Nutrition Lec 2- 1st Qtr

MODULE 2 - NCM 105 NUTRITION & DIET THERAPY ………..

NUTRITION CARE PROCESS ……….

Nutrition Care Process (NCP)

  • Systematic problem-solving method.

  • Dietetics & nutrition professionals use it to critically think & make decisions.

  • To address nutrition-related problems.

  • To provide Safe / Effective / Quality nutrition care.

  • Provides a framework for professionals to customize care.

  • Taking into account the client’s needs & values.

  • Using the best evidence available to make decisions.

Nutrition Care Process Illustration

  1. Assessment Of Nutritional Status

  • Involves a collection & analysis of health-related information.

  • To identify specific nutrition problems & underlying causes.

5 Standard Domains

  1. Food Nutritional-Related History (subjective & objective data).

  2. Anthropometric Measurement (human measurements).

  3. Biochemical Data / Medical Test / Procedures (lab tests).

  4. Nutrition-Focused Physical Findings (physical assessment).

  5. Client History (underlying condition/medication that affects diet).

Food Nutritional-Related History

  • 1.1 - Dietary Intake Data (usual intake every meal/day & food allergies).

  • 1.2 - Nutrient Intake Analysis (identify nutritional inadequacies).

  • 1.3 - Food Frequency (how often of consumption).

  • 1.4 - Food Diary (detailed recording of food intake).

  • 1.5 - 24-Hour Recall (ate/drank last 24 hours).

Physical Assessment

  • 2.1 - Anthropometric Data (Height / Weight / BMI).

BMI Results

  • Underweight = Below 18.5.

  • Normal (Healthy Individual) = 18.5 to 24.9.

  • Overweight = Above 25.

  • Obese = Above 30.

  • Extremely Obese = Above 35.

Nutrition Diagnosis & Plan Of Care

  • Consists of the identification of nutritional problems.

  • Nutrition-related activities provide the primary intervention.

  • Each nutritional problem is formatted as a PES statement.

  • (P) Problem / (E) Etiology / (S) Signs & Symptoms (interrelated).

Nutrition Problems & Needs

  • Purpose is to identify & describe a specific nutrition problem that can be resolved/improved through treatment/nutrition intervention by a food & nutrition professional.

(P)roblem Related To (E)tiology As Evidenced By (S)igns & Symptoms

PES Format

  1. Problem (Nutrition Diagnosis Label)

    • Describes alterations in the patient's nutritional status.

  2. Etiology

    • Cause/contributing risk factors.

    • Linked to the label by the words "related to".

    • May be Social / Situational / Physical / Developmental / Cultural / Psychological / Pathological / Environmental nature.

  3. Signs (Objective) & Symptoms (Subjective)

    • To determine that the patient has the nutrition diagnosis specified.

    • Linked to the label & etiology by the words “as evidenced by”.

3 Domains/Categories

  1. Intake

  • Too much/little of a food/nutrient.

  • Compared to actual/estimated needs.

  1. Clinical

  • Nutrition problems that relate to medical/physical conditions.

  1. Behavioral

  • Knowledge / Attitudes / Beliefs / Physical Environment / Access To Food / Food Safety.

Example Of Nutrition Diagnosis (PES Format)

  • Unintentional weight gain related to long-term use of corticosteroids as evidenced by involuntary weight gain of 10% of body weight over the past 6 months.

  • Excessive energy intake related to poor knowledge of appropriate portion sizes as evidenced by excess weight with a BMI of 40 (obese).

  • Excessive energy intake related to frequent consumption of large portions of high-fat meals as evidenced by average daily energy intake exceeding the recommended amount by 2 m and 6-kilogram weight during the past 18 months.

  • Altered nutrition-related laboratory values related to alteration in GI function as evidenced by abnormal glomerular filtration rate (GFR).

Planning The Diet With Cultural Competency

  • Appropriate diet is adequate/balanced & considers the individual's characteristics: Age / Stage Development / Taste Preferences / Food Habits.

  • Reflects the availability of Foods / Socioeconomic Conditions / Cultural Practices / Family Traditions / Preparation Facilities / Cooking Skills.

  • Adequate & balanced diet meets all the nutritional needs of an individual for Maintenance / Repair / Living Processes / Growth / Development.

