NSC 325: Malnutrition and the Nutrition Care Process

NSC 325: Week Overview

Understanding Malnutrition

• Definition: Malnutrition is categorized as undernutrition.

• Key Concept: Patient weight alone is not the sole determinant of malnutrition; other criteria are essential.

• Diagnosis Requirement: A minimum of two criteria are required to diagnose malnutrition.

• Etiological Categories of Malnutrition:

  • Acute Illness or Injury: Characterized by an acute inflammatory response.

  • Chronic Illness: Involves chronic inflammatory conditions.

  • Social or Environmental Circumstances: Malnutrition stemming from external factors such as poverty, food insecurity, or neglect.

• Severity Levels: Each etiological category can be further classified as Moderate (Non-Severe) or Severe Protein-Calorie Malnutrition.

Specific Malnutrition Criteria and Thresholds

1. Energy Intake (% of Estimated Energy Expenditure (EEE))

   • Acute Illness or Injury:

     • Moderate: <75\% of EEE for >7 days.

     • Severe: <50\% of EEE for >5 days.

   • Chronic Illness:

     • Moderate: <75\% of EEE for >1 month.

     • Severe: <75\% of EEE for >1 month.

   • Social or Environmental:

     • Moderate: <75\% of EEE for >3 months.

     • Severe: <50\% of EEE for >1 month.

2. Weight Loss

   • Acute Illness or Injury:

     • Moderate: $1-2\%$ in 1 week, $5\%$ in 1 month, $7.5\%$ in 3 months.

     • Severe: >2\% in 1 week, >5\% in 1 month, >7.5\% in 3 months.

   • Chronic Illness:

     • Moderate: $5\%$ in 1 month, $7.5\%$ in 3 months, $10\%$ in 6 months, $20\%$ in 1 year.

     • Severe: >5\% in 1 month, >7.5\% in 3 months, >10\% in 6 months, >20\% in 1 year.

   • Social or Environmental:

     • Moderate: $5\%$ in 1 month, $7.5\%$ in 3 months, $10\%$ in 6 months, $20\%$ in 1 year.

     • Severe: >5\% in 1 month, >7.5\% in 3 months, >10\% in 6 months, >20\% in 1 year.

3. Loss of Body Fat:

   • Acute Illness/Injury: Mild, Moderate, Severe

   • Chronic Illness: Mild, Moderate, Severe

   • Social/Environmental: Mild, Moderate, Severe

4. Loss of Muscle Mass:

   • Acute Illness/Injury: Mild, Moderate, Severe

   • Chronic Illness: Mild, Moderate, Severe

   • Social/Environmental: Mild, Moderate, Severe

5. Fluid Accumulation (Edema):

   • Acute Illness/Injury: Mild ($+1$), Moderate ($+2$) to Severe (+>3)

   • Chronic Illness: Mild ($+1$), Moderate ($+2$) to Severe (+>3)

   • Social/Environmental: Mild ($+1$), Moderate ($+2$) to Severe (+>3)

6. Hand Grip Strength:

   • Acute Illness/Injury: N/A (not applicable for moderate), Measurably Reduced for severe.

   • Chronic Illness: N/A, Measurably Reduced.

   • Social/Environmental: N/A, Measurably Reduced.

The Nutrition Care Process (NCP)

• The NCP is a systematic, client-centered method for providing high-quality nutrition care.

• It consists of four distinct but interrelated steps:

  • A: Assessment

    • Involves collecting and documenting data.

    • Subcategories of assessment data:

      • Anthropometrics: Physical measurements (e.g., height, weight, body mass index).

      • Biochemical data: Laboratory values (e.g., blood glucose, albumin).

      • Clinical/client status: Medical history, physical exam findings, current health conditions.

      • Diet/nutrition history: Food and nutrient intake, eating patterns, food allergies/intolerances.

  • D: Diagnosis

    • Identifying and labeling specific nutrition problems.

  • I: Intervention

    • Planning and implementing strategies to address the identified nutrition problems.

  • M: Monitoring

    • Regular review and measurement of progress toward goals.

  • E: Evaluation

    • Comparing current data with previous status, intervention goals, or reference standards to determine the effectiveness of interventions.

The PES (Problem-Etiology-Signs/Symptoms) Statement

• Nutrition diagnoses are formulated as PES statements.

• This statement serves as the critical link between the nutrition assessment findings and the planned nutrition intervention.

• Structure:

  • Problem… (What is the specific nutrition problem?)

  • related to Etiology… (What is the root cause or contributing factor of the problem?)

  • as evidenced by Signs or symptoms… (How do you know this problem exists? What data supports it?)

Crafting a Nutrition Diagnosis

• Data-Driven: Diagnoses must be based on the data gathered during the nutrition assessment.

• Nutrition-Specific: The diagnosis must be a