Nutrition and Diet Therapy – Lecture

STUDENT ACTIVITY SHEET BS NURSING / SECOND YEAR

Session # 2

LESSON TITLE: Nutrition Care Process Materials:

Pen and notebook
LEARNING OUTCOMES:
At the end of the lesson, you can:
1. Define the Nutrition Care Process;
2. Assess the nutritional status of given clientusing
relevant parameters appropriate nutritional
assessment tools.;
3. Formulate with client relevant nutrition diagnosis;
4. Implement safe and quality interventions with the
client to address the nutritional needs, problems and
issues;
5. Provide health education in nutrition and diet therapy
to targeted clientele (individual, family, population Reference:
groups, or community); and, https://www.ncpro.org/nutrition-care-process
6. Manage resources (human, physical, financial,time)
efficiently and effectively.

LESSON PREVIEW/REVIEW
Let us have a review of what you have learned from the previous lesson. Kindly identify what label each image represents
with their definition. You may use the back page of this sheet, if necessary. Have fun!

1 2 3

1. Structure-function claims: describe the effect that a substance has on the structure or function of the body and
do not make reference to a disease

2. Health Claims: characterize the relationship of a food or food component to a disease or health-related
condition.
3. Nutrient Claims: characterize the level of nutrient in the food.

MAIN LESSON
You will study and read their book, if available, about this lesson.

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NUTRITION CARE PROCESS (ADIME)

The Nutrition Care Process (NCP) is a systematic approach to providing high quality nutrition care. The NCP consists of
four distinct, interrelated steps:

1. Nutrition Assessment: The dietitian/nutritionist collects and documents information such as food or nutrition-
related history; biochemical data, medical tests and procedures; anthropometric measurements, nutrition-focused
physical findings and client history.

2. Nutrition Diagnosis: Data collected during the nutrition assessment guides the dietitian/nutritionist in selection of
the appropriate nutrition diagnosis (i.e., naming the specific problem).

3. Nutrition Intervention: The dietitian/nutritionist then selects the nutrition intervention that will be directed to the
root cause (or etiology) of the nutrition problem and aimed at alleviating the signs and symptoms of the diagnosis.

4. Nutrition Monitoring/Evaluation: The final step of the process is monitoring and evaluation, which the
dietitian/nutritionist uses to determine if the client has achieved, or is making progress toward, the planned goals.

Using the NCP does not mean that all clients get the same care. Use of a care process provides a framework for the
dietitian/nutritionist to individualize care, taking into account the client’s needs and values and using the best evidence
available to make decisions.

The Nutrition Care Process

NCP Step 1: Nutrition Assessment

Purpose: Nutrition Assessment is a systematic approach to collect, classify, and synthesize important and relevant data
needed to identify nutrition-related problems and their causes. This step also includes reassessment for comparing and
re-evaluating data from the previous interaction to the next and collection of new data that may lead to new or revised
nutrition diagnoses based on the client’s status or situation It is an ongoing, dynamic process that involves initial data
collection and continual reassessment and analysis of the client’s* status compared to accepted standards,
recommendations, and/or goals. This contrasts with nutrition monitoring and evaluation where nutrition and dietetics
practitioners use the same data to determine changes in client behavior, nutritional status, and the efficacy of nutrition
intervention.

Finding Nutrition Assessment Data: For individuals, data can come directly from the patient/client through interview,
observation and measurements, a health record, and the referring health care provider. For population groups, data from
surveys, administrative data sets, and epidemiological or research studies are used.

Terminology for nutrition assessment is organized in five domains (categories):

Biochemical Data,
Food/Nutrition-Relat Anthropometric Nutrition-Focused
Medical Tests, and Client History
ed History Measurements Physical Findings
Procedures
Food and nutrient Height, weight, body Lab data (e.g., Physical appearance, Personal history,
intake, food and mass index (BMI), electrolytes, glucose) muscle and fat medical/health/family
nutrient growth pattern and tests (e.g., gastric wasting, swallow history, treatments
administration, indices/percentile emptying time, resting function, appetite, and and
medication, ranks, and weight metabolic rate) affect complementary/altern
complementary/altern history ative medicine use,
ative medicine use, and social history
knowledge/beliefs,
food and supplies
availability, physical
activity, nutrition
quality of life.