  • Includes energy & all nutrients in proper amounts & proportion.

  • Presence/absence of 1 essential nutrient may affect the Availability / Absorption / Metabolism / Dietary Needs of others.

  • Recognition of nutrient interrelationships provides further support for the principle of maintaining food variety to provide the most complete diet.

Nutrition Intervention

  • Planning & implementation of appropriate care after problems are identified.

  • Inform the dietary department & wait for diet order (nursing responsibility).

  • It includes:

    • Counseling/education about appropriate dietary & lifestyle practices.

    • Change in medication & other treatment.

    • Adjustments in the meal service provided to a hospital client.

Intervention Must Consider The Individual's:

  • Food Habits.

  • Lifestyle.

  • Other Personal Factors.

Goals Are Stated In Terms Of Measurable Outcomes

  • EXAMPLE: Goal of an overweight person with diabetes might include improvements in blood glucose level and body weight.

Other Goals May Be Positive Changes Dietary Behaviors & Lifestyle

  • EXAMPLE: Diabetic patient can learn how to control carbohydrate intake & portion sizes or begin a regular exercise program.

  1. Food & Nutrient Delivery

  • Individualized approach for food/nutrient provision.

  • Including Meals / Snacks / Enteral / Parenteral / Nutrition / Supplements / Feeding Assistance / Feeding Environment / Nutrition-Related Medication Management.

  1. Food Administration

  2. Oral Nutritional Supplements (ONS)

  • Sterile Liquids / Semi-Solids / Powders that provide nutrients.

  • Widely used within the acute & community health settings.

  • For individuals who cannot meet their nutritional requirements through oral diet alone.

  1. Enteral Nutrition

  • Any method of feeding that uses the gastrointestinal (GI) tract.

  • To deliver part or all of a person's caloric requirements.

Short-Term Enteral Access Tubes

  • Placed into the nares or sometimes orally (usually at the bedside).

  • Provides a means to meet patient nutrient needs.

  • Provide a change to assess tolerance of the tube feedings if more permanent long-term placement is determined to be required.

Types Of Formulation

  1. Ready to use formula (any purchased product).

  2. Tube feedings (should be blended).

  3. Standard tube feeding (Milk Base / Sugar / Cooked Egg).

  4. Blenderized tube feeding (soft diet blended & fed to patient via NGT).

Long-Term Enteral Access Tubes

  • Allows short/long-term delivery of nutrients to the digestive tract.

  • For patients who cannot maintain requirements orally & GIT obstruction.

2 Common Types Used In Enteral Nutrition

  1. Gastro-Jejunum Tube (G-J Tube)

  • Used when large amounts of food are vomited out.

  • End-tube through abdominal wall into small intestine (jejunum).

  • Port remains outside the body.

  • Placed so that liquid food is delivered straight to small intestine.

  • Can include a normal oral diet, the use of liquid supplements, or the delivery of part/all of the daily requirements by use of a tube (tube feeding).

  1. Gastrostomy Tube (G Tube)

  • End-tube through abdominal wall into stomach.

  • Port remains outside the body.

  • Placed so that liquid food is sent straight into the stomach.

  1. Parenteral Nutrition

  • Delivery of calories & nutrients into a vein.

  • Many reasons for enteral & parenteral nutrition including GI disorders.

  • Bowel Obstruction / Short Bowel Syndrome / Crohn’s Disease / Ulcerative Colitis / Certain Cancers / Comatose Patients.

  • Total Parenteral Nutrition (TPN)

  • Provides total nutritional intake (no other food).

  • Contains a sufficient amount of nutrients/minerals.

  • High concentration (thicker).

  • Administered to large veins (vena cava & subclavian).

  • Long-term use (several weeks/months).

  • Peripheral Parenteral Nutrition (PPN)

  • Provides partial/supplemental sources of nutrients (can eat).

  • Contains an incomplete amount of nutrients/minerals.

  • Low concentration (thinner).

  • Administered to small veins (peripheral).

  • Short-term use (maximum of 2 weeks).

  1. Monitoring Nutritional Status

  2. Strategies To Address Age-Related Changes Affecting Nutrition

  • Elderly

  • Encourage healthier food choices.

  • Snacking on healthy foods.

  • Make food taste good.

