Nutrition Care Process PDF

**NUTRITION CARE PROCESS** **THE THERAPEUTIC PROCESS SETTING AND FOCUS OF CARE** - Hospital - Home - Private practice - Outpatient facility - Long-term care facility - Rehabilitation center - Public health community setting. - Ultimate goal of nutrition support is to establi...

**NUTRITION CARE PROCESS** **THE THERAPEUTIC PROCESS SETTING AND FOCUS OF CARE** - Hospital - Home - Private practice - Outpatient facility - Long-term care facility - Rehabilitation center - Public health community setting. - Ultimate goal of nutrition support is to establish nutritional balance according to specific needs of the individual. **NUTRITION CARE MODEL** **THE THERAPEUTIC PROCESS HEALTH CARE TEAM** Registered dietitian nutritionist (RDN) Physcian and Support Staff Nurses **Roles of the Nurse and the Clinical Dietitian** **Coordinator and advocate** **Inrerpreters** **Teacher and counselors** **The Nutrition Care Process** - is "a systematic problem-solving method that dietetics professionals use to critically think and make decisions to address nutrition-related problems and provide safe and effective quality nutrition care. - It is composed of the following four distinct and interrelated nutrition steps: 1. Assessment 2. Diagnosis 3. Intervention 4. Monitoring and Evaluation. **Part 1. Nutritional assessment** **PHASES OF THE CARE PROCESS *NUTRITION ASSESSMENT*** - To assess nutrition status and provide person-centered care, as much information as possible about the patient'ssituation is collected. needs, desires, and goals - Appropriate care considers the patient's nutrition status, food habits, and living situation as well as his or her - The patient and his or her family are the primary sources of this information. Other sources include the patient's medical chart, oral or written communication with hospital staff, and related research. **Data obtained during the nutrition assessment are organized into five categories**. 1. **Food/nutrition-related history** - Food and nutrition intake - Food and nutrition administration - Medication complementary/alternative medical use - Knowledge and beliefs - Availability of foods and supplies - Physical history - Nutrition quality of life 2. **Anthropometric measurements** - Height - Weight - BMI - Growth pattern indices / percentile rank - Weight history 3. **Medical history and procedure** - Lab data - Test results 4. **Nutrition-focused physical findings** - Physical appearance - Muscle and fat wasting - Swallow function - Appetite - Affect 5. **Client history** - Personal history - Medical, family health history - Treatment complementary/alternative medicine use - Social history **Part 1.1 NUTRITIONAL HISTORY** **FOOD/NUTRITION-RELATED HISTORY** i. **Dietary Intake Data Food- and Nutrition-Related History** - Knowledge of the patient's basic eating habits may help to identify possible nutrition deficiencies. - A more extended view of the diet may reveal additional information about food habits or problems as they relate to the individual's socioeconomic status, family, living situation, and general support system. - the information on the food, drink and supplements consumed. - the personal dietary intake is influenced by factors usch as economic situation, availability of food, eating behavior, emotional climate, cultural backgroudn, effects of disease and the ability to acquire and absorb nutrients. - Direct questions about supplement use (e.g., vitamins, minerals, multivitamin/mineral combinations, herbs) are more likely to yield accurate answers and to provide insight into overall nutrient consumption. - Allergies and intolerances should be noted so that alternative recommendations meet nutrition needs without causing negative reactions. - Physical activity logs are similar to dietary intake logs in that all activity is recorded throughout the day in an effort to calculate energy expenditure.  **METHODS FOR OBTAINING DIETARY INTAKE :** 1. **Nutrient Intake Analysis** - also may be referred to as a nutrient intake record analysis or calorie count, depending on the information collected and the analysis done - it is atool used in various inpatient setting to idenitify nutritional inadequacies by monitoring intake before deficiencies develop. - information about actual intake is collected through direct observation or an inventory of foods eaten based on observation of what remains on the individual's tray or plate after a meal - A NIA shoul be recorded for at least 72 hours to reflect daily variations in intake 2. **Food Diary** - also known as food journals, are essential tools in dietary assessment, enabling individuals to record their food and beverage intake over a specific period, usually ranging from one to seven days. - This method allows for detailed t racking of dietary habits, providing insights into portion sizes, meal timing, and food choices 3. **Food Frequency** - retrospective review of intake based on frequency (i.e. food consumed per day, per week or per month) - are valuable tools in nutritional assessment, designed to gauge the frequency of food consumption over a defined time frame. By asking participants to report the frequency of consumption of various food items, FFQs can