Module 2: Nutrition Care Process

Nutrition Care Process (ADIME)

Is a systematic problem-solving method that dietetics and nutrition professionals use to critically think and make decisions to address nutrition-related problems and provide safe, effective, high-quality nutrition care

1. Nutrition Assessment

2. Nutrition Diagnosis

3. Nutrition Intervention

4. Monitoring and Evaluation

Nutrition Care Process consists of four distinct yet interrelated steps:

Nutrition Assessment

Involves a collection and analysis of health-related information in order to identify specific nutrition problems and their underlying causes. (Nutrition Care Process (ADIME))

Nutrition Diagnosis

Consists of identification of nutritional problem for which nutrition-related activities provide the primary intervention. (Nutrition Care Process (ADIME))

Nutrition Intervention

After nutrition problem has been identified, the appropriate nutrition care can be planned and implemented. (Nutrition Care Process (ADIME))

1. Counseling or education about appropriate dietary and lifestyle practices, a change inmedication and other treatment, or adjustments in the meal services provided to a hospital patient.

2. Considering the individual's food habits, lifestyle and other personal factors.

3. Goals are stated in terms of measurable outcomes; for example, the goal of an overweight person with diabetes might include improvements in blood glucose level and body weight.

4. Other goals may be positive changes in dietary behaviors and lifestyle; for example, a diabetes patient may learn how to control carbohydrate intake or portion sizes or begin a regular exercise program.

A nutrition intervention may include: (Nutrition Care Process (ADIME))

1. Food habits

2. Lifestyle

3. Other personal factors

The intervention must consider the individual's: (Nutrition Care Process (ADIME))

Nutrition Monitoring and Evaluation

The effectiveness of the nutrition care plan must be evaluated periodically: the patient progress must be monitored closely, an updated assessment data or diagnosis may require adjustments in goals or outcome measures. (Nutrition Care Process (ADIME))

Nutrition Monitoring and Evaluation

Sometimes a new situation alters nutritional needs; for example a change in the medical treatment or a new medication may alter a person's tolerance to certain foods; The nutrition care plan must be flexible enough to adapt to the new situation (Nutrition Care Process (ADIME))

Nutrition Monitoring and Evaluation

If progress is slow or a patient is unable or unwilling to make the suggested changes, the care plan should be redesigned and take into account the reasons why the earlier plan was not successful; The new plan may need to include motivational techniques or additional patient education. (Nutrition Care Process (ADIME))

Nutrition Monitoring and Evaluation

If the patient remains unwilling to modify behaviors despite the expected benefits, the health care provider can try again at a later time when the patient may be more receptive. (Nutrition Care Process (ADIME))

1. Food Nutrition-Related History

2. Anthropometric measurement

3. Biochemical data, Medical test, and Procedures

4. Nutrition-focused Physical findings

5. Client History

A. Assessment of Nutritional Status → The information in the assessment may be obtained through the 5 standardized domains:

1. Dietary Intake Data

2. Nutrient Intake Analysis

3. Food Frequency

4. Food Diary

5. 24-hour recall

1. Food Nutritional-Related History: (A. Assessment of Nutritional Status)

1. Dietary Intake Data

Obtaining more or less accurate data of food; the result may vary depending on an individual's memory and honesty and the assessor's skill and training. (A. Assessment of Nutritional Status - 1. Food Nutritional-Related History)

2. Nutrient Intake Analysis

Will assess current intake of different components of the diet to find deficiencies or excesses of needed nutrients in the body. (A. Assessment of Nutritional Status - 1. Food Nutritional-Related History)

3. Food Frequency

Surveys the food and beverages consumed during a specific time period. (A. Assessment of Nutritional Status - 1. Food Nutritional-Related History)

4. Food Diary

A detailed log of food during a specified time period, usually several days; also called food Record (A. Assessment of Nutritional Status - 1. Food Nutritional-Related History)

4. Food Diary

It may also include information regarding medications, disease symptoms, and physical activity. (A. Assessment of Nutritional Status - 1. Food Nutritional-Related History)

5. 24-hour recall

It includes questions about the times when meals or snacks were eaten, amounts consumed, and ways in which the foods were prepared. (A. Assessment of Nutritional Status - 1. Food Nutritional-Related History)

5. 24-hour recall

An individual recounts all the foods and beverages consumed in the past 24 hours or during the previous day. (A. Assessment of Nutritional Status - 1. Food Nutritional-Related History)

Anthropometric Data:

