FSHN 361: Nutrition Care Process

The title of this course is Nutrition and Health Assessment. So obviously, we are going to be focusing on assessing individuals for their nutrition and health risks. But how do we do that? Look at these two individuals. Can you see nutrition or health risk just by looking at them? Of course not. We need to gather nutrition and health related data that provides evidence for a risk the Academy of Nutrition and Dietetics Has developed the system to help us do that. It’s called the nutrition care process the nutrition care process was developed as a Framework for improving the consistency and quality of nutrition care and the predictability of the nutrition care outcomes It is not intended to be standardized nutrition care for clients using what is sometimes referred to as cookbook medicine Where everybody gets the exact same plan like you’re following a set recipe Rather the nutrition care process is designed to establish a standard a standardized process for providing that care Even identifying who what might need to go through. This nutrition care process is an awkward first step So there are nutrition screening tools that are out there. Sometimes we have referrals from physicians or even self referral what but no matter how we identify individuals who are going to start the process a Nutrition professional can use the nutrition care process to identify the nutrition problems and then the best evidence-based Intervention strategies, so I’m going to do a quick overview of the four steps of the nutrition care process Starting with step one which is nutrition assessment a formal description of this step is the systematic method for obtaining Verifying interpreting data needed to identify nutrition related problems causes and significance That’s a mouthful but it’s really just collecting data that we would use as evidence for identifying a problem the type of data we typically collect is usually summarized with the acronym of ABCD and so the type of dad would be Anthropometrics, so think about height weight head circumference biochemical that would be things like blood lipids blood glucose and Clinical clinical is physical assessment data, which is separate from anthropometrics and client history information so think about family history for a risk of a disease and Then that deed the final one is dietary or we take a look at the food and nutrition related history Step two is nutritional diagnosis A nutritional diagnosis is the identification and labeling of a specific nutritional problem nutrition and dietetics professionals use standardized nutrition diagnosis terminology and you will be limited to using only that terminology for diagnosis in this class These diagnoses are actually organized and described in the electronic nutrition care process and terminology Manual and you will need access to that in this course Students new to nutrition care process often find this is the hardest step and I’m going to discuss it more in details in a moment But I want to make sure that we quickly go over all four of those steps so what I want to go through the final two steps of the nutrition care process then come back and talk about nutritional diagnosis a bit more The final two steps then are the nutrition intervention and monitoring evaluation Nutrition intervention is defined as the selection of a nutrition strategy to resolve or improve the nutritional diagnosis And the nutrition monitoring evaluation is used to determine and measure the amount of progress made From the nutrition intervention and whether that nutrition any nutritional related goals and expected outcomes are being met Now that’s a quick overview of the four steps in this course We do not really focus on step three and four But they flow from steps one and two if steps one and two are done Completely and accurately we will be able to identify the best interventions and then we’ll know the criteria that we want to monitor But let’s go back to that step two nutrition and diagnosis and talk about how we’re going to go through that As mentioned before the nutrition diagnosis step is to identify and label a specific nutritional problem It’s important to emphasize that this nutritional diagnosis is not a medical diagnosis They identified or diagnosed problem must being within the realm that a nutrition and dietetics Can treat independently for example let’s say you had a client with a high blood pressure and a diet that had too much sodium as A nutritional professional we can recognize hypertension from a blood pressure data point But we do not treat hypertension. We can independently work with our client to reduce their sodium intake but not their blood pressure Given this assessment data, we might consider diagnosis of hypertension or access to sodium intake Remember, this is a nutritional diagnosis an appropriate diagnosis would be excessive sodium intake not hypertension Nutritional diagnosis needs to be related to what a nutrition and dietetics professional does not what he or she knows So now I’m going to move to actually looking at how we’re gonna use the electronic nutrition care process Terminology reference metal to determine these nutrition diagnosis because we have very specific terminology that we need to link to use So here is the electronic manual and you would need to have already accessed it and we’re going to launch the the publication so I’m going to pick my language and then I’m going to click on that launch the publication and This is the overview of electronic the nutrition terminology reference manuals So you may