Lecture 2 NPG nutritional Diagnosis, Intervention and Monitoring & Evaluation Flashcards
Components of the NCP
Describe nutrition diagnosis
Identify and describe a specific nutrition problem
* Articulated as a structured sentence: Nutrition diagnosis statement or “PES” statement
* Standardizes the diagnosis terminology used
Skills needed for nutrition diagnosis
Critical thinking
* Determine problem you can resolve (as a dietitian)
* Evaluate the etiology that can be addressed (through nutrition intervention)
* Select the assessment data that can be measured to indicate resolution or improvement of the problem
Describe the PES statement
3 components
* Problem (P): nutrition diagnosis
* Etiology (E): cause of nutrition problem
* Signs and Symptoms (S): based on objective evidence of the nutrition problem
How is the diagnosis written?
The diagnosis is a generic sentence is written as:
“Problem” related to “etiology” as evidenced by “signs and symptoms”.
Evaluating the PES statement
- Problem: Can the RDN resolve or improve the nutrition diagnosis?
- Etiology: Is this the root cause of the problem?
- Signs and symptoms: Can these be monitored and documented and improved?
How is the terminology for nutrition diagnosis ‘PROBLEM’ organized?
organized in three domains (categories)
* IN - Intake
* NC - Clinical
* NB - Behavioural-environmental
* No nutrition diagnosis at this time
eNCPT
electronic nutrition care process terminology
Describe NI
Intake
* Nutritional problems related to energy, nutrients, fluids, or bioactive substances through oral diet or nutrition support
Describe NC
Nutritional problems related to medical or physical conditions
Describe NB
Nutritional problems related to knowledge, attitudes/beliefs, or physical environment
Correct or Incorrect?
Correct
Correct or incorrect
correct
Correct or incorrect?
Incorrect
* HbA1C would be S/S
Characteristics of a well written PES statement
- Clear and concise
- Specific to client
- Accurately related to etiology
- Based on reliable and accurate nutrition assessment data
What happens if intervention cannot resolve the etiology?
If the intervention cannot be aimed at resolving the underlying cause (e.g., physiologic-metabolic etiologies)ànutrition intervention targeted to minimize signs and symptoms of the nutrition problem.
Considerations when making a PES statement
- Can the RD resolve the problem?
- Does the etiology make sense? Does it match the assessment data?
- Is there a reasonable intervention? Is the intervention within the scope of RD practice?
- Can you monitor this patient on the basis of the stated signs and symptoms?
Multiple nutrition diagnosis
If there is more than one nutrition diagnosis identified, prioritize what is most pertinent to the patient at this time.
* Each nutrition diagnosis is documented in separate sentences.
Describe the nutrition intervention
Planning + Implementation: Planned actions to resolve or improve nutrition related problem (behaviour, environment condition and/or aspects of health status).
* Advice
* Education
* Delivery of the food component or specific diet or meal plan
* Targeted to resolve the nutrition diagnosis and/or improve the signs and symptoms
* Detail nutrition prescription and identify strategies
* Determine patient-focused goals: SMART
* Nutrition prescription
What is the nutrition prescription
Client’s individual recommended dietary intake based on current reference standards and dietary guidelines and the client’s health and nutrition diagnosis. Aimed at resolving the cause of the nutrition problem.
* i.e.,: 1900 kcal/day, 60-72g protein/day, reduce added sugars and salt
- Assessment data
- PES statement
- Current evidence
- Policies and procedures
- Client preferences
What does the nutrition prescription include?
Nutrition Counselling
Counselling is HOW we deliver the intervention
* “Supportive process, characterized by a collaborative counselor-client relationship to establish food, nutrition and physical activity priorities, goals and individualized action plans that acknowledge and foster responsibility for self- care to treat an existing condition and promote health”
* May involve: education, goal setting, social support, problem solving, self-monitoring, etc
* Theoretical Basis/Approach Strategies
Planning the nutrition intervention
- Collaborate with the client to identify goals of the intervention and expected outcomes
- Prioritize the nutrition interventions based on client preference, urgency, impact potential and available resources
- Write a nutrition prescription
- Determine a specific, science-based nutrition intervention strategy
- Define time and frequency of care, including intensity, duration and follow-up
Implementing the nutrition intervention
- Collaborate with the client to carry out the plan of care (individualized)
- Communicate the plan of nutrition care
- Modify the plan of care as needed (continue data collection)
- Follow-up and verify that the plan is being implemented
- Revise strategies based on changes in condition or response to intervention
