nutrition care process PDF

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Summary

nutrition care process is a unit that helps the learner to understand how to manage diseases nutritionally...

Description

1.0 Introduction to Nutrition care Process 1.1 Meaning of terms 1.2 Relationship between nutrition and disease

“Interactions of Nutrition and Infection (disease) is a synergistic one Malnutrition can make a person more susceptible to infection, and infection also contributes to malnutrition, which causes a vicious cycle. An inadequate dietary intake leads to weight loss, lowered immunity, mucosal damage, invasion by pathogens, and impaired growth and development in children A sick person’s nutrition is further aggravated by diarrhea, malabsorption, loss of appetite, diversion of nutrients for the immune response, and urinary nitrogen loss, all of which lead to nutrient losses and further damage to defense mechanisms. These, in turn, cause reduced dietary intake. In addition, fever increases both energy and micronutrient requirements. Malaria and influenza, for example, have mortality rates proportionate to the degree of malnutrition

1.3 Role of health professionals in nutrition care process

A healthcare professional’s role in nutritional care varies depending on the job. Depending on the nature of the problem, a healthcare team might include physicians, nurses, nutritionists, dietitians, and others such as pharmacists, mental health counselors, and physical therapists.

A nutrition professional can advise, counsel, coordinate, educate, guide, inform, suggest, and support. A nutrition professional can develop a comprehensive nutrition program, including nutrition and lifestyle goals.

The role of a nurse in nutrition care process is to assess and educate. The nurse develops a nutrition plan and tell the patient what to eat.

1.4 Steps in nutrition care process

Nutrition care process [NCP] is a systematic approach to providing high quality nutrition care and is visually summarized by the Nutrition Care Model.

Etiology [Causes/ Contributing factors] 

Related factors that contribute to problem



Identifies cause of the problem



Helps determine whether nutrition intervention will improve problem



Note: etiology may not always be clear

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. Components of Nutrition assessment 

Gather data, considering



Compare to relevant standards



Identify possible problem areas

Nutritional Assessment Critical thinking 

Observe



Determining appropriate data to collect



Selecting assessment tools



Distinguishing relevant from irrelevant data



Organizing data

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Determining when problems require referral

Nutrition Diagnosis 

Nutritional problem



Names and describes the problem



Problem may already exist, or may be at risk of occurring



Not a medical diagnosis

Nutrition Dx Domains: 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



Class: Nutrient balance

Nutrition Dx Domains: Clinical Defined as “nutritional findings/problems identified that relate to medical or physical conditions 

Class: functional balance



Class: Biochemical balance



Class: weight balance

Nutrition Dx Domains: Behavioral-Environmental Defined as “nutritional findings/problems identified that relate to knowledge, attitudes/beliefs, physical environment, or access to food and food safety 

Class: knowledge and beliefs



Class: physical activity, balance and function



Class: food safety and access

Components of Nutrition Diagnosis 

Problem



Etiology



Signs/Symptoms

o Signs o 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



Excessive calorie intake related to regular consumption of large portions of high-fat meals



Swallowing difficulty related to stroke

Signs/Symptoms 

Evidence



Linked to etiology

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

Nutrition Diagnosis  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

Nutrition Diagnosis Components 

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  based on reliable, accurate assessment data 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.” –



Directed at the etiology or effects of a diagnosis

Intervention Objectives Should be patient-centered 

Must be achievable



Stated in behavioral terms



Pt and counselor must establish goals together



What will the patient do or achieve if objectives met

Intervention Objectives  Problem 1: Involuntary weight loss  Objectives:

1… 2.  Problem 2: Inadequate protein-energy intake 2° poor appetite  Objectives: 1. 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.  Problem 2: Inadequate protein-calorie intake 2° poor appetite  Intervention: 1. 

