Introduction to Nutrition Management of Human Disease

Course Overview

  • Course Title: FNN 301 Introduction to Nutrition Management of Human Disease

  • School: School of Nutrition

  • Instructor: Daniela Malta, PhD, RD

  • Resource: Marcia Nelms, Nutrition Therapy and Pathophysiology, 4th Edition. © 2020 Cengage.

Course Objectives

  1. Describe Factors Impacting Nutritional Status:

    • Identify and discuss at least three factors impacting nutritional status.

  2. Importance of Understanding Nutrition Problems:

    • Explain the significance of knowing the factors influencing a nutrition problem.

  3. Nutrition Care Process (NCP):

    • Define the Nutrition Care Process and outline its purpose in nutrition management.

  4. Basics of Professional Charting:

    • Understand the fundamentals of professional charting in nutrition management.

Part 1: Nutrition Care Process

Improving Nutritional Status Through Nutrition Care

  • Nutritional Status: Understanding it in relation to various influencing factors,

    • Human Biology Factors: Include gender, age, genetics, physiology phases, etc.

    • Lifestyle Factors: Encompasses personal behaviors, mental health, and stress management.

    • Food and Nutrient Factors: Refers to both the types and amounts of food consumed.

    • Environmental Factors: Affects food access and choices including social, economic, and cultural barriers.

    • System Factors: Relate to broader influences such as healthcare systems and policy decisions.

Macro-Level Environments and Influences

  1. Physical Environments (Settings):

    • Home, work, school, childcare, restaurants, convenience stores, etc.

  2. Social Environments (Networks):

    • Family, friends, peers, and their influence on individual food choices.

  3. Individual Factors (Personal):

    • Includes attitudes, beliefs, skills, knowledge, motivations, and demographics.

Impact of Illness on Nutritional Status

  • Symptoms and Effects of Illness:

    • Illness can lead to reduced food intake, altered digestion and absorption, and altered nutrient metabolism.

    • Common Symptoms Include: Anorexia, nausea, vomiting, mouth ulcers, depression, difficulty swallowing, pain with eating.

  • Treatment Effects:

    • Treatments may restrict diets, affect digestion, and alter nutritional needs or absorption.

Purpose of Providing Nutrition Care

  • Restoration of Nutritional Balance:

    • Identify the underlying cause of nutritional issues to select effective interventions.

Assessment of Nutritional Status

  • Factors Affecting Nutritional Status:

    • Human Biological Factors: Age, sex, genetics, physiological needs, medications required for disease treatment.

    • Lifestyle Factors: Personal beliefs about food, behaviors, stress management, and health habits.

    • Food and Nutrient Factors: Refers to quantity and quality of food consumed and dietary restrictions/preferences.

    • Environmental Factors: Social influences, economic conditions, food safety issues, and food accessibility.

Nutrition Care Process (NCP) Definition

  • Systematic Approach:

    • Solve nutrition-related problems to ensure safe and high-quality nutrition care.

Steps in Nutrition Care Process

  1. Screening and Assessment:

    • Collect and analyze relevant data about a patient’s nutrition.

  2. Nutrition Diagnosis:

    • Identify nutrition-related problems using standardized language and diagnostic models.

  3. Nutrition Intervention:

    • Develop and implement a care plan based on the diagnosis.

  4. Monitoring and Evaluation:

    • Assess progress and adjust the nutrition care plan as needed based on patient response.

Nutrition Care Process Stages

Stage 1: Nutrition Assessment

  • Objectives of Assessment:

    • Observe verbal/nonverbal cues, select relevant data, and utilize practical assessment tools.

  • Data Collection Domains:

    1. Food/Nutrition related History (FH)

    2. Anthropometric Measures (AD)

    3. Biochemical Data (BD)

    4. Nutrition Focused Physical Findings (PD)

    5. Client History (CH)

Stage 2: Nutrition Diagnosis

  • PES Statements:

    • Format: Problem (P) related to Etiology (E) as evidenced by Signs and Symptoms (S).

    • Components of Dietary Patterns:

    1. Nutrient Intake Problems (NI)

    2. Clinical Issues (NC)

    3. Behavioral-Environmental Issues (NB)

Stage 3: Nutrition Intervention

  • Intervention Strategies:

    • Develop a nutrition prescription with well-defined goals (using SMART criteria).

    • Domains for the Intervention Approach:

    1. Food and/or Nutrient Delivery (ND)

    2. Nutrition Education (E)

    3. Nutrition Counseling (C)

    4. Coordination of Nutrition Care (RC)

Stage 4: Nutrition Monitoring & Evaluation

  • Monitoring Parameters:

    • Track daily protein/energy intake, weight changes, and adherence to nutritional prescriptions.

  • Evaluation Strategies:

    • Measure progress against established goals, evaluating barriers, and documenting outcomes.

Documentation and Charting

Importance of Documentation

  • Standardized Language:

    • Necessary for accurate and flexible notation regarding patient care metric.

    • Acceptable Formats: SOAP (Subjective, Objective, Assessment, Plan), PIE (Problem, Intervention, Evaluation), ADIME (Assessment, Diagnosis, Intervention, Monitoring/Evaluation).

Using SOAP Notes

  1. Subjective: Input gathered directly from the patient, including feelings and experiences.

  2. Objective: Measurable data (e.g., vital signs, weight).

  3. Assessment: Interpretation of the data, providing a professional perspective.

  4. Plan: Outline of actionable steps based on patient assessment and goals.

Example PES Statement

  • Patient Background Example:

    • Mr. R is a 76-year-old man facing nutritional challenges due to age, limited cooking ability, and supportive network constraints.

  • PES Example: Unintended weight loss (P) related to inadequate energy intake (E) as evidenced by weight loss of 5 kg and decreased appetite (S).

Creating SMART Goals

Definition of SMART Goals

  • Specific: Clear, unambiguous goals.

  • Measurable: Quantifiable progress tracking.

  • Action-oriented: Steps are actionable.

  • Realistic: Achievable within constraints.

  • Timely: Defined timeline for completion.

Goals for Mr. R

  • Goal 1 (Energy):

    • “I will include at least one calorie-dense food daily for the next four weeks.”

  • Goal 2 (Protein):

    • “I will consume at least one protein-rich food twice daily for the next month.”

Conclusion

  • The Nutrition Care Process is a structured and systematic method essential for addressing nutritional concerns, ensuring quality care, and promoting patient health outcomes.

  • Emphasis on accurate assessment, effective intervention planning, ongoing evaluation, and robust documentation practices is vital in nutrition management.