want to check around it and look at that but right now we’re going to focus in here on terminology around diagnosis, so If you put a cursor over your terminology say we have a terminology for assessment diagnosis intervention and monitoring evaluation We’ll look at that diagnosis and under diagnosis. We’ve got four different areas We’ve got intake we’ve got clinical. We’ve got behavioral and environmental and then other for right now I’m going to click on intake Once you get here we are now going to have these nutrition diagnostic terminologies and for every Terminology for every diagnosis. There’s going to be three things that you need to really pay attention to one You’re going to be have a very specific title. So we’ve got that Specific term that’s used for that diagnosis. We also have a very specific code So for the diagnosis of increased energy expended the code would be ni 1.14 inadequate energy intake ni 1.2 on down the list if you click on the title It will take you to a page that will give you more specific specific information about that diagnosis One of the things it has is a definition. So for increase energy expenditure We’ve got the definition of resting metabolic rate more than predicted requirement due to body composition medications or endocrine neurological or genetic changes the other thing you want to pay attention to is that Etiology, so etiology means it’s the cause or the contributing factor So would this definition fit your client and for this? Definition this diagnosis it be a physiological cause increase in nutrient needs due to an apple ism growth maintenance or above body temperature or Voluntary or involuntary physical activity movement. So those are the things we’re going to pay attention to the title to the code and to the definition As we use the system There’s two things that I really want you to have key concepts. I want you to think about One is you want to use that that definition that title and the etiology that best? Defines your situation your client situation The other thing is we’re going to communicate this in a very standardized clear and effective manner so as we go through these those are the two things we’re going to pay attention getting the right code right diagnosis and then communicating that effectively to do this I’m going to go through two scenarios Where we have two clients that have energy imbalance and show how we can use this system to have different diagnosis with essentially the same Situation so we have Alice and Alex they both are losing weight They’re both are losing weight, but they don’t want to we could conclude that. They are energy imbalance Remember, we only are allowed to use those these nutrition diagnosis terminology in the system So there isn’t that terminology of just energy imbalance So we’re going to have to be a little bit more specific There are many different diagnosis. In fact in energy balance. We’ve got increased energy expenditure inadequate energy in take excessive energy intake Predicted inadequate energy and taken predicted excessive energy intake five different titles So we need to kind of figure out which one fits the situation Well, I think we’re going to need a little bit more information So let me give you a bit more about both Alison Alex Ellis is 76 year old female who recently started a medication that has impacted her appetite She’s had a 5 pound weight loss over the last three weeks due to consuming about 500 calories less than her estimated need for 1,700 calories Alex on the other hand is a 41 year old male He typically is way stable, but he’s recently started training for a long-distance competition next month He’s also lost 5 pounds of the last three weeks And due to consuming less than 500 calories needed then the estimated need for 3400 calories very different situation We can quickly realize that that that general Description of unwanted weight loss due to energy imbalance is not sufficient to communicate effectively these two situations You will need to read the definition and review the ideologies to identify the ones that best match the situation For Alice it’s going to be inadequate energy intake ni 1.2. So let’s take a look at why that fits? Energy intake the definition says energy intake that is less than energy expenditure established by reference standard and a recommendation Recommendations based on physiological needs so we’ve established that she’s taking in 500 calories less than what was estimated at 1,700 calories if we look at ideologies. There’s profit a pathological physiological decreased ability to consume sufficient energy That describes Alice so that’s going to be a good nutritional diagnosis for her Let’s go back and take a look at how about Alex? For Alex. The best one is going to be the predicted inadequate energy intake. Let’s take a look at why that one fits his situation So the definition future energy intake those Anticipated based on observation experience or scientific reason to be less than estimated in Jake’s furniture established reference standards and recommendation based on physiological Needs it fits so far we know because he’s taking in 500 calories less than we estimated he needs and we looked down at that etiology, and we can see that one of them is Anticipated change in physical demand or work or leisure activity such as a job chain or training for competitive sports So as we identified that that definition that nutritional diagnosis that best fits our situation We need to look at the definition. We need to take a look the etiology now once you have The correct diagnosis, we