Should be targeted at etiology



If not etiology, then signs and symptoms

Four categories of nutrition interventions: 

Food and/or nutrient delivery



Nutrition education



Nutrition counseling



Coordination of nutrition care

Nutrition Monitoring and Evaluation 

Monitor progress and determine if goals are met



Identifies patient/client outcomes relevant to the nutrition diagnosis and intervention plans and goals



Measure and compare to client’s previous status, nutrition goals, or reference standards

Evaluate outcomes 

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

What gets Measured

Nutrition Goals and Objectives 

Are necessary in order to evaluate



Should be achievable



Should be directly or indirectly related to nutrition care

2.0 Nutrition assessment

The process of estimating the nutritional position of an individual or group, at a given point in time, by using proxy measurements of nutritional adequacy. It provides an indication of the adequacy of the balance between dietary intake and metabolic requirements It can be done at the community level OR individual level

Nutritional assessment is the interpretation of anthropometric, biochemical (laboratory), clinical and dietary data to determine whether a person or groups of people are well nourished or malnourished (over-nourished or under-nourished) Aim: To discover facts useful in guiding actions intended to improve nutritional status and health at either individual or community level 2.1 Importance of nutrition assessment data 





Diagnostic tool for both individuals or groups of people: •

Does a problem exist?

•

Is there a risk of the problem developing?

•

What is the magnitude of the problem

Monitoring tool for both individuals or groups of people: 

Has the situation changed?



What is the direction and magnitude of change?



Is there a trend or a pattern?

Evaluation tool for both individuals or groups of people 

This is applicable where an on-going programme, treatment, or intervention is to be evaluated.



It is useful in determining if the intended effect (impact/recovery) has been achieved e.g. Nutrition Rehabilitation Programme



Targeting tool (groups only) 

To what group, geographic area, during which period does one focus the intervention? E.g. Which province had the highest prevalence of malnutrition, which age group, or what socio-economic status of people have the highest prevalence of a deficiency etc?

Importance of nutrition assessment 

To identify people at risk of malnutrition for early intervention or referral before they become malnourished y



To identify malnourished clients for treatment—malnourished people who are not treated early have longer hospital stays, slower recovery from infection and complications, and higher morbidity and mortality



To track child growth



To identify medical complications that affect the body’s ability to digest food and utilize nutrients

2.2 Source of nutrition assessment data Nutritional assessment can be done using the ABCD methods. These refer to the following: 

A.Anthropometry



B.Biochemical/biophysical methods

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C.Clinical methods

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D.Dietary methods.

2.3 Types of nutrition assessment data 2.4 Critical thinking in nutrition assessment

3.0 Nutrition diagnosis The purpose of a nutrition diagnosis is to identify and describe a specific nutrition problem that can be resolved or improved through treatment/nutrition intervention by a food and nutrition professional. A nutrition diagnosis (e.g., inconsistent carbohydrate intake) is different from a medical diagnosis. (eg diabetes).

Food and nutrition professionals use nutrition assessment data to identify and label the patient/client’s* nutrition diagnosis using standard nutrition diagnostic terminology. There is a reference sheet for each nutrition diagnosis that includes its definition, possible etiology/causes, and common signs or symptoms identified in the nutrition assessment step Terminology for nutrition diagnosis is organized in 3 domains (categories)

Intake Too much or too little of a food or

Clinical Nutrition problems that

Behavioral Environment Knowledge, attitudes, beliefs,

nutrient compared to actual or

relate to medical or

physical environment, access to

estimated need

physical conditions

food, or food safety

Documenting a nutrition diagnosis:

Food and nutrition professionals write a PES (Problem, Etiology, Signs and Symptoms) statement to describe the problem, its root cause, and the assessment data that provide evidence for the nutrition diagnosis.

The format for the PES statement is “[Nutrition diagnosis term (problem)] related to [Etiology] as evidenced by [Signs/Symptoms].”PES (P) Problem or Nutrition

(E)Etiology

(S) Signs/Symptoms

Diagnosis Term Describes alterations in the

Cause/Contributing Risk

Data or indicators used to

patient/client’s nutritional

Factors

determine the patient/client's

Linked to the nutrition

nutrition diagnosis. Linked to the etiology by the

diagnosis term by the words

words “as evidenced by.”

status

“related to.” No nutrition diagnosis at this time (NO-1.1) may be documented if the assessment indicates that no nutrition problem exists to justify a nutrition intervention or if further nutrition assessment data are needed to identify a nutrition diagnosis Guidelines for selecting the nutrition diagnosis and writing a clear PES statement: Select the most important and urgent problem to be addressed. When writing the PES statement, food and nutrition professionals can ask a series of questions (identified in the critical thinking skills section below) that help clarify the nutrition diagnosis.

