The Nutrition Care Process

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Nutrition Therapy and Pathophysiology | 3e
Nelms | Sucher | Lacey | Roth
Karen Lacey, MS, RD, CD
University of Wisconsin–Green Bay
The Nutrition Care Process
Chapter 2

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Improving Health Status through
Nutrition Care
• Health status
– Nutrition interventions
• Strategies and focus of care based on status of
health
– Continuum of care
• Totally healthy
• Acute illness
• Chronic disease or condition
• Terminal illness

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Improving Nutritional Status
through Nutrition Care
• Nutrition status
– Human biology factors
– Lifestyle factors
– Food and nutrient factors
– Environmental factors
– System factors
– See Table 2.1

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Factors Affecting Nutritional Status

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Purpose of Providing Nutrition Care
• What is the purpose of nutrition care?
– To restore a state of nutritional balance by
influencing factors contributing to the
imbalance
• R.D.s are highly qualified to do this

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The AND’s Standardized Nutrition
Care Process
• What is the nutrition care process?
– Systematic problem solving method
– Four steps:
• Nutrition assessment
• Nutrition diagnosis
• Nutrition intervention
• Nutrition monitoring and evaluation
– Includes a system of standardized nutrition
language

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Standardized Nutrition Language
• Standardized language
– Uniform terminology used to describe practice
– Provides a common language for
documentation and communication
• Nutrition diagnostic terminology
• Nutrition assessment, monitoring and evaluation
terms
• Nutrition intervention

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Use of the NCP to Improve Quality
of Care
• Consistent structure and framework
– Provides high quality care
– Addresses
• Process of care (systematic and consistent steps
of NCP)
• Content of care (evidence-based practice guides)
– Guides critical thinking
– See Figure 2.2

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Demonstrating Quality

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Critical Thinking Used in the
Nutrition Care Process

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Big Picture of Nutrition Care:
The Model
• Central core
– Relationship between client and dietetics professional
• Individualized and client-focused
• Outer rings
– Environmental factors impacting the client’s ability to
receive and benefit from nutrition care
– Professional strengths of the dietitian
• Supported by other systems
– Screening and referral systems
– Outcomes management systems

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Four Steps of the Nutrition Care
Process and Model

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Step 1: Nutrition Assessment
• Obtain and verify appropriate data
– AND’s Evidence-Based Guides for Practice
• Cluster and organize assessment data
– Food/nutrition-related history
– Anthropometric measurements
– Biochemical data, medical tests, and
procedures
– Nutrition-focused physical findings
– Client history

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Step 1: Nutrition Assessment
(cont’d.)
• Evaluate data using reliable standards
– Comparative standards domain
– Scientifically valid
– Formulate nutrition prescriptions

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Step 2: Nutrition Diagnosis
• Direct link between assessment and
intervention
• Describes a problem for which nutrition-
related activities provide the primary
intervention
– NOT a medical diagnosis
• Three domains
– Intake, clinical, and behavioral-environmental

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Step 2: Nutrition Diagnosis (cont’d.)
• PES statements
– Problem: Diagnostic label
– Etiology: Factors related to cause or
existence of problem
– Signs and symptoms: Defining characteristics
• Stated as “problem (P) related to etiology
(E) as evidenced by signs and symptoms
(S)”

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How is a PES Statement Created?
• Evaluate nutrition assessment
– Find patterns and relationships among data and
causes
• Identify the problem(s)
– Focus on those that can be treated by
nutritional intervention
• Validate and confirm problem(s)
– Use signs and symptoms
• Explore the etiology
– Focus on a nutrition related causes

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How are PES Statements
Evaluated?
• Problem
– Can a dietetics practitioner impact it?
• Etiology
– Is it the root cause?
– Is there an intervention that can address it”
• Signs and symptoms
– Can they be measured?
– Are they sensitive to the intervention?

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Relationship of Nutrition Diagnosis
to the Other Steps in NCP
• Links assessment to intervention
• Uses data to quantify and qualify the
problem
• Base outcome measures on signs and
symptoms
• See Figure 2.4

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Other Steps of the NCP

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Steps of the NCP
• Step 3: Nutrition Intervention
– Prioritize the nutrition diagnoses
– Write the nutrition prescription
– Set goals
– Plan the intervention
– Implement the intervention

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Step 4: Nutrition Monitoring &
Evaluation
• Monitor progress
– Monitor, measure and evaluate on a planned
schedule
• Measure outcomes
– Nutrition, clinical and health status,
patient/client centered, and health care
utilization
• Evaluate outcomes
– Create outcomes management system
– Contribute to the body of evidence-based
research

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Documentation
• Standardized language
• Relevant, accurate, and timely
• Variety of formats are acceptable:
– SOAP
– Focus notes
– PIE
– ADIM
– Electronic Medical Records