Nutrition Care Process Briefer CP Orientation
Transcript of Nutrition Care Process Briefer CP Orientation
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RelationshipBetween
Patient/Client/Group& Dietetics
Professional
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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
interdisciplinarycollaboration
Screening& Referral
System
OutcomesManagement System
Monitor the success of the Nutrition Care
Process implementation
Evaluate the impact with aggregate data
Identify and analyze causes of less thanoptimal performance and outcomes
Refine the use of the Nutrition Care
Process
ADA NUTRITION CARE PROCESS AND MODEL
Document
Nutrition Monitoring andEvaluation
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 actionsare carried out
Documen t
Document
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ADAs Nutrition Care
Process Steps
Nutrition Assessment
Nutrition Diagnosis
Nutrition Intervention
Nutrition Monitoring and Evaluation
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Nutrition Assessment (Definition)
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.
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Nutrition Assessment
Components Gather data, considering
Dietary intake
Nutrition related consequences of health and disease
condition Psycho-social, functional, and behavioral factors
Knowledge, readiness, and potential for change
Compare to relevant standards
Identify possible problem areas
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Nutrition Assessment: Critical
Thinking Observing verbal and non-verbal cues to guide
interviewing methods
Determining appropriate data to collect
Selecting assessment tools and procedures andapplying in valid and reliable ways
Distinguishing relevant from irrelevant data
Organizing data to relate to nutrition problems
Determining when problems require referral
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ADAs Nutrition Care
Process Steps
Nutrition Assessment
Nutrition Diagnosis
Nutrition Intervention
Nutrition Monitoring and Evaluation
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Nutrition Diagnosis
Nutritionalproblem that the dietitian is
responsible for treating
Names and describes the problem
Problem may already exist, or may be atrisk of occurring
Not a medical diagnosis Type 2 diabetes = medical diagnosis
Excessive carbohydrate intake resulting in elevated
blood glucose levels = nutrition diagnosis.
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Nutrition Dx Domains: Intake
Defined as actual problems related tointake of energy, nutrients, fluids, bioactivesubstances 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
Class: Nutrient balance
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Nutrition Dx Domains: Clinical
Defined as nutritional findings/problems identifiedthat relate to medical or physical conditions
Class: functional balance (change in physical or
mechanical functioning with nutritionalconsequences)
Class: Biochemical balance: change in capacityto metabolize nutrients as a result of
medications, surgery, or as indicated by alteredlab values
Class: weight balance: chronic weight orchanged weight status when compared with
usual or desired body weight
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Nutrition Dx Domains:
Behavioral-Environmental
Defined as nutritional findings/problems
identified that relate to knowledge,
attitudes/beliefs, physical encironment, or
access to food and food safety
Class: knowledge and beliefs
Class: physical activity, balance and
function
Class: food safety and access
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Nutrition Diagnosis Components
Problem (Diagnostic Label)
Etiology (Cause/contributing risk
factors) Signs/Symptoms (Defining
characteristics)
Signs = objective data = observable,measurable changes
Symptoms = subjective data = changes pt
feels and expresses
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Nutrition Diagnosis
Components Problem (Diagnostic Label)
Describes alterations in pts nutritional status
Diagnostic labels Impaired (nutrient utilization)
Altered (GI function)
Inadequate/excessive (calorie intake)
Inappropriate (intake of types of carbohydrate)
Swallowing difficulty
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Nutrition Diagnosis Components
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
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Nutrition Diagnosis Components
Etiology (Cause/Contributing Factors)
Excessive calorie intake (problem) related
to regular consumption of large portions of
high-fat meals (etiology) Swallowing difficulty (problem) related to
stroke (etiology)
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Nutrition Diagnosis
Components Signs/Symptoms (Defining
characteristics)
Evidence that problem exists
Linked to etiology by words as evidenced
by
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Nutrition Diagnosis Components
Etiology (Cause/Contributing Factors) Excessive calorie intake (problem) related
to regular consumption of large portions
of high-fat meals (etiology) as evidencedby diet history and weight status
Swallowing difficulty (problem) related to
stroke (etiology) as evidenced by coughing
following drinking of thin liquids (signs andsymptoms)
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Nutrition Diagnosis
Excessive calorie intake (P)
related to regular consumption of large
portions of high-fat meals (E)
as evidenced by diet history & 12 lb wt
gain over last 18 mo (S & S)
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Nutrition Diagnosis
Components 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)
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Nutrition Diagnosis Components
Nutrition Diagnosis Statement should be:
clear, concise
specific
related to one problem
accurate related to one etiology
based on reliable, accurate assessment
data
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Nutritional vs Medical Dx
Medical Diagnosis Nutritional Diagnosis
Diabetes Excessive CHO intake r/t visits to Coldstone Creamery
as evidenced by diet hx and high hs blood glucose
Trauma and closed
head injury
Increased energy needs r/t multiple trauma as
evidenced by results of indirect calorimetry
Liver failure Altered gastrointestinal function r/t cirrhosis of the liver
as evidenced by steatorrhea and growth failure
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Nutritional vs Medical Dx
Medical Dx Nutritional Diagnosis
Obesity Excessive energy intake r/t lack of access to healthy food
choices (restaurant eating) as evidenced by diet history
and BMI of 35.