Critical thinking skills: P – Can the nutrition professional resolve or improve the nutrition diagnosis of the patient/client? When all things are equal and there is a choice between stating the PES statement using two nutrition diagnoses from different domains, consider the Intake nutrition diagnosis as the one more specific to the role of the RDN.

E – Evaluate whether the etiology is the specific “root cause” that can be addressed with a nutrition intervention. If addressing the etiology cannot resolve the problem, can the RDN intervention at least lessen the signs and symptoms? S – Will measuring the signs and symptoms indicate if the problem is resolved or improved? Are the signs and symptoms specific enough that the RDN can monitor (measure/evaluate changes) and document resolution or improvement of the nutrition diagnosis?

4.0 Nutrition interventions The purpose of a nutrition intervention is to resolve or improve the nutrition diagnosis or nutrition problem by provision of advice, education, or delivery of the food component of a specific diet or meal plan tailored to the patient/client’s* needs. Determining a nutrition intervention: The nutrition diagnosis and its etiology drive the selection of a nutrition intervention. Nutrition intervention strategies are selected to change nutritional intake, nutrition-related knowledge or behavior, environmental conditions, or access to supportive care and services. Nutrition intervention goals provide the basis for monitoring progress and measuring outcomes Terminology for nutrition intervention is organized in 4 domains (categories):

Food and/or Nutrient Delivery Individualized approach for food/nutrient provision

Nutrition Education A formal process to instruct or train a patient/client in a skill or to impart knowledge to help patients/clients voluntarily manage or modify food, nutrition and physical activity choices and behavior to maintain or improve health

Use of nutrition intervention terminology:

Nutrition Counseling A supportive process, characterized by a collaborative counselorpatient relationship, to establish food, nutrition and physical activity priorities, goals, and individualized action plans that acknowledge and foster responsibility for self-care to treat an existing condition and promote health

Coordination of Nutrition Care Consultation with, referral to, or coordination of nutrition care with other health care providers, institutions, or agencies that can assist in treating or managing nutritionrelated problems

Nutrition intervention is accomplished in two distinct and interrelated steps: planning and implementing. Planning the nutrition intervention involves: a. Prioritizing nutrition diagnoses b. Consulting the academy's evidence-based nutrition practice guidelines and other practice guidelines c. Determining patient-focused expected outcomes for each nutrition diagnosisd. d. Conferring with patient/client/caregivers e. Defining a nutrition intervention plan and related strategies f. Defining time and frequency of care g. Identifying resources needed. Implementation is the action phase and involves: a. Communication of the nutrition care plan b. Carrying out the plan.

Critical thinking skills: 

Setting goals and prioritizing



Defining the nutrition prescription or basic plan



Making interdisciplinary connections



Initiating behavioral and other nutrition interventions



Matching nutrition intervention strategies with patient/client’s needs, nutrition diagnosis, and values

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Choosing from among alternatives to determine a course of action



Specifying the time and frequency of car

4.7 Components of nutrition interventions 4.8 Planning nutrition intervention 5.0 Nutrition monitoring and evaluation 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. The aim is to promote more uniformity within the dietetics profession in assessing the effectiveness of nutrition intervention.

Determining what to measure for nutrition monitoring and evaluation: Practitioners should select nutrition care indicators that will reflect a change as a result of nutrition care. The monitoring and evaluation phase should be considered during the assessment phase, while determining the Nutrition Diagnosis and the Nutrition Intervention. Additional factors to consider are the medical diagnosis, health care outcome goals, nutrition quality management goals, practice setting, patient/client population, and disease state and/or severity

Terminology for nutrition monitoring and evaluation is organized in 4 domains (categories)**:

Food/Nutrition-Related History Outcomes

Anthropometric Measurement Outcomes

Food and nutrient intake, food and nutrient administration, medication, complementary/alternati ve medicine use, knowledge/beliefs, food and supplies availability, physical activity, nutrition quality of life

Height, weight, body mass index (BMI), growth pattern indices/percentil e ranks, and weight history

Biochemical Data, Medical Tests, and Procedure Outcomes Lab data (e.g., electrolytes, glucose) and tests (e.g., gastric emptying time, resting metabolic rate)

Nutrition-Focused Physical Finding Outcomes Physical appearance, muscle and fat wasting, swallow function, appetite, and affect