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Use of Nutrition Assessment Data: Nutrition assessment data, or indicators, are compared to reference standards,
recommendations, or goals. These norms and standards may be national, institutional, or regulatory. Nutrition
assessment findings are then communicated in nutrition diagnosis (problem) statements and nutrition intervention goal
setting

NCP Step 2: Nutrition Diagnosis

Purpose: Nutrition Diagnosis is a nutrition and dietetics practitioner’s identification and labeling of an existing nutrition
problem(s) that the practitioner is responsible for treating. Nutrition diagnoses (e.g., inconsistent carbohydrate intake) are
different from medical diagnoses (e.g., diabetes).
Determining a Nutrition Diagnosis: Nutrition and dietetics practitioners use standard nutrition diagnostic terminology to
label the client’s nutrition diagnosis(es) through organized nutrition assessment data that are clustered for comparison
with defining characteristics listed on the reference sheets. The eNCPT provides a reference sheet for each nutrition
diagnosis that includes its definition, possible etiology/causes, and common signs or symptoms identified in the Nutrition
Assessment step.

Terminology for Nutrition Diagnosis is organized in three domains (categories):

Intake Clinical Behavioral-Environmental
Too much or too little of a food or Nutrition problems that relate to Knowledge, attitudes, beliefs,
nutrient compared to actual or medical or physical conditions physical environment, access to food,
estimated needs or food safety

Communicating a Nutrition Diagnosis: Nutrition and dietetics practitioners write a PES (Problem, Etiology, Signs and
Symptoms) statement to describe each problem, the root causes, and the assessment data that provide evidence for the
nutrition diagnosis(es).

The format for each PES statement is “[Nutrition diagnosis term (problem)] related to [etiology] as evidenced by
[signs/symptoms].”

(P) Problem or Nutrition Diagnosis (E) Etiology (S) Signs/Symptoms

Term
Cause/Contributing Risk Factors Data or indicators used to determine
Describes alterations in the client’s Linked to the nutrition diagnosis term the client's nutrition diagnosis.
nutritional status. by the words “related to.”
Linked to the etiology by the words
“as evidenced by.”
No nutrition diagnosis at this time (NO-1.1) may be documented if the assessment indicates that no nutrition problem exists to justify a
nutrition intervention.

Guidelines for Writing a Clear PES Statement:

When writing the PES statement, nutrition and dietetics practitioners can ask a series of questions that help clarify the
nutrition diagnosis(es).

Critical thinking skills:

P – Can the nutrition and dietetics practitioner resolve or improve the client's nutrition diagnosis? When all things are
equal and there is a choice between stating a PES statement using two nutrition diagnoses from different domains,
consider the Intake nutrition diagnosis as the one more specific to the role of the dietitian/nutritionist.

E – Evaluate whether the etiology for each problem is the specific “root cause” that can be addressed with a nutrition
intervention. If addressing the etiology cannot resolve the problem, can the dietitian/nutritionist intervention at least
lessen the signs and symptoms?

S – Will measuring the signs and symptoms indicate if the problem is resolved or improved? Are the signs and symptoms
specific enough to monitor (measure/evaluate changes) and communicate resolution or improvement of a nutrition
diagnosis?

PES Overall – Do the nutrition assessment data support the nutrition diagnosis, etiology, and signs and symptoms?

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NCP Step 3: Nutrition Intervention

Definition: A nutrition intervention is a purposely planned action(s) designed with the intent of changing a nutrition-related
behavior, risk factor, environmental condition, or aspect of health status to resolve or improve the identified nutrition
diagnosis(es) or nutrition problem(s). Nutrition interventions are selected and tailored to the client needs by planning and
implementing appropriate interventions.