Related to physical measurements of the human body, such as height, weight, body circumference, and percentage of body fat. (A. Assessment of Nutritional Status - 2. Physical Assessment)

Anthropometric Data:

Can reveal problems related to both protein energy malnutrition (PEM) and overnutrition (A. Assessment of Nutritional Status - 2. Physical Assessment)

Height-weight tables and growth chart

Are used to calculate the body mass index (BMI). (A. Assessment of Nutritional Status - 2. Physical Assessment)

1. Height (or Length).

2. Body Weight.

3. Head Circumference

4. Circumference of Waist and Limbs

5. Anthropometric Assessment in Infant and Children

6. Anthropometric Assessment in Adults

Anthropometric Data: (A. Assessment of Nutritional Status - 2. Physical Assessment)

BMI (Body Mass Index)

An index of a person's weight in relation to height determined by dividing the weight (in kilograms) by the square of the height (in meters). (A. Assessment of Nutritional Status - 2. Physical Assessment)

2.2; 39.37

To convert pounds to kilograms divide by _________. To convert inches to meters divide by ____________ (A. Assessment of Nutritional Status - 2. Physical Assessment)

18.5 to 24.9

Healthy Individual BMI: (A. Assessment of Nutritional Status - 2. Physical Assessment)

Below 18.5

Underweight BMI: (A. Assessment of Nutritional Status - 2. Physical Assessment)

Above 25

Overweight BMI: (A. Assessment of Nutritional Status - 2. Physical Assessment)

Above 30

Obese BMI: (A. Assessment of Nutritional Status - 2. Physical Assessment)

Body Composition

Refers to your body weight (A. Assessment of Nutritional Status - 2. Physical Assessment)

Arm Circumference

Mid (A. Assessment of Nutritional Status - 2. Physical Assessment)

Fold or Skin - Fold Thickness

Fat (A. Assessment of Nutritional Status - 2. Physical Assessment)

1. Nutrition Problems and/or Needs

2. Planning the Diet with Cultural Competency

3. Resources needed in Planning and Implementing Dietary Regimen

B. Nutrition Diagnosis and Plan of Care:

1. Nutrition Problems and/or Needs

The purpose 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. (B. Nutrition Diagnosis and Plan of Care)

nutrition

A ________ diagnosis (eg: inconsistent carbohydrate intake) is different from a medical diagnosis (eg: diabetes) (B. Nutrition Diagnosis and Plan of Care)

Problem/Nutrition Diagnosis label

Describes alterations in the patient's/client's nutritional status. (B. Nutrition Diagnosis and Plan of Care - 1. Nutrition Problems and/or Needs)

Related to (Etiology )

Is the cause/contributing risk factors and is linked to the nutrition diagnosis label by the words "related to"; May be social, situational, physical, developmental, cultural, psychological, pathological and/or environmental nature. (B. Nutrition Diagnosis and Plan of Care - 1. Nutrition Problems and/or Needs)

As evidenced by [Signs (objective)/Symptoms (Subjective)]

Is data used to determine that the patient/client has the nutrition diagnosis specified and is linked by the words "as evidenced by." (B. Nutrition Diagnosis and Plan of Care - 1. Nutrition Problems and/or Needs)

1. Intake

2. Clinical

3. Behavioral-Environmental

Terms divided into 3 categories: Intake, clinical and behavioral-environment (3 classifications of the nutrition diagnosis) (B. Nutrition Diagnosis and Plan of Care - 1. Nutrition Problems and/or Needs)

1. Intake

Too much or too little of a food or nutrient compared to actual or estimated needs (3 classifications of the nutrition diagnosis)

2. Clinical

Nutrition problems that relate to medical or physical conditions (3 classifications of the nutrition diagnosis)

3. Behavioral-Environmental

Knowledge, attitudes, beliefs, physical environment, access to food, or food safety (3 classifications of the nutrition diagnosis)

2. Planning the Diet with Cultural Competency

An appropriate diet is adequate and balanced and considers the individual's characteristics such as age and stage of development, taste preferences, and food habits. (B. Nutrition Diagnosis and Plan of Care)

2. Planning the Diet with Cultural Competency

It also reflects the availability of foods, socioeconomic conditions, cultural practices and family traditions, storage and preparation facilities, and cooking skills. (B. Nutrition Diagnosis and Plan of Care)

2. Planning the Diet with Cultural Competency

An adequate and balanced diet meets all the nutritional needs of an individual for maintenance, repair, living processes, growth, and development. (B. Nutrition Diagnosis and Plan of Care)

