Lecture 6 Nutritional Care BY DR UMER FAROOQ

Nutritional Care : Nutritional care is the process of meeting the nutritional requirement of healthy individual for maintenance of health and in case of disease, meeting the changing nutritional needs In a healthy person, nutritional care involves the assessment of the nutritional status, identification of nutritional adequacy along with balanced diet and appropriate dietary habits to maintain health In case of acute or chronic illness, nutritional therapy plays a major role in meeting the patient’s nutritional needs to promote healing and health The Nutrition Care Process (NCP) is designed to improve the consistency and quality of individualized care for patients or groups and the predictability of the patient outcomes

Steps in nutritional care The following five steps are the constituents of nutritional care process 1. Nutrition Assessment 2. Nutrition Diagnosis 3. Nutrition Planning 4. Nutrition Intervention 5. Nutrition Monitoring and Evaluation

1. Nutrition Assessment The purpose of nutritional assessment is to obtain, verify, and interpret data needed to identify nutrition-related problems, their causes, and significance For individuals, data can come directly from the patient through interview, observation and measurements, a medical record, and the referring health care provider. For population groups, data from surveys, administrative data sets, and epidemiological or research studies are used Nutrition Assessment is organized in 5 categories i. Food/Nutrition Related History ii. Anthropometric Measurements iii. Biochemical Data, Medical Tests, and Procedures iv. Nutrition-Focused Physical Findings v. Patient’s personal, medical and social History

2. 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 (e. g. , diabetes). Nutrition Diagnosis is organized into 3 categories i. Intake of Food ii. Clinical Problem iii. Behavioral-Environmental Factors 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.

3. Nutrition Planning a) After determining the diagnosis , implementation of Nutritional care is planned according to the following Basic Principles of Diet Therapy : They are based on the normal requirements of the patient. There are three basic ways to modify the nutritional components of normal diet • Nutrients • Energy • Texture b) Personal Adaptation : Patient’s diet is personalized keeping in view the patient’s personal needs, disease, dietary modifications and food plan

4. Nutrition Intervention 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’s needs It is organized into 4 categories i. Food and/or Nutrient Delivery • Oral diet • Tube feeding • Total Parenteral Nutrition (TPN) • Peripheral vein ii. Nutrition Education iii. Nutrition Counseling iv. Coordination of Nutrition Care

5. 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 Monitoring and Evaluation involves following categories i. Food/Nutrition-Related History Outcomes ii. Anthropometric Measurement Outcomes iii. Biochemical Data, Medical Tests, and Procedure Outcomes iv. Nutrition-Focused Physical Finding Outcomes

The following important points should be considered in evaluating the nutritional care process of an individual patient a) Nutritional Goals b) Accuracy of Care Plan c) Ability to follow diet

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