  • Consider adding supplements.

  • Encourage exercise.

  • Child

  • Plenty of fruits & vegetables.

  • Plenty of starchy foods (Bread / Rice / Potatoes / Pasta).

  • Milk & dairy foods/non-dairy alternatives.

  • Sources of protein (Meat / Fish / Eggs / Beans).

  1. Selected Therapeutic Diets

Therapeutic Diet

  • Meal plan that controls the intake of certain foods or nutrients.

  • Part of the treatment of a medical condition (observed).

  • Normally prescribed by a physician & planned by a dietician.

  • Usually a modification of a regular diet (depending on the patient’s needs).

  • Not all diets are the same for each patient.

  • Needed for Cardiovascular Disease / Gastrointestinal Disease / Diabetes.

What Disease Requires A Therapeutic Diet?

  • Cardiovascular Disease (Coronary Artery Disease / Hypertension / Heart Attacks / Stroke).

  • Diabetes.

  • Gastrointestinal Disease (Crohn's Disease / Ulcerative Colitis / Celiac Disease).

Factors To Be Considered In Planning Therapeutic Diets

  • Possible duration of the disease.

  • Factors in the diet that must be altered (to overcome these conditions).

  • Tolerance for food by mouth.

  • Normal diet may be modified as well.

Importance Of Diet Therapy

  • Diet plays a very crucial role in controlling and managing various diseases.

  • Especially lifestyle diseases like Diabetes / Cardiovascular Diseases / Obesity.

  • Known as Nutritional Therapy.

Principles Of Diet Therapy Are To:

  • Maintain good nutritional status & correct deficiencies/diseases.

  • Provide rest to the body.

  • Help metabolize the nutrients.

  • Make changes in body weight when necessary.

Types Of Medical Diet

Standard Hospital Diet

Liquid Diet

  1. Clear Liquid Diet

  • Foods that have no or low residue and fat (transparent).

  • Nutritionally inadequate.

  • Not to be given more than 2 days unless ordered by a doctor.

  • Aims to prevent dehydration or to clear the git.

  • EXAMPLE: Water / Sports Drink / Ice Chips / Basic Broth / Tea.

  • Full / General / Medical Liquid Diet

  • More liberal than a clear liquid diet (viscous consistency).

  • Administered in small frequent feeding.

  • Not to be given for a long time.

  • Only food in liquid form or becomes liquid at room temperature.

  • Avoid Coffee / Tea / Alcohol / Soda.

  • EXAMPLE: Yogurt / Smoothie / Cream / Pureed Eggs / Milk.

  1. Soft Diet

  • Bland flavor.

  • Given after a full liquid diet.

  • Meat & Poultry - Minced/ground (fish is tender).

  • Vegetables: Diced / Chopped / Cooked (a little longer than usual).

  • Fruits: Soft & raw.

  • Bread: Soft Rolls / Bread / Biscuits.

  • Dessert: Pies / Tender Crust / Cakes / Pudding.

Balanced Diet (General / Full / Complete)

  • Food preparation that provides complete nutrients.

  • Supplies Carbohydrates / Proteins / Fats / Vitamins / Minerals / Fiber.

  • Given in their normal proportions.

  • Eat 3 meals a day instead of frequent ones (in between meals).

  • Eat Heavy breakfast / Moderate lunch / Light supper.

  • Right kind / Right time & interval / Right amount / Right Mind.

  • Avoid Tea / Coffee / Alcohol / Carbonated beverages.

  • Drink at least 8 glasses of water a day between meals.

Bland Diet (CAP-Free Diet)

  • Provides food not irritating to the digestive tract.

  • Do not increase acid production in the stomach.

  • Free from Caffeine / Alcohol / Pepper.

Cold Diet (Tonsil Diet)

  • Any liquid that could be served cold & iced (avoid ice cream & milk).

  • Aims at giving relief to fresh mouth sores & surgery (tonsillectomy).

  • Surgery patients take a Clear Liquid / Full Liquid / Soft Diet.

  • Not nutritionally adequate.

  • Prescribed to patients for not more than 2 days.

Constipating Diet (Anti-Diarrhea Diet)

  • Aids in stool formation.

  • Recommended to LBM.

  • Combination of low Residue / Fiber / Fat diet.