provide insights into eating patterns and nutrient intake - *determined* its FFQs allow for the identification of dietary patterns and nutrient intake with relative ease. 4. **24-Hour Recall** - method of data collection requires individual to remember the specific foods and amounts of foods they consumed in the past 24 hours - A 24-hour dietary recall (24HR) is a structured interview intended to capture detailed information about all foods and beverages (dietary supplements) consumed by the respondent in the past 24 hours, most commonly, from midnight to midnight the previous day - A key feature of the 24HR is that, when appropriate, the respondent is asked for more detailed information than first reported. - Dietary recalls typically ask about foods and beverages first, before questions on dietary supplements \- A 24HR usually requires 20 to 60 minutes to complete. Problems commonly associated with this method of data collection include 1\. an inability to recall accurately the kinds and amounts of food eaten 2\. difficulty in determining whether the day being recalled represents an individual's typical intake or was exceptional 3\. the tendency for persons to exagerate low intakes and underreport high intakes of foods. **24-hour Recall Form and Food Group Evaluation** The following question pattern may be used for conducting the 24-hour recall. The information should then be recorded in the chart at the end. \"In order to get a more complete picture of your family\'s health, I need to know more about your eating habits. Would you please tell me everything you ate or drank all day yesterday? Let\'s begin with:\" 1\. What time did you go to bed the night before last? Was this the usual time? 2\. What time did you get up yesterday? Was this the usual time? 3\. When was the first time you had anything to eat or drink? What did you have and how much? 4\. When did you eat again? Where? What and how much? 5\. When did you eat next? What did you eat and how much? 6\. Did you eat or drink anything else? a. Anything from 1st to 2nd meal? b. Anything from 2nd to 3rd meal? c.. Anything from 3rd meal to bed time? 7\. Was this day\'s food intake different from usual? If so, why? 8\. Is weekend eating different? \_ If so, why? **PART 1.2 PHYSICAL ASSESSMENT** **NUTRITION ASSESSMENT** i. **Anthropometric Measurements** → the physical measurements of the human body that are used for health assessment, including height, weight, skin fold thickness, and circumference (i.e., of the head, hip, waist, wrist, and mid-arm muscle). - Height should be measured using a wallmounted measuring tape, if possible, or the moveable measuring rod on a platform clinic scale. Have the person stand as straight as possible, without shoes or a hat. - Children who are younger than 2 years old should be measured while they are lying down with astationary headboard and a movable footboard. - Alternative measures for nonambulatory patients provide estimates for people who are confined to a bed, who cannot stand up straight, or who have lower body amputations ii. **Weight and body mass index.** - For accurate results,patients should be weighed at consistent times If the patient is wearing the same clothing each time that he or she is weighed (e.g., an examination gown), a more consistent weight measurement will be obtained. - Inquire about recent weight loss Patients who have lost ≥5% of their body weight in 1month or ≥10% of their body weight over any amount of time for unknown reasons should be referred to an RDN for a thorough evaluation. - The body mass index is calculated by using both weight and height measurements and it is ahelpful assessment tool throughout the life cycle. iii. **MID ARM CIRCUMFERENCE (MAC**)- - is measured in centimeters halfway between the acromion process of the scapula and the olecranon process at the tip of the elbow. - It's should be measured when assessing for nutritional status of children and compared with the standards developed by the WHI for children aged 6 to 59 months of age (de Onis et al,1997) - AC \> 14cm **normal nutritional state** - AC 14 -- 12.5 **mild/modest undernutrition** - AC \< 12.5 **severe underrutrition** **c. BODY COMPOSITION** - The dietitian may measure various aspects of body size and composition to determine relative levels of lean tissue compared to fat mass. - Some methods include a skin fold thickness measurement with calipers, hydrostatic weighing, bioelectrical impedance analysis, dual-energy x-ray absorptiometry, and the BOD POD body composition tracking system (Life Measurement, Inc., Concord, Calif). **SKIN FOLD THICKNESS MEASUREMENT** - The most direct measure of fatness i n people is measurement of skinfold thickness using skinfold calliper. - These springs loaded callipers exert a constant pressure on a fold of skin, the thickness of skin is indicated in a meter. - The thickness depends in the amount of fat stored subcutaneously in the region of the skinfold. quickly. **d. WAIST CIRCUMFERENCE** - Individuals who store body fat in the abdominal region have significantly more health risks than their counterparts of the same weight who store fat in the hip and thigh regions. - For a lowered health risk, waist circumference should be \