Dependence mechanical
ventilation
Excessive energy intake r/t high volume PN as evidenced
by RQ >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 lb
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ADAs Nutrition Care
Process Steps
Nutrition Assessment
Nutrition Diagnosis Nutrition Intervention
Nutrition Monitoring and Evaluation
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Nutrition Intervention Definition
Purposely-planned actions designed withthe intent of changing a nutrition-relatedbehavior, risk factor, environmental
condition, or aspect of health status for anindividual, a target group, or population atlarge.
Lacey and Pritchett, JADA 2003;103:1061-
1072
Directed at the etiology or effects of adiagnosis
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Intervention Objectives
Should be patient-centered Must be achievable
Stated in behavioral terms, quantifiable
terms Pt and counselor must establish goals
together
may involve other members of health careteam
What will the patient do or achieve ifobjectives met
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Intervention Objectives
Problem 1: Involuntary weight loss
Objectives:
1. Pt will stop losing wt and begin to gain wt
slowly, to a target wt of 145# 2. Pt will modify his diet to increase intake to
meet calorie and protein needs
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Intervention Objectives
Problem 2: Inadequate protein-energy intake
2 poor appetite
Objectives:
1. Pt will attend senior center for lunch dailyto improve socialization and calorie intake
2. Pt will include nutrient-dense foods in his
diet
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Nutrition Intervention
Intervention translates assessment data
into strategies, activities, or interventions
that will enable the patient or client tomeet the established objectives.
Interventions should be specific:
What? When?
Where? How?
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Nutrition Intervention
Problem 1: Involuntary Weight loss
Intervention:
Pt will try to eat three meals a day plus bedtimesnack
Pt will include at least one nutrient-dense supplement
per day in his diet
Pt will increase energy intake to 1800 kcal per day,complete 3-day food record for analysis of adequacy
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Nutrition Intervention
Problem 2: Inadequate protein-calorieintake 2 poor appetite
Intervention: Pt will include nutrient-dense foods with meals,
especially when appetite is minimal
Patient will begin meal with nutrient-dense foods,
follow with others Pt will attend senior center for lunch daily to
improve socialization/appetite
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ADAs Nutrition Care
Process Steps
Nutrition Assessment
Nutrition Diagnosis Nutrition Intervention
Nutrition Monitoring and Evaluation
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Nutrition Monitoring &
Evaluation
Components
Evaluate outcomesCompare current findings
with previous status,
intervention goals, and/or
reference standards
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What gets Measured?Nutrition
Monitoringand Evaluation
Types of Outcomes
End-result outcome
Direct nutrition outcomes
Clinical and health status outcomes
Patient/client-centered outcomes
Healthcare utilization
Intermediate-result outcome
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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
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NCP Example: Acute Care
Nutrition Assessment
Medical hx: 72 y.o. female admitted with decompensatedCHF; heart failure team consulted; has been admitted withsame dx x 2 in past month; meds: Lasix and Toprol; currentdiet order: 2 gram sodium; has lost 5 pounds in 24 hourssince admission; Output > input by 2 liters
Nutrition history: has been told to weigh self daily but has noscale at home. Does not add salt to foods at the table.
Noticed swollen face and extremities on day prior toadmission. Day before admission ate canned soup for lunchand 3 slices of pizza for dinner; does not restrict fluids; hasnever received nutrition counseling
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NCP Example: Acute Care
Nutrition Diagnosis Excessive sodium intake r/t frequent use of canned
soups and restaurant foods as evidenced by diethistory
Knowledge deficit r/t no previous nutritioneducation as evidenced by frequent use of highsodium convenience foods and inability to namehigh sodium foods
Excess fluid intake r/t dietary indiscretions asevidenced by diet hx and current fluid status
Self-monitoring deficit r/t lack of access to scale asevidenced by patient self report
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NCP Example: Acute Care
Nutrition Intervention
Excessive sodium intake: Patient will attendSenior Feeding site that provides low sodium
meals; Patient will implement survival skills lowsodium diet principles and attend heart failurediet program in heart failure clinic
Self-monitoring deficit: Patient will obtain free
home scale from CHF case manager; will limitfluids to 2 liters/day per instructions in HeartFailure Clinic if adherence to low sodium dietdoes not achieve appropriate fluid balance
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NCP Example: Acute Care
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