Assignment no. 1. (To be submitted on Feb.

15, 2020)
Illustrate the Nutrition Care Process and Discuss each step

Name of Student: Patrick John D. Gonzales

Section: BSND2A

Figure no. 1 – The Nutrition Care Process Model

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from:https://cpncampus.com/biblioteca/files/original/21dbd6985586b3b6647a3291b963e117.pdf

Nutrition Care process is the process of nutrition care as per mandated by Academy of
Nutrition and Dietetics (AND), formerly called American Dietetic Association (ADA). As per
defined by AND, NCP is the standardized method in identifying, planning and meeting the
nutritional needs and requirements of a larger scale individuals (in the community or specific
groups) or small scale (clients and patients in the clinical setting). Moreover, the NCP provides a
framework for critical analysis, thinking and decision making that assists Registered Nutritionist
– Dietitians in their responsibilities and roles in various practice settings leading to more
effective and efficient nutrition care. Furthermore, NCP focuses on its goal on disease
prevention, treatment and management thus giving a greater recognition of RNDs in the primary
health care system here and abroad.
The first step of the NCP is the nutrition assessment, it is the systematic way of
obtaining, verifying and interpreting the data from the anthropometric, biochemical, clinical and
dietary studies derived from patients, family members, clients, caregivers and other individuals
and groups. It is also the current and dynamic technique involving pre – data collection as well
as reassessment and analysis of the client/patient status compared to a specific criterion. Data
being collected in the assessment are the following: Anthropometric measurements,
Biochemical data, medical tests and procedures, Nutrition – focused results of physical
examination, Food and nutrition – related history, client history through screening/referral forms,
medical/health records, patient/client interview, consultation with the other caregivers and family
members, statistical reports, administrative data, epidemiologic studies and community-based
surveys and focus groups. The nutritional assessment composed of identifying standards by
which data has been compared, reviewing data collected for factors that affect nutrition and
health status and also includes the clustering individual data elements to identify a nutrition
diagnosis as described in diagnostic reference sheets. This also needs critical thinking in which
appropriate data to collect, if there is a need for additional information, prior analysis in
distinguishing relevant and irrelevant data including important and important dates. Selecting
assessment materials and procedures are required in various situations, which these
assessment tools can be used in valid and reliable ways. This step needs also the validation of
data gathered and interpreted. Results of the assessments leads to the right initial determination
that a certain nutritional problem exists in that certain person. If a nutritional diagnosis is
formulated, the RND labels the diagnosis and creates the PES statement in the NCP Step 2. If a
nutritional problem is not identified then further information or testing may be done to assure
determination. The plan for the determination of continuation of care could be done through
progression of NCP, need for additional information/testing or discharge from nutrition care if the
problem cannot be modified by nutrition care.
Step 2 of the NCP is called the nutritional diagnosis, where a food and nutrition
professional identification and labeling of an existing nutritional problem in which a food and
nutritional professional is responsible for treating them independently. Diagnosis reference
sheets are needed, where organized assessment is done in clustering comparisons of
characteristics of suspected diagnoses. The nutrition diagnosis is summarized into a structured
sentence called the nutrition diagnosis statement or the PES statement. PES statement is
consisting of three different components, namely P (problem), E (etiology) and S (signs and
symptoms). The statement has a distinct format: The Problem related to Etiology as evidenced
by signs and symptoms. The problem/nutritional diagnosis commonly describes on the
alterations on the patient’s/client’s nutritional status. Description are labelled with words like
“altered”, “excessive” or “inadequate”. Etiology is the factor that is collected during the nutritional
assessment that contributes to the maintenance of pathophysiological, psychