Nutrition Care Process

Nutrition Care Process KNH 411

Ø ADA NUTRITION CARE PROCESS AND MODEL Screening & Referral System Ø Identify risk factors Ø Use appropriate tools and methods Ø Involve interdisciplinary collaboration Nutrition Diagnosis Ø Identify and label problem Nutrition Assessment Ø Determine cause/contributing risk Ø Obtain/collect timely and factors appropriate data Ø Cluster signs and symptoms/ Ø Analyze/interpret with defining characteristics evidence - based standards Ø Document Document Relationship Between Patient/Client/Group Nutrition Intervention Dietetics & Ø Plan nutrition intervention · Professional Formulate goals and determine a plan of action Implement the nutrition intervention Ø · Care is delivered and actions Nutrition Monitoring and - are carried out Evaluation Ø Documen t Ø Monitor progress Ø Measure outcome indicators Ø Evaluate outcomes Ø Document Outcomes Management Sys tem Ø Monitor the success of the Nutrition Care Process implementation Ø Evaluate the impact with aggregate data Ø Identify and analyze causes of less than optimal performance and outcomes Ø Refine the use of the Nutrition Care Process

ADA’s Nutrition Care Process Steps • Nutrition Assessment • Nutrition Diagnosis • Nutrition Intervention • Nutrition Monitoring and Evaluation

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.

Nutrition Assessment Components • Gather data, considering • Compare to relevant standards • Identify possible problem areas

Nutrition Assessment: Critical Thinking • 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 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) • Class1: Calorie energy balance • Class2: Oral or nutrition support intake • Class3: Fluid intake balance • Class4: Bioactive substances balance • Class5: Nutrient balance

Nutrition Dx Domains: Clinical Defined as “nutritional findings/problems identified that relate to medical or physical conditions • Class1: functional balance • Class2: biochemical balance • Class3: 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 • Class1: knowledge and beliefs • Class2: physical activity, balance and function • Class3: food safety and access

Nutrition Diagnosis Components • Problem • Etiology • Signs/Symptoms • Signs • Symptoms

Nutrition Diagnosis Components • Problem • Describes alterations in pt’s nutritional status • Diagnostic labels • Impaired • Altered • Inadequate/excessive • Inappropriate • Swallowing difficulty

Nutrition Diagnosis Components • Etiology • Related factors that contribute to problem • Identifies cause of the problem • Helps determine whether nutrition intervention will improve problem • Linked to problem

Nutrition Diagnosis Components • Etiology • Excessive calorie intake related to regular consumption of large portions of high-fat meals • Swallowing difficulty related to stroke

Nutrition Diagnosis Components • Signs/Symptoms • Evidence- that the problem exists • Linked to etiology- “as evidence by”

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

Nutritional vs Medical Dx

Nutrition Intervention Definition • “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

Intervention Objectives 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!

Intervention Objectives • Problem 1: Involuntary weight loss • Objectives: • 1. Increase calorie intake, very specific • 2. Gain X pounds in X month

Intervention Objectives • Problem 2: Inadequate protein-energy intake 2° poor appetite • Objectives: • Increase nutrient dense foods high in protein • Divide up protein rich foods throughout the day • Improve socialization of eating foods

Nutrition Intervention • 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

Nutrition Intervention • Problem 1: Involuntary Weight loss • Intervention: 1. Instruct client on (high protein, high calorie feeding) 2. Gradually increase plan 3. 4.

Nutrition Intervention • Problem 2: Inadequate protein-calorie intake 2° poor appetite • Intervention: 1. Begin with nutrient dense foods 2. 3.

Nutrition Monitoring & EvaluationComponents Evaluate outcomes Compare current findings with previous status, intervention goals, and/or reference standards

What gets Measured? Nutrition Monitoring and Evaluation Types of Outcomes • Direct nutrition outcomes • Clinical and health status outcomes • Patient/client-centered outcomes • Healthcare utilization Intermediate-result outcome End-result outcome

Nutrition Goals and Objectives • Are necessary in order to evaluate • Should be achievable- and based on scientific evidence • Should be directly or indirectly related to nutrition care

NCP Example: Acute 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

NCP Example: Acute Care Nutrition Diagnosis- PESS 1. 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

NCP Example: Acute Care 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

NCP Example: Acute Care Monitoring and Evaluation 1. Monitor BP and tell her to keep a weight log and food log 2. Case manager will monitor readmissions 3.

Nutrition Care Process