  • Avoid fatty meats.

  • Avoid leafy veggies & high-fiber fruit temporarily.

  • Eat more Bananas / Apples / Star Apples.

  • Eat small frequent meals.

  • Drink more liquids (boil water).

  • Drink strained juice or fat-free broths.

  • Add salt & sugar to the diet.

  • Avoid milk for at least 2 days

Diabetic Diet (Calculated Diet)

  • Balanced diet measured to provide the number of exchanges/servings.

  • Based on the individual’s caloric requirement.

  • Concentrated sweets & simple carbohydrates are avoided.

  • High in fiber & low in fat.

  • Avoid Candies / Sweets / Softdrinks / Chocolates / Ice Cream / Cakes.

  • Use legumes & whole grains.

  • Eat Heavy breakfast / Moderate lunch / Light supper.

  • Limit fruits to 3 exchanges per day.

  • Drink a cup of low-fat milk daily.

  • Avoid Coffee / Tea Alchohol / Wine / Liquor.

  • Drink 6-8 glasses of water per day.

  • Low Salt / Fat / Cholesterol diet.

High-Calorie Diet (Up-Building & High Carbohydrate Diet)

  • For those with athletic events.

  • Allows food/drink with an energy value of 50%-100%.

  • Above the caloric requirement & actual food intake.

High-Fiber Diet

  • Modified balanced diet with higher fiber content.

  • Effected by including more Fruits / Nuts Vegetables / Whole Grains.

High-Protein Diet

  • Calls for 15 g of protein/kg ideal body weight.

  • Prescribed for growth & repair.

  • Pregnancy / Tissue & Bone Regeneration / Inflammatory / Injury.

Hypoallergenic Diet

  • Eliminates foods that contain identified allergens (causing allergy).

  • Depends on the person's sensitivity.

  • Individualization is important because reactions to certain food may vary.

Low-Cholesterol Diet

  • Limiting food choices to only those with little/no cholesterol.

  • Planned so that cholesterol intake is no more than 300 mg per day.

  • Limit all cooked meat up to a maximum of 2 exchanges per day.

  • Cut off fatty portions of meat.

  • Use sparingly Corn Oil / Soybean Oil / Peanut Oil (fat-rich).

  • Avoid eggs & egg products.

  • Boil / Pan / Oven / Broil / Bake food.

  • Eat fruits rather than rich desserts.

  • Eat Fruits / Vegetables / Unrefined Cereal / Nuts / Grains / High-fiber.

  • Drink 6-8 glasses of water per day.

  • Do not overeat.

Low-Fat Diet

  • Allows a minimal amount of dietary fat.

  • Comprises less than or equal to 15% of the total caloric requirement.

  • Prescribed for Liver / Gallbladder / Hyperlipidemia / Heart Disorders.

  • Not a no-fat diet but a low-fat diet.

  • Avoid Pork / Fatty Meats / Animal Fats / Skin.

  • Eat more unrefined/unprocessed foods.

  • Drink fruit juices instead of Full-Cream Milk / Shakes / Chocolate Drinks.

  • Use & drink only Soy / Skim / Low Fat / Non-Fat milk.

  • Boil / Bake / Broil food.

  • Prefer plain rice over fat-rich bakery products.

  • Choose low fat soups.

  • Take note of salad dressings & sauces.

Low-Protein Diet

  • Allows a minimal amount of dietary protein.

  • Ranges from 20-40 grams per day.

  • For kidney & liver problems.

  • Limit protein rich food to 1-2 exchanges/servings per day.

Recording/Reporting Of Nutrition Status Monitoring

  • Provide evidence that intervention is changing the patient’s behavior/status.

  • Ensure patient understands goals & importance (not just because).

  • Discuss Problems / Questions / Concerns with patients regarding goals.

  • Continue on the path or need to change.

  • Continue documentation & updates on the patient’s file.

  • Continue to measure to assess progress.

Evaluation

  • Systematic comparison of current findings with previous status.

  • Compare the current findings to intervention goals/reference standards and evaluate the overall impact.

  • Compare new data to old & compare obtained results to the desired goals.

  • Assess whether goals are being obtained & if they are truly helping to improve the patient’s health (if not then discuss alternatives).

  • Decide to discharge the patient or continue counseling.