Exploring the Nutrition Care Process
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Transcript Exploring the Nutrition Care Process
EXPLORING THE
NUTRITION CARE PROCESS
Roxanne Davis-Cote, MPH, RD, LD
Beaufort Memorial Hospital
NUTRITION CARE PROCESS
Today’s Objectives:
Describe the 4 Components of the Nutrition Care
Process (NCP)
Devise a nutrition diagnostic statement in the PES
format using standardized language
Prepare at least 1 measurable goal that would
positively affect the nutrition diagnosis identified by
the interventions implemented
NUTRITION CARE PROCESS
Acronym for components: ADIME
Assessment (A)
Diagnosis (nutrition diagnosis) (D)
Intervention (I)
Monitor/Evaluate (M/E)
ASSESSMENT
In-depth review of the medical record
Effective interviewing of patient,
caregiver, family, groups (when appropriate)
Attention to nutrition-focused physical findings
Collaboration with other health care providers
for additional insight
ASSESSMENT
Domains to Review
Food/Nutrition Related History
Anthropometric Measurements (wt, ht, BMI, growth
patterns, wt history)
Biochemical Data, Medical Tests, Procedures (labs,
medications, procedures)
Nutrition-Focused Physical Findings (findings from
evaluation of body systems to include muscle and
subcutaneous fat wasting, oral health,
suck/swallow/breath ability, appetite, affect)
Client History (past medical history, social history,
pertinent procedures)
ASSESSMENT
Critical thinking during this step
Determine necessary data to collect
Distinguish between relevant and irrelevant information
Validate the data
Determine need for any additional information
Select appropriate assessment tools
Apply assessment tools in reliable and valid ways
Ex: Predictive equations vs. Indirect calorimetry
Nutrition Care Indicators
NUTRITION CARE INDICATORS
Defined markers that can be observed and
measured
Incorporated in the Assessment Domains
Ex: Food/Nutrition Related History:
food/nutrient intake, medications, food/nutrition-related
knowledge, food access, functional capabilities
Determines what will be measured
DIAGNOSIS
Nutrition Diagnosis (PES Format)
“The identification and labeling of the specific
nutrition problem that food and nutrition
professionals are responsible for treating
independently”- IDNT Reference Manual 3rd
Edition
DIAGNOSIS
PES Statement
Problem: Required to use EXACT WORDING as
Standardized Language
Actual or Predicted
5 New Diagnoses added using the word “predicted”
Predicted Suboptimal Energy Intake (NI-1.6)
Predicted Excessive Energy Intake (NI-1.7)
Predicted Suboptimal Nutrient Intake (NI-5.11.1)
Predicted Excessive Nutrient Intake (NI-5.11.2)
Predicted Food-Medication Interaction (NC-2.4)
DIAGNOSIS
Etiology: Explains WHY the Problem exists
Do NOT need to use exact wording from IDNT
references
Can use another diagnosis (but if done, MUST use
standardized language)
Signs/Symptoms: Gives Proof as to why a
nutrition problem exists
Measurable data
Potential outcome data
DIAGNOSIS
Determining the Nutrition Diagnosis
3 Domains: Intake, Clinical, Behavior-Environmental
When there are 2 equally acceptable choices for a
problem from 2 different domains, choose from the
intake domain
The Intake Domain will likely have a nutritional
etiology therefore likely will have a nutrient-directed
intervention
DIAGNOSIS
Considerations for determining Nutrition
Problem:
Assessment data
Is there anything nutritionally abnormal?
What can you as a dietitian affect?