Determining a nutrition intervention: The nutrition diagnosis and its etiology drive the selection of a nutrition
intervention. The nutrition intervention is typically directed toward resolving the nutrition diagnosis(es) by altering or
eliminating the nutrition etiology(ies). Less often, it is directed at relieving the signs and symptoms of the nutrition problem
or problems. Nutrition intervention goals, ideally, developed collaboratively with the client, provide the basis for monitoring
progress and measuring outcomes.

Terminology for Nutrition Intervention is organized in five domains (categories):

Food and/or Nutrition Education Nutrition Coordination of Population Based
Nutrient Delivery Counseling Nutrition Care Nutrition Action
Customized A formal process to A supportive Consultation with, Interventions
approach for instruct or train a process, referral to, or designed to improve
food/nutrient client in a skill or to characterized by a coordination of the nutritional
provision. impart knowledge to collaborative nutrition care with well-being of a
help clients counselor-client other health care population.
voluntarily manage or relationship, to providers,
modify food, nutrition, establish food, institutions, or
and physical activity nutrition and physical agencies that can
choices and behavior activity priorities, assist in treating or
to maintain or goals, and action managing
improve health plans that nutrition-related
acknowledge and problems
foster responsibility
for self-care to treat
an existing condition
and promote health.

Use of Nutrition Intervention Terminology:

Nutrition intervention is accomplished in two distinct and interrelated steps: planning and implementing

Planning the nutrition intervention involves:

⎯ Prioritizing nutrition interventions based on urgency, impact, and available resources
⎯ Collaborating with the client to identify goals of the intervention for each diagnosis
⎯ Writing a nutrition prescription based on a client’s customized recommended dietary intake of energy and/or
selected food or nutrients based on current reference standards and dietary guidelines and a client’s health
condition and nutrition diagnosis
⎯ Selecting specific nutrition intervention strategies that are focused on the etiology of the problem and that are
known to be effective based on best current knowledge and evidence
⎯ Defining the time and frequency of care, including intensity, duration, and follow-up

Implementation is the action phase and involves:

⎯ Collaborating with the client to carry out the plan of care
⎯ Communicating the nutrition care plan
⎯ Modifying the plan of care as needed
⎯ Following up and verifying that the plan is being implemented
⎯ Revising strategies based on changes in condition or response to intervention

NCP Step 4: Nutrition Monitoring and Evaluation

Definition: The purpose of nutrition monitoring and evaluation is to determine and measure the amount of progress made
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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. Nutrition
Monitoring and Evaluation identifies outcomes/indicators relevant to the diagnosis and nutrition intervention plans and
goals.

During the first interaction, appropriate outcomes/indicators are selected to be monitored and evaluated at the next
interaction. During subsequent interactions, these outcomes/indicators are used to demonstrate the amount of progress
made and whether the goals or expected outcomes are being met. Factors to consider when selecting indicators are the
medical diagnosis, health care outcomes, client goals, nutrition quality management goals, practice setting, client
population, and disease state and/or severity.

Terminology for Nutrition Monitoring and Evaluation is organized in four domains (categories)
Food/Nutrition-Related Anthropometric Biochemical Data, Nutrition-Focused
History Outcomes Measurement Outcomes Medical Tests, and Physical Finding
Procedure Outcomes Outcomes
Food and nutrient intake, Height, weight, body mass Lab data (eg., electrolytes, Physical appearance,
food and nutrient index (BMI), growth pattern glucose) and tests (eg, muscle and fat wasting,
administration, medication, indices/percentile ranks, gastric emptying time, swallow function, appetite,
complementary/alternative and weight history resting metabolic rate) and affect
medicine use,
knowledge/beliefs, food
and supplies availability,
physical activity, nutrition
quality of life

Collection and Use of Nutrition Monitoring and Evaluation Outcome Data: This step consists of three components:
monitoring, measuring, and evaluating the changes in nutrition care indicators. Practitioners monitor by providing
evidence that the nutrition intervention is or is not changing the client’s behavior or status. They measure outcomes by
gathering data for outcomes/indicators. Finally, nutrition and dietetics practitioners compare the current findings with
previous status, nutrition intervention goals, and/or reference standards and evaluate the overall impact of the nutrition
intervention on the client’s nutrition diagnosis(es) and health outcomes. The use of standardized indicators and criteria
increases the validity and reliability of outcome data collection, communication, and aggregation of data for reporting
outcomes of the nutrition and dietetics practitioner’s interventions.