2. Planning the Diet with Cultural Competency

It includes energy and all nutrients in proper amounts and in proportion to each other. (B. Nutrition Diagnosis and Plan of Care)

2. Planning the Diet with Cultural Competency

The presence or absence of one essential nutrient may affect the availability, absorption, metabolism, or dietary need for others. (B. Nutrition Diagnosis and Plan of Care)

2. Planning the Diet with Cultural Competency

The recognition of nutrient interrelationships provides further support for the principle of maintaining food variety to provide the most complete diet (B. Nutrition Diagnosis and Plan of Care)

1. Current Dietary Guidance

2. Cultural Aspects of Dietary Planning

3. Religion and Food

2. Planning the Diet with Cultural Competency → National Guidelines for Diet Planning: (B. Nutrition Diagnosis and Plan of Care)

1. Current Dietary Guidance

Increased attention was being given to prevention of hunger and disease. (B. Nutrition Diagnosis and Plan of Care → National Guidelines for Diet Planning:)

1. Current Dietary Guidance

Guidelines directed toward prevention of a particular disease, such as those from the National Cancer Institute; the American Diabetes Association; the American Heart Association; and the National Heart, Lung, and Blood Institute's cholesterol education guidelines, contain recommendations unique to particular conditions. (B. Nutrition Diagnosis and Plan of Care → National Guidelines for Diet Planning:)

1. Current Dietary Guidance

The American Dietetic Association supports a total diet approach, in which the overall pattern of food eaten, consumed in moderation with appropriate portion sizes and combined with regular physical activity, is key. (B. Nutrition Diagnosis and Plan of Care → National Guidelines for Diet Planning:)

2. Cultural Aspects of Dietary Planning

To plan diets for individuals or groups that are appropriate from a health and nutrition perspective, it is important that registered dietitians and health providers use resources that are targeted to the specific client or group. (B. Nutrition Diagnosis and Plan of Care → National Guidelines for Diet Planning:)

2. Cultural Aspects of Dietary Planning

Attitudes, rituals, and practices surrounding food are part of every culture in the world and there are so many cultures in the world that it defies enumeration. (B. Nutrition Diagnosis and Plan of Care → National Guidelines for Diet Planning:)

2. Cultural Aspects of Dietary Planning

When faced with planning a diet to meet the needs of an unfamiliar culture, it is important to avoid forming opinions that are based on inaccurate information or stereotyping. (B. Nutrition Diagnosis and Plan of Care → National Guidelines for Diet Planning:)

3. Religion and Food

Dietary practices have been a component of religious practice for all of recorded history. (B. Nutrition Diagnosis and Plan of Care → National Guidelines for Diet Planning:)

3. Religion and Food

Before planning menus for members of any religious group, it is important to gain an understanding of some traditions or dietary practices. (B. Nutrition Diagnosis and Plan of Care → National Guidelines for Diet Planning:)

3. Resources needed in Planning and Implementing Dietary Regimen

Agency in the Philippines known as Nutrition Council of the Philippines created the program PPAN (Phil. Plan of Action for Nutrition 2017-2022 A call to urgent action for Filipinos and its leadership. (B. Nutrition Diagnosis and Plan of Care)

Nutrition Council of the Philippines

Agency in the Philippines known as ____________ created the program PPAN (Phil. Plan of Action for Nutrition 2017-2022 A call to urgent action for Filipinos and its leadership. (B. Nutrition Diagnosis and Plan of Care - 3. Resources needed in Planning and Implementing Dietary Regimen)

PPAN (Phil. Plan of Action for Nutrition 2017-2022 A call to urgent action for Filipinos and its leadership.

Agency in the Philippines known as Nutrition Council of the Philippines created the program ____________________ (B. Nutrition Diagnosis and Plan of Care - 3. Resources needed in Planning and Implementing Dietary Regimen)

1. It is a results-based plan with SMART results at different levels designed in a results framework.

2. It consists of 12 programs and 46 projects serving as a framework for actions that could be undertaken by member agencies of the National Nutrition Council (NNC), other national government agencies, local government units, non-government organizations, academic institutions, and development partners. For better accountability, a member agency of the NNC Governing Board has been designated as lead for one or more of these programs.