now have to think about how to communicate it Remember we have to do two key things we have to get the right diagnosis And then we also need to communicate it in a clear and concise and effective way And the nutrition care process has a specific way to do that The nutrition care process has developed a set sentence structure for this purpose Pas statement where the P stands for problem the e stands for etiology and the S stands for signs and symptoms Here is the specific format for writing these types of symptoms problem related to ideology as evidenced by signs and symptoms if we would write a pas statement for Alice we might say Inadequate energy intake in AI 1.2 a related to a loss of appetite secondary to medication as evidenced by five pound Weight loss over the last three weeks due to consuming 500 calories less than her estimated needs of 1,700 calories For PE estimate for Alex. We would say predicted inadequate energy intake in AI 1.4 related to inability to consume sufficient energy to meet increased needs while training for competitive events next month as evidenced by five pounds of weight loss over the last three weeks due to consuming 500 calories less than an estimated need of 3400 calories per day We can see in this the the problem the specific diagnosis is there Included the the code we related to a specific ideology. That’s Related to the individual themselves, and then we have some signs symptoms There’s not an exact way to write a PDS statement. There are wrong ways However, and we will have criteria that we will be using to evaluate your PDS statements in this course Here are the criteria that we’re going to use to evaluate your pef statements written in this course You have to have the appropriate diagnosis and when you write it out You’re going to include the title and the code Now in the professional environment when you actually go and get into a worksite You would not include the code the code that we have in its nutrition care process is specific to the field of Dietetics It is not part of the medical chart. But in this class we’re gonna expect you to include that in your PE s statement The etiology we’re gonna be looking at that ideology focuses on the cause It does not just restate the diagnosis for signs and symptoms. They need to be appropriate They mean focused on the diagnosis. You need to have at least two data points And those types of data that we’re looking for is going to focus on nutrition data, not physiological data So that would be a nutrition data would be food and nutrient intake Physiological data would be like cholesterol Height and weight, it’s not wrong to have physiological data But we want to make sure that you include at least one data point that is nutrition based You need to include a reference standard so if you’re going to give a nutrition value you’re going to say this is the value that I’m Using the reference standards to say it’s either too high or too low and then finally We’re going to avoid these vague terms Like higher or lower more or less if someone needs to have less sodium in the diet You need to describe what value they should be having or how much they should be taking out. So avoiding those vague terms let’s take a look at a couple of sample PS statements and show you a poor one and then a better one, so A poor example of a PS statement is excessive fat intake in I five point five point two Related to eating too much fat as evidenced by a BMI of 31 and consuming too many calories from fat Now the problem we have several problems with this the the code is there the definition is okay But the etiology is just restating the died. It’s not going to help us identify What’s the cause of the problem if we have a good etiology? It will clearly link to what we need to do for intervention. And if we only restate the problem, that’s not going to be useful Another problem with this is what we’ve used in appropriate data. The diagnosis is excessive fat intake BMI is not related to dietary fat intake it’s a data point for obesity in excess of calorie intake But it’s not related to dietary fat. If you’re going to have a diagnosis of excessive fat intake you need to give dietary fat intake Also too many calories from fat that is way too vague. You need to give a value What was the percent of calories coming from fat and you must give a standard to give it to comparison? Here’s a good example Excessive fat intake give the code related to frequent consumption of fast food meals so there we have a specific etiology as evidenced by a diet of 37 percent of calories coming from fat compared to the AMD ours of 20 to 35 percent so we’ve given you a data point related to food and we’ve given the reference standard and Then excessive food protein food and group intake a lesson of greater than 8 ounces equivalent per day Compared to the recommendation of 3 to 4 ounces per day Both of those are dietary related and they are going to be directly related to how we’re going to intervene with some idea of a strategy for intervention with that in Summary, the nutrition care process is a standardized approach for providing nutritional care using the four defined steps You will gather relevant data determine an appropriate nutrition diagnosis and then communicate using standardized terminology Along with clear evidence to support your conclusions if these first two steps are done well You will be ready to select the best evidence-based intervention strategies to help your clients achieve their nutrition and health-related goals

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