Nutrition Care Process
KNH 411
ADA NUTRITION CARE PROCESS AND MODEL
Screening & Referral
System


Identify risk factors
Use appropriate tools
and methods
 Involve
interdisciplinary
collaboration
Nutrition Assessment
 Obtain/collect timely and
appropriate data
 Analyze/interpret with
evidence- based standards
Document
Nutrition Diagnosis
 Identify and label problem

Determine cause/contributing risk
factors
 Cluster signs and symptoms/
defining characteristics
 Document
Relationship
Between
Patient/Client/Group
& Dietetics
Professional
Nutrition Monitoring and
Evaluation

Monitor progress

Measure outcome indicators

Evaluate outcomes
 Document




Outcomes
Management System
Monitor the success of the Nutrition Care
Process implementation
Evaluate the impact with aggregate data
Identify and analyze causes of less than
optimal performance and outcomes
Refine the use of the Nutrition Care
Process
Nutrition Intervention
 Plan nutrition intervention

Formulate goals and
determine a plan of action
Implement the nutrition intervention
 Care is delivered and actions
are carried out
 Document
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
 Determining appropriate data to collect
 Selecting assessment tools
 Distinguishing relevant from irrelevant data
 Organizing data
 Determining when problems require referral
ADA’s Nutrition Care
Process Steps
 Nutrition Assessment
 Nutrition Diagnosis
 Nutrition Intervention
 Nutrition Monitoring and Evaluation
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)
 Class: Calorie energy balance
 Class: Oral or nutrition support intake
 Class: Fluid intake balance
 Class: Bioactive substances balance
 Class: Nutrient balance
Nutrition Dx Domains: Clinical
Defined as “nutritional findings/problems
identified that relate to medical or physical
conditions
 Class: functional balance
 Class: Biochemical balance
 Class: 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
 Class: knowledge and beliefs
 Class: physical activity, balance and function
 Class: 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
 Linked to etiology
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 highfat 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
 based on reliable, accurate assessment data
Nutritional vs Medical Dx
Medical Diagnosis
Diabetes
Trauma and closed
head injury
Liver failure
Nutritional Diagnosis
Nutritional vs Medical Dx
Medical Dx
Obesity
Dependence mechanical
ventilation
Anorexia nervosa
Nutritional Diagnosis
ADA’s Nutrition Care
Process Steps
 Nutrition Assessment
 Nutrition Diagnosis
 Nutrition Intervention
 Nutrition Monitoring and Evaluation
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
 Pt and counselor must establish goals together
 What will the patient do or achieve if objectives met
Intervention Objectives
 Problem 1: Involuntary weight loss
 Objectives:
 1.
 2.
Intervention Objectives
 Problem 2: Inadequate protein-energy intake 2° poor appetite
 Objectives:
1.
2.
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.
2.
3.
4.
Nutrition Intervention
 Problem 2: Inadequate protein-calorie intake 2° poor
appetite
 Intervention:
1.
2.
3.
ADA’s Nutrition Care
Process Steps
 Nutrition Assessment
 Nutrition Diagnosis
 Nutrition Intervention
 Nutrition Monitoring and Evaluation
Nutrition Monitoring & Evaluation
Components
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
 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
1.
2.
3.
4.
NCP Example: Acute Care
Nutrition Intervention
 1.
 2.
 3.
 4.
NCP Example: Acute Care
Monitoring and Evaluation
1.
2.
3.