Agency in the Philippines known as Nutrition Council of the Philippines created the program PPAN (Phil. Plan of Action for Nutrition 2017-2022 A call to urgent action for Filipinos and its leadership: (B. Nutrition Diagnosis and Plan of Care - 3. Resources needed in Planning and Implementing Dietary Regimen)

1. Food and Nutrient Delivery

2. Food Administration

C. Nutrition Intervention:

1. Food and Nutrient Delivery

An individualized approach for food/nutrient provision including meals and snacks, enteral, parenteral, nutrition, supplements, feeding assistance, feeding environment, and nutrition-related medication management. (C. Nutrition Intervention)

1. Oral Nutritional Supplements (ONS)

2. Enteral nutrition

3. Parenteral nutrition

2. Food Administration: (C. Nutrition Intervention)

1. Oral Nutritional Supplements (ONS)

Are sterile liquids, semi-solids or powders, which provide macro and micro nutrients. (C. Nutrition Intervention)

1. Oral Nutritional Supplements (ONS)

They are widely used within the acute and community health settings for individuals who are unable to meet their nutritional requirements through oral diet alone. (C. Nutrition Intervention)

2. Enteral nutrition

Generally refers to any method of feeding that uses the gastrointestinal (GI) tract to deliver part or all of a person's caloric requirements. (C. Nutrition Intervention)

Short-term enteral access tubes

Are placed into the nares or, sometimes, orally, usually at bedside. (C. Nutrition Intervention - 2. Food Administration)

Short-term enteral access tubes

Provides a means to meet patient nutrient needs and can provide a chance to assess tolerance of the tube feedings if more permanent long-term placement is determined to be required. (C. Nutrition Intervention - 2. Food Administration)

1. Ready to use formula

2. Tube feedings

3. Standard tube feedings

4. Blenderized tube feeding

Short-term enteral access tubes - Types of formulation: (C. Nutrition Intervention - 2. Food Administration)

Long-term enteral access

Options include endoscopic or surgical gastrostomy tubes. (C. Nutrition Intervention - 2. Food Administration)

1. Gastrostomy tube (G tube)

2. Gastro-jejunum tube (G-J tube)

2 common Types of tubes used in enteral nutrition: (C. Nutrition Intervention - 2. Food Administration)

Gastrostomy tube (G tube)

The end of the G tube is placed through the abdominal wall into your child's stomach. (C. Nutrition Intervention - 2. Food Administration)

Gastrostomy tube (G tube)

A port remains outside the child's body. It is placed so that liquid food is sent straight into the stomach (C. Nutrition Intervention - 2. Food Administration)

Gastro-jejunum tube (G-J tube)

This tube is often used if your child vomits when large amounts of food are in the stomach. (C. Nutrition Intervention - 2. Food Administration)

Gastro-jejunum tube (G-J tube)

Like the G tube, it is placed through the abdominal wall. (C. Nutrition Intervention - 2. Food Administration)

Gastro-jejunum tube (G-J tube)

The end is put into part of the small intestine called the jejunum; A port remains outside the child's body. (C. Nutrition Intervention - 2. Food Administration)

Gastro-jejunum tube (G-J tube)

Is placed so that liquid food is delivered straight into your small intestine. (C. Nutrition Intervention - 2. Food Administration)

Gastro-jejunum tube (G-J tube)

It can include a normal oral diet, the use of liquid supplements or delivery of part or all of the daily requirements by use of a tube (tube feeding). (C. Nutrition Intervention - 2. Food Administration)

Parenteral nutrition

Refers to the delivery of calories and nutrients into a vein. This could be as simple as carbohydrate calories delivered as simple sugar in an intravenous solution or all of the required nutrients could be delivered including carbohydrate, protein, fat, electrolytes (for example sodium and potassium), vitamins and trace elements (for example copper and zinc). (C. Nutrition Intervention - 2. Food Administration)

enteral and parenteral nutrition

There are many reasons for __________ including GI disorders such as bowel obstruction, short bowel syndrome, Crohn's disease, and ulcerative colitis; as well as certain cancers or in comatose patients.

1. Strategies to Address Age-Related Changes Affecting Nutrition

2. Selected Therapeutic Diets

D. Monitoring Nutritional Status:

1. food choice

2. healthier choices

3. Snacking

4. taste good again; salt

5. supplements

6. exercise

)1. Strategies to Address Age-Related Changes Affecting Nutrition - Elderly:

1. Encourages healthier _____________. Helped your loved one limit his or her intake of solid fats, sugars, alcoholic beverages and salt.

2. Suggest ways to replace less healthy foods with _____________.

3. ___________ on healthy foods is a good way to get extra nutrients and calories between meals . It may be especially helpful for older adults who quickly get full at mealtimes.

4. Make food ____________. If on a restricted diet, herbs and spices can help restore flavor to bland foods. Avoid herb or spice blends that are heavy in ___________.