Go over the problem using your own words
DIAGNOSIS
Examples:
Inadequate oral intake related to (r/t) decreased
appetite and mouth sores as evidenced by (AEB) pt
eating <50% meals and often skipping meals
Inadequate Enteral Nutrition (EN) infusion r/t
nausea and vomiting AEB frequent feeding
interruptions, 5 episodes of vomiting yesterday, and
<50% infusion goal met over the past 3 days
PRACTICE TIME
Formulate a Diagnosis Statement in the PES
format using Standardized Language
Split up into groups
Review Case Study in your area
10 minutes
Choose someone to present your diagnosis statement
INTERVENTION
The nutrition-related plan designed to improve
the nutrition diagnosis/etiology/signs and
symptoms
1st step is Nutrition Prescription:
Individualized statement of needs the patient has at
a given moment
May be adjusted as clinical picture changes
Examples:
1800kcal, 65g protein/day
Intake of 2gm K+/day
Can include preventative interventions
The main heading MUST use the standardized
language
INTERVENTION
Examples:
Meals and Snacks: Continue current diet. Will send
snacks tid.
Medical Food Supplements: recommend addition of
oral supplement 2 times/day
Vitamin and Mineral Supplements: MD please
consider addition of MVI daily
Nutrition-Related Medication Management: consider
addition of appetite stimulant
MONITOR/EVALUATE
Helps the nutrition professional to determine
whether there has been any progress made in the
patient/client nutrition status and whether
goals/expected outcomes are being met
Monitors progress towards goals
Compares nutrition care indicators against the
patient’s baseline or evidence-based indicators
MONITOR/EVALUATE
3 Steps to M/E:
Monitor: Provide evidence showing if nutrition
interventions are improving patient nutrition
behavior or status
Measure: Collect data on appropriate nutrition care
indicators
Evaluate: Compare current findings with previous
nutrition information, goals, or reference standards
and evaluate the impact of each intervention using
measurable nutrition outcome indicators
MONITOR/EVALUATE
Characteristics of M&E:
Measurable: Use of evidence-based standards or
guidelines
Related to PES Statement
Guides nutrition intervention planning
Communicates expected outcomes
Patient-centered and individualized
At least 1 goal for each nutrition diagnosis
MONITOR/EVALUATE
Examples:
Weight: patient to maintain wt of ___+/- 2kg
Liquid Meal Replacement or supplement: Patient will
drink ____oral supplements/day
Food and Beverage Intake: Patient will eat 75-100%
of 3 meals/day
Enteral Nutrition Intake: Patient will reach goal
infusion rate within 24 hours
PRACTICE
•
Identify at least 1 intervention be for the nutrition
problem you diagnosed
•
Review Same Case study
Prepare at least 1 measurable goal that would
positively affect the nutrition diagnosis identified by the
intervention(s) implemented
REASSESSING NUTRITION STATUS
Ways to document progress of a Nutrition
Diagnosis in Reassessment
Nutrition Diagnosis Progress Report
Monitoring and Evaluating
Data under Assessment- documented in assessment
portion of note
REASSESSING NUTRITION STATUS
Nutrition Diagnosis Progress Report
Progress explained in the PES statement using words
such as:
Improved or progress toward resolution
Continues or ongoing
Resolved
Worsened
No progress
No longer applicable
REASSESSING NUTRITION STATUS
Monitoring and Evaluating:
Evaluates progress towards goals
How effective have the interventions been?
M&E standards may change in reassessment
Goals change according to evolving conditions
Has initial diagnosis resolved but a new one
developed?
When a nutrition diagnosis is resolved, drop it in the
next reassessment
In Reassessments, designate new nutrition diagnosis
under New Nutrition Diagnosis heading
WORKING NCP INTO YOUR PRACTICE
How Can I incorporate NCP into the way I currently
document?
ADIME
Assess, Diagnose,
Intervene, Monitor,
Evaluate
PGIE (Problem, Goal,
Intervention, Evaluation):
Problem: PES Statement
Goal: Nutrition
Prescription
Intervention: Nutrition
Intervention/goal
Evaluate: Evaluate
SOAP
S: Food/Nutr Related history,
Any other data if self-reported
O: Biochemical data, medical
tests (data documented by RD
or found in medical record)
A: Comparative Standards
Nutrition Diagnosis
P:Intervention
Monitor/Evaluate
PIE (Problem, Intervention,
Evaluation)
P: PES Statement
I: Nutrition Intervention
E: Evaluation
QUESTIONS?