CHECK FOR UNDERSTANDING

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to the
correct answer and another one (1) point for the correct ratio. Superimpositions or erasures in your answer/ratio is not
allowed.

1. It is a systematic approach to providing high quality nutrition care. The NCP consists of four distinct, interrelated steps?
a. Nursing Care Process
b. Nutrition Care Process
c. Education Process
d. Nursing Model for Nutrition
ANSWER: B
RATIO: Nutrition care process is a systematic approach used by dietetics professionals to evaluate and treat nutrition-related
problems.

2. Terminology for this step of NCP is organized in three domains (categories):

a. Monitoring/Evaluation
b. Implementation
c. Diagnosis
d. Assessment
ANSWER: C
RATIO: Terminology for nutrition diagnosis is organized in three domains (categories) namely; intake, clinical, and behavioral-
environmental. Nutrition diagnosis is a nutrition and dietetics practitioner's identification and labeling of an existing nutrition
problem(s) that the practitioner is responsible for treating.

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3. The final step of the process is monitoring and evaluation, which the dietitian/nutritionist uses to determine if the
client has achieved, or is making progress toward, the planned goals.
a. Assessment
b. Diagnosis
c. Implementation
d. Monitoring/Evaluation
ANSWER: D
RATIO: The final step of the nutrition care process is monitoring and evaluation, which the dietitian or nutritionist uses to
determine if the client has achieved, or is making progress toward, the planned goals.

4. Anthropometric measurement includes?

a. Height, weight, body mass index (BMI), growth pattern indices/percentile ranks, and weight history
b. Lab data (e.g., electrolytes, glucose) and tests (e.g., gastric emptying time, resting metabolic rate)
c. Physical appearance, muscle and fat wasting, swallow function, appetite, and affect
d. Food and nutrient intake, food and nutrient administration, medication, complementary/alternative medicine use
ANSWER: A
RATIO: Anthropometric measurement includes the following; Height, weight, body mass index (BMI), growth pattern
indices/percentile ranks, and weight history.Choice B is under Biochemical Data, Medical Tests, and Procedures. Choice C is
under nutrition-focused physical findings. Choice D is under food/nutrition-related history.

5. Implementation is the action phase and involves the following. EXCEPT?

a. Collaborating with the client to carry out the plan of care
b. Communicating the nutrition care plan
c. Defining the time and frequency of care, including intensity, duration, and follow-up
d. Following up and verifying that the plan is being implemented
e. Revising strategies based on changes in condition or response to intervention
ANSWER: C
RATIO: Implementation is the action phase and involves:(1) Collaborating with the client to carry out the plan of care (2)
Communicating the nutrition care plan (3) Modifying the plan of care as needed (4) Following up and verifying that the plan is
being implemented (5) Revising strategies based on changes in condition or response to intervention. Letter C is under
planning the nutrition intervention.

RATIONALIZATION ACTIVITY
The instructor will now provide you the rationalization to these questions. You can now ask questions and debate among
yourselves. Write the correct answer and correct/additional ratio in the space provided.
1. ANSWER:
RATIO:

2. ANSWER:
RATIO:

3. ANSWER:
RATIO:

4. ANSWER:
RATIO:

5. ANSWER:
RATIO:

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LESSON WRAP-UP

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Activity: CAT: MUDDIEST POINT

This technique will help you determine which key points were missed in the main lesson. You will respond to only one
question:

In today’s session, what was least clear to you?

For today’s session, the least clear to me was learning about the nutrition care process such as how to assess the nutritional
status of a client, formulating nutrition diagnosis, how to implement interventions, and how to monitor/evaluate.

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