5. Consider adding __________ to your loved one's diet. He or she may benefit from a ___________ shake or other nutritional ___________.

6. Encourage _____________. Even a little bit of __________ can help improve one's appetite and keep his or her bones and muscles strong

(D. Monitoring Nutritional Status - 1. Strategies to Address Age-Related Changes Affecting Nutrition)

1. fruits; vegetables

2. starchy foods

3. milk; dairy

4. protein

1. Strategies to Address Age-Related Changes Affecting Nutrition - Children:

• You need to get a variety of foods from the main groups, including:

1. Plenty of _______ and _________.

2. Plenty of _____________ such as bread, rice, potatoes, pasta.

3. Some ________ and _______ foods or non-dairy alternatives

4. Some sources of _________, such as meat, fish, eggs and beans.

(D. Monitoring Nutritional Status - 1. Strategies to Address Age-Related Changes Affecting Nutrition)

Therapeutic diet

Is a meal plan that controls the intake of certain foods or nutrients. (D. Monitoring Nutritional Status - 2. Selected Therapeutic Diets)

Therapeutic diet

It is part of the treatment of a medical condition and are normally prescribed by a physician and planned by a dietician. (D. Monitoring Nutritional Status - 2. Selected Therapeutic Diets)

Therapeutic diet

It is usually a modification of a regular diet. (D. Monitoring Nutritional Status - 2. Selected Therapeutic Diets)

1. Cardiovascular disease — Such as coronary artery disease, hypertension, heart attacks, and stroke

2. Diabetics — Can benefit from a therapeutic diet as can people with gastrointestinal diseases such as Crohn's disease, ulcerative colitis and celiac disease

What disease requires a therapeutic diet? (D. Monitoring Nutritional Status - 2. Selected Therapeutic Diets)

1. Possible duration of the disease

2. Factors in the diet which must be altered to overcome these conditions

3. Patient's tolerance for food by mouth

4. Normal diet may be modified too

Factors to be considered in planning therapeutic diets: (D. Monitoring Nutritional Status - 2. Selected Therapeutic Diets)

Diet plays a very crucial role in controlling and managing various diseases, especially lifestyle diseases like diabetes, cardiovascular diseases and obesity.

What is the importance of diet therapy? (D. Monitoring Nutritional Status - 2. Selected Therapeutic Diets)

Diet therapy

Also known as Nutritional Therapy. (D. Monitoring Nutritional Status - 2. Selected Therapeutic Diets)

1. Maintain good nutritional status, correct deficiencies or disease, if any.

2. Provide rest to the body

3. Help metabolize the nutrients

4. Make changes in body weight, when necessary

The principles of diet therapy are to: (D. Monitoring Nutritional Status - 2. Selected Therapeutic Diets)

1. Balanced Diet

2. Bland Diet (CAP-free Diet)

3. Clear Liquid Diet

4. Cold Liquid (Tonsil Diet)

5. Constipating Diet (Anti-diarrhea Diet)

6. Full Liquid Diet

7. Diabetic Diet (Calculated Diet)

8. High Calorie Diet (Up-building Diet, High Carbohydrate Diet)

9. High-Fiber Diet

10. High-protein Diet

11. Hypoallergenic Diet

12. Low-cholesterol Diet

13. Low Fat Diet

14. Low-protein Diet

Types of Medical Diet:

Balanced Diet

A food preparation which provides complete nutrients as well as supplies carbohydrates, proteins, fats, vitamins, minerals and fiber in their normal proportions. (Types of Medical Diet)

Balanced Diet

Basis for all diet modifications (Types of Medical Diet)

Balanced Diet

Food preparation that is complete in nutrients in their normal proportions (Types of Medical Diet)

1. General Diet

2. Full Diet

3. Complete Diet

Other terms for Balanced Diet: (Types of Medical Diet)

1. 3 meals

2. regular

3. heavy; moderate; light

4. kind; time; amount; condition

5. tea; coffee; alcoholic; carbonated beverages

6. 8 glasses

Tips on Balanced diet:

1. Eat_________ a day instead of frequent ones or eating between meals.

2. Establish a ________ eating habit

3. Eat _______ breakfast, _________ lunch and ___________ supper

4. Eat food of right ________; at the right ______ and interval, in the right _________ and the right __________ of mind.

5. Avoid t___, c_________, a_______ and c___________

6. Drink at least __________ of water a day between meals (Types of Medical Diet)

Bland Diet (CAP-free Diet)

Provides food that are not irritating to the digestive tract and do not increase acid production in the stomach (Types of Medical Diet)