stroke

Signs/Symptoms › Evidence- that the problem exists › Linked to etiology- “as evidence by”

Etiology › Excessive calorie intake “related to”

regular consumption of large portions of high-fat meals as evidenced by diet history and weight status

› Swallowing difficulty related to stroke as evidenced by coughing following drinking of thin liquids

Excessive calorie intake “related to” regular consumption of

large portions of high-fat meals “as evidenced by” diet history & 12 lb

wt gain over last 18 mo

Food, nutrition and nutrition-related knowledge deficit R/T lack of education on infant feeding practices as evidenced by infant receiving bedtime juice in a bottle

Altered GI function R/T ileal resection as evidenced by medical history and dumping syndrome symptoms after meals

Nutrition Diagnosis Statement should be: clear, concise specific related to one problem Accurate- related to E based on reliable, accurate assessment

data

Medical Diagnosis Nutritional Diagnosis

Diabetes Increased blood glucose level, excess calorie intake

Trauma and closed head injury

TPN, IV hydration line, increase energy needs (state of catabolism) R/T the trauma, as evidence by weight

Liver failure No insulin, blood glucose stability, R/T fact that the liver is not functioning, as evidence by increased blood glucose levels.

Medical Dx Nutritional Diagnosis

Obesity Intake energy imbalance or calorie increase R/T increased calories or obesity or lack of healthy foods or SES, AEB weight, BMI

Dependence mechanical ventilation

Increased carbohydrates, excessive calories R/T high TPN, AEB vent settings

Anorexia nervosa Decreased calorie intake, R/T history of anorexia and self limiting behavior, AEB weight and diet history

Nutrition Assessment Nutrition Diagnosis Nutrition Intervention Nutrition Monitoring and

Evaluation

“Purposely-planned actions designed with the intent of changing a nutrition-related behavior, risk factor, environmental condition, or aspect of health status for an individual, a target group, or population at large.” – › Lacey and Pritchett, JADA 2003;103:1061-

1072 Directed at the etiology or effects of a

diagnosis

Should be patient-centered Must be achievable Stated in behavioral terms, quantifiable

terms Pt and counselor must establish goals

together What will the patient do or achieve if

objectives met

SMART goals!

Problem 1: Involuntary weight loss› Objectives:

1. Increase calorie intake, very specific 2. Gain X pounds in X month

Problem 2: Inadequate protein-energy intake 2° poor appetite› Objectives:

1.Increase nutrient dense foods high in protein

2.Divide up protein rich foods throughout the day

3.Improve socialization of eating foods

Intervention translates assessment data into strategies, activities, or interventions that will enable the patient or client to meet the established objectives.

Interventions should be specific

Problem 1: Involuntary Weight loss› Intervention:

1. Instruct client on (high protein, high calorie feeding)

2. Gradually increase plan

3.

4.

Problem 2: Inadequate protein-calorie intake 2° poor appetite› Intervention:

1. Begin with nutrient dense foods

2.

3.

Nutrition Assessment Nutrition Diagnosis Nutrition Intervention Nutrition Monitoring and

Evaluation

Evaluate outcomesCompare current

findings with previous status, intervention goals, and/or reference standards

Nutrition Monitoring

and Evaluation

Types of Outcomes

End-result outcome

•Direct nutrition outcomes

•Clinical and health status outcomes

•Patient/client-centered outcomes

•Healthcare utilization

Intermediate-result outcome

Are necessary in order to evaluate Should be achievable- and based on

scientific evidence Should be directly or indirectly related

to nutrition care

Nutrition Assessment Medical hx: 72 y.o. female admitted with

decompensated CHF; heart failure team consulted; has been admitted with same dx x 2 in past month; meds: Lasix and Toprol; current diet order: 2 gram sodium; has lost 5 pounds in 24 hours since admission; Output > input by 2 liters

Nutrition history: has been told to weigh self daily but has no scale at home. Does not add salt to foods at the table. Noticed swollen face and extremities on day prior to admission. Day before admission ate canned soup for lunch and 3 slices of pizza for dinner; does not restrict fluids; has never received nutrition counseling

Nutrition Diagnosis- PESS1. Fluid intake concerns, R/T dietary discretion

AEB symptoms

2. Excessive Na intake R/T foods eaten AEB diet history

3. Knowledge deficit R/T no previous nutritional education AEB inability to name Na foods

4. Self monitoring deficit R/T

Nutrition Intervention 1. Low Na diet 2. Go to senior center to eat 3. Attend diet program 4. Find someone to help the woman to get scale

Monitoring and Evaluation

1. Monitor BP and tell her to keep a weight log and food log

2. Case manager will monitor readmissions

3.