Nutrition Care Process NCP Nutrition Counseling FNU 425

Nutrition Care Process (NCP) Nutrition Counseling FNU 425 Israa Shatwan Fall 2014

Nutrition Care Process �Nutrition Assessment �Nutrition Diagnosis �Nutrition Intervention �Nutrition Monitoring and Evaluation Israa Shatwan Fall 2014

Israa Shatwan Fall 2014

Israa Shatwan Fall 2014

Nutrition Assessment �Obtain adequate information in order to identify nutritionrelated problems. �Make decision about the nature and cause of nutrition related problems. Israa Shatwan Fall 2014

Nutrition Assessment cont’d Five categories: �Food/Nutrition- Related History (FH). �Anthropometric Measurements (AD). �Biochemical Data, Medical Tests, and Procedures (BD). �Nutrition-Focused Physical Finding s(PD). �Client History (CH). Israa Shatwan Fall 2014

Nutrition Assessment cont’d • Food/Nutrition- Related History: Ø Food and nutrient intake. Ø Food and nutrient administration. Ø Medication/herbal supplement use. Ø Knowledge/beliefs. Ø Food and supplies availability, physical. Israa Shatwan Fall 2014

Nutrition Assessment cont’d • Anthropometric Measurements: Ø Height. Ø Weight. Ø Body mass index (BMI). Ø Growth pattern indices/percentile ranks. Ø Weight history. Israa Shatwan Fall 2014

Nutrition Assessment cont’d �Biochemical Data, Medical Tests, and Procedures: Ø Lab data (e. g. , electrolytes, glucose) and tests (e. g. , gastric emptying time, resting metabolic rate). Israa Shatwan Fall 2014

Nutrition Assessment cont’d �Nutrition-Focused Physical Findings Ø Physical appearance, muscle and fat wasting, swallow function, appetite, and affect. Israa Shatwan Fall 2014

Nutrition Assessment cont’d �Client History: Ø Personal history, medical/health/family history. Ø Treatments and complementary/alternative medicine use. Ø Social history. Israa Shatwan Fall 2014

Case study Israa Shatwan Fall 2014

Case study cont’d �Cardiology, with heart failure Ø 67 years old white male, lives a lone in apartment, on disability, 5’ 6’’, 135#. Ø Heart failure diagnosed 2 months ago, weight loss of 20# from dyspnea, shortness of breath and inability to consume large meals. Ø Unable to shop or cook; uses many processed foods with high sodium intake. Ø Patient’s 24 hour recall shows 1000 -1200 kcal intake. Israa Shatwan Fall 2014

Case study cont’d • Food/Nutrition- Related History Ø Food intake v. Mineral: sodium. v. Types of foods/ meals: convenience frozen meal. v. Amount of food: unable to consume large meals. v. Energy intake: 1000 -1200 kcalday. Israa Shatwan Fall 2014

Case study cont’d • Anthropometric Measurements �Ht 5’ 6’’ �Weight 135# �Weight change 20# in 2 Mo �Biochemical Data, Medical Tests, and Procedures �None �Nutrition-Focused Physical Findings �None Israa Shatwan Fall 2014

Case study cont’d • Client History �Personal data: 67 yr white male. �Social history: lives a lone in apartment, on disability. �Nutrition oriented medical history �Cardiovascular- heart failure in last 2 mo, shortness of breath. Israa Shatwan Fall 2014

Case study cont’d • Comparative standers �Estimated energy needs. � 1600 kcalday to maintain weight. �Weight and growth recommendation. �Recommended body mass index. Israa Shatwan Fall 2014

Case study #1 cont’d FH . AD BD PD CH

Israa Shatwan Fall 2014

Israa Shatwan Fall 2014

Israa Shatwan Fall 2014

Israa Shatwan Fall 2014

Nutrition Diagnosis • Identify and describe a specific nutrition problem that can be resolved or improved through treatment/nutrition intervention by a food and nutrition professional. Israa Shatwan Fall 2014

Nutrition Diagnosis cont’d Three categories: �Intake (NI). �Excessive or Inadequate intake compared to requirements. �Clinical (NC). �Medical or physical conditions that are outside normal. �Behavioral-Environmental (NB). �Knowledge, attitudes, beliefs, physical environment, access to food, food safety. Israa Shatwan Fall 2014

Nutrition Diagnosis cont’d �Nutrition vs Medical Dx Nutrition Diagnosis Diabetes Excessive CHO intake related to evening visits to Coldstone Creamery as evidenced by diet hx and high hs blood glucose. Liver failure Altered gastrointestinal function related to cirrhosis of the liver as evidenced by steatorrhea and growth failure. Israa Shatwan Fall 2014

Nutrition Diagnosis cont’d PES statement: P (problem) related to E (Etiology) as evidence by S (Signs and symptoms) Israa Shatwan Fall 2014

Nutrition Diagnosis cont’d • PES Statement Should Be: Ø Clear. Ø Specific. Ø Related to one problem. Ø Accurate – related to one etiology. Ø Based on reliable, accurate assessment data. Israa Shatwan Fall 2014

Nutrition Diagnosis cont’d �Evaluating Your PES Statement �There are no right or wrong PES statements. �But some are better than others. Israa Shatwan Fall 2014

Nutrition Diagnosis cont’d �Excessive fat intake (NI-5. 6. 2) related to high intake of fried foods and bakery goods as evidenced by diet history and hyperlipidemia �Excessive energy intake (NI-1. 5) related to high intake of fried foods and snack items as evidenced by diet history and BMI �Food/nutrition related knowledge deficit (NB-1. 1) related to lack of education on cholesterol lowering diet as evidenced by history and patient self-report Israa Shatwan Fall 2014

Evaluating PES Statement �P Ø Can the RD resolve or improve the nutrition diagnosis? Ø Consider the Intake Domain as the preferred problem type �E Ø Is the etiology listed the “root cause”? Ø Will RD intervention resolve or improve the problem by addressing the etiology? Ø Can RD intervention at least lessen the symptoms? �S Ø Will measuring the Signs and Symptoms tell you if the problem is resolved or improved? Ø Are the Signs and Symptoms specific enough? � PES Overall Ø Do nutrition assessment data support the nutrition diagnosis, etiology, and Signs and Symptoms? Israa Shatwan Fall 2014

Case study cont’d �Cardiology, with heart failure Ø 67 years old white male, lives a lone in apartment, on disability, 5’ 6’’, 135#. Ø Heart failure diagnosed 2 months ago, weight loss of 20# from dyspnea, shortness of breath and inability to consume large meals. Ø Unable to shop or cook; uses many processed foods with high sodium intake. Ø Patient’s 24 hour recall shows 1000 -1200 kcal intake. Israa Shatwan Fall 2014

which one is PES statement? . . . Israa Shatwan Fall 2014

Israa Shatwan Fall 2014

Israa Shatwan Fall 2014

Israa Shatwan Fall 2014

Israa Shatwan Fall 2014

Israa Shatwan Fall 2014

Israa Shatwan Fall 2014

Nutrition Interventions �Resolve or improve the identified nutrition problem by planning and implementing appropriate nutrition interventions that are tailored to the patient/client’s needs. Israa Shatwan Fall 2014

Nutrition Interventions cont’d Four categories of nutrition interventions: �Food and/or nutrient delivery (ND) �Nutrition education (E) �Nutrition counseling (C) �Coordination of nutrition care (RC) Israa Shatwan Fall 2014

Nutrition Interventions cont’d �Food and/or nutrient delivery (ND) Ø An individualized approach for food/nutrient provision, including meals and snacks, enteral and parenteral feeding, and supplements. Israa Shatwan Fall 2014

Nutrition Interventions cont’d �Nutrition education (E) Ø 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 choices and eating behavior to maintain or improve health. Israa Shatwan Fall 2014

Nutrition Interventions cont’d �Nutrition counseling (C) Ø A supportive process, characterized by a collaborative counselor-patient relationship, to set priorities, establish goals, and create individualized action plans that acknowledge and foster responsibility for self-care to treat an existing condition and promote health. Israa Shatwan Fall 2014

Nutrition Interventions cont’d �Coordination of nutrition care (RC) �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. Israa Shatwan Fall 2014

Nutrition intervention is accomplished in two distinct and interrelated steps: 1 2 • planning • implementing Israa Shatwan Fall 2014

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 diagnosis 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. Israa Shatwan Fall 2014

Implementation is the action phase and involves: a. communication of the nutrition care plan b. carrying out the plan. ˗ ﺧﻄﺔ ˗ ﺗﻨﻔﻴﺬﻫﺎ - Israa Shatwan Fall 2014

Applying the Nutrition Care Process: Nutrition Diagnosis and Intervention https: //www. andeal. org/files/file/Skipper_Article%20%282%29. pdf Israa Shatwan Fall 2014

Case study �Nutrition prescription: 1600 -2000 calorie diet with small frequent meals and 1 -2 8 oz serving of a medical food supplement (contributing = 600 calorie). Israa Shatwan Fall 2014

Case study cont’d �Food and/or nutrient delivery (ND) Ø Medical food supplements. �Nutrition education (E) Ø Skill development- shop and cooking. �Nutrition counseling (C) Ø Cognitive behavioral theory. Ø Problem solving. �Coordination of nutrition care (RC) Ø Referral to community agencies. Israa Shatwan Fall 2014

Nutrition Monitoring and Evaluation �determine the amount of progress made and whether goals/expected outcomes are being met. �Nutrition monitoring and evaluation identifies patient/client* outcomes relevant to the nutrition diagnosis and intervention plans and goals. Israa Shatwan Fall 2014

Nutrition Monitoring and Evaluation cont’d Four categories : �Food/Nutrition-Related History Outcomes. �Anthropometric Measurement Outcomes. �Biochemical Data, Medical Tests, and Procedure Outcomes. �Nutrition-Focused Physical Finding Outcomes. Israa Shatwan Fall 2014

Case study �Patient verbalized moderate understanding of how to prepare food meals and plan meals and snacks using a shopping list. �Area and level of knowledge (FH-3. 1. 1) moderate prepare and plan meals and snacks. Israa Shatwan Fall 2014

Case study cont’d �Plan to monitor energy intake and activities of daily living related to physical and cognitive ability to plan and prepare meals snacks at next visit. �Energy intake (FH-1. 2. 1. 1). �Physical activity and function- physical and cognitive ability to complete task for meal preparation (FH-6. 2. 1 and FH 6. 2. 6). Israa Shatwan Fall 2014

Case study cont’d Follow up �Energy intake is now at 1500 calories, only 100 less than estimated requirements (FH 1. 2. 1. 1). �Evaluation of food and nutrition history shows that ADLs (Activities of Daily Living) related to meal planning and preparation have improved and patient is now able to plan meals snacks using a shopping list for 4 of the 7 days of the week and is preparing food for 18 meals per week. (FH 6. 2. 1 and FH 6. 2. 6). Israa Shatwan Fall 2014