Lecture 2: The Nutrition care process

Question 1

Improving Health and Nutritional Status through

Nutrition Care

Answer 1

A person’s state of health is a continuum that can change from
being totally healthy and resistant to disease
to having an acute illness
to living with a chronic disease or condition that significantly alters
one’s capacity to function well
to having a terminal illness.
Regardless of the state of health, nutrition is very important(l)

Question 2

Nutritional status

Answer 2

Assessing a person’s nutritional status involves not only comparing the amounts and
types of nutrients that a person consumes to nutrient requirements at various stages
throughout the continuum of growth, health, and illness but also examining the wide
variety of factors that influence both nutrient intake and nutrient requirements.
• If one consumes adequate amounts and types of nutrients to support and optimize a
given health state, the balance between nutrient intake and nutrient requirements is
considered to be “good.”
an inadequate or excessive intake of nutrients, or the form of nutrients is not well
utilized by the body, a nutrient “imbalance” is present

Question 3

Factors affecting Nutritional status

Answer 3

1. Human Biological Factors 
Factors affecting Nutritional status 
2. Lifestyle Factors 
3. Food and Nutrient Factors 
4. Environmental Factors
5. System Factors

Question 4

Lifestyle Factors

Answer 4

(determine food, physical activity, and related choices)
a. Attitudes/beliefs
b. Knowledge
c. Behaviors
Example: understanding which foods contain saturated fats and cholesterol can
influence what type and amount of meats and added fats a person consumes

Question 5

Food and Nutrient Factors

Answer 5

determine the type and amount of nutrients 
available for use by the body) 
a. Intake/composition 
b. Quantity 
c. Quality

Question 6

Human Biological Factors

Answer 6

(determine nutrient requirements— normal,
increased, decreased, change in form, etc.)
a. Biology factors (age, sex, genetics)
b. Physiological phases (growth, pregnancy, lactation, aging)
c. Pathological factors (disease, trauma, altered organ function or metabolism)
Example: a mother who is breastfeeding needs to consume more kcal
and protein compared to a non-breastfeeding mother.

Question 7

Environmental Factors

Answer 7

(external influences that impact consumption and
lifestyle)
a. Social (cultural food practices and beliefs, parenting, peer influences)
b. Economic (household finances, economy of the community/ country)
c. Food safety and sanitation (contaminated or unwholesome food, unsafe
food handling)
d. Food availability/access
Example: people frequently consume more food than usual at a social event
where food is served. It is also common that adults prefer the types of foods
that were typically consumed in the household where they grew up as a child

Question 8

System Factors

Answer 8

(external influences that impact on delivery and services)
a. Health care system
b. Educational system
c. Food supply system (industry, agriculture, institutions)
Example: A family whose income is near or at the poverty level and that has
limited access to health care will likely purchase fewer fresh foods and may
use the services of urgent care more frequently

Question 9

Purpose of Providing

Nutrition Care

Answer 9

Providing nutrition care can influence
and change the factors that contribute
to an imbalance in nutritional status
and thus restore nutritional health.

Question 10

The Nutrition Care Process

Answer 10

defined as “a systematic problem-solving method that dietetics practitioners
use to critically think and make decisions to address nutrition related problems
and provide safe, effective, high quality nutrition care”.

1. Nutrition assessment
2. Nutrition diagnosis
3. Nutrition intervention
4. Nutrition monitoring and evaluation

Question 11

Benefits of using the Nutrition Care Process

Answer 11

When professionals use a systematic process with standardized language,
1. there is less variation of practice and a higher degree of predictability in
terms of outcomes.

2. Increases the dietetics practitioner’s potential to provide high-quality
   nutrition care to individuals and groups.
3. It combines the process of care (the systematic and consistent steps of the
   NCP) with the content of care (incorporation of evidence-based practice
   guides) to improve both quality of care and nutritional status
4. the ability to clearly state patient goals and evaluate outcomes (1)

Question 12

NCP can improve outcomes because

Answer 12

1. It is a systematic method used to make decisions to provide safe and
   effective care.
2. Provides a common language for documenting and communicating the
   impact of nutrition care.
3. Relies on an evidence-based approach.
4. Uses specific critical thinking skills for each step.

Question 13

NCP and model

Answer 13

1. Nutrition care is provided within the context of a larger model that includes
   a central core focused on individualized care and positive relationships.
2. Both external (environmental) and internal (resources of dietetics
   practitioner) factors influence the type of nutrition care provided.
3. The steps of the nutrition care process are supported by two other
   systems: the screening and referral system and the outcomes management
   system. Dietetics practitioners participate in both of these system but may
   not have sole responsibility for accomplishing these tasks (1).

Question 14

Components of Nutrition Assessment Process

Answer 14

1. Obtain and verify appropriate data.
   • Information collected depends on the practice setting, individual’s health status,
   initial assessment or follow-up
   • The dietitian needs to know what type of data is most appropriate to collect and to
   be able to determine whether those data are valid and accurate
2. Cluster and organize assessment data according to assessment domains (see
   next slides) and possible nutrition diagnoses.
3. Evaluate the data using reliable standards.
4. Calculate estimated nutrient needs (e.g., nutrition prescription as appropriate)
   (1)

Question 15

Step 1. Nutrition assessment (Domains)

Answer 15

1. Food Nutrition Related History (FH)- Examples: Total energy intake, fat
   and cholesterol intake, meal/snack pattern, area and level of knowledge,
   eligibility for community programs, type of physical activity
2. Anthropometric measurements (AD)- Examples: Weight, weight
   change, body mass index
3. Biochemical Data, Medical Tests, and Procedures (BD)-Examples: Lab
   data (e.g., electrolytes, fasting glucose, cholesterol, HDL, BUN) and tests
   (e.g., gastric emptying time, resting metabolic rate)
4. Nutrition-Focused Physical Findings (PD)- Examples: Findings from
   evaluation of body systems, muscle and subcutaneous fat wasting, oral
   health, suck/swallow/breathing ability, appetite, and affect, Body language,
   skin
5. Client history (CH)- Current and past information related to personal,
   medical, family, and social history-Examples: Education, medical
   treatment/therapy, socioeconomic factors (1)

Question 16

Step 1. Nutrition assessment-critical thinking

Answer 16

1. Determining appropriate data to collect
2. Determining the need for additional information
3. Selecting appropriate assessment tools and procedures
4. Applying the assessment tools in valid and reliable ways
5. Distinguishing relevant from irrelevant data
6. Distinguishing important from unimportant data
7. Validating the data (2)

Question 17

Step 1. Nutrition assessment- results

Answer 17

1. Leads to appropriate initial determination that a nutrition diagnosis/problem exists
2. If a nutrition diagnosis can be made, the dietitian labels the problem and moves to
   Step 2 of the Nutrition Care Process
3. If a nutrition problem is not identified, further information or testing may be
   necessary to make a determination
4. If the assessment indicates that no nutrition problem currently exists that warrants
   a nutrition intervention, the term “No nutrition diagnosis at this time (NO-1.1)”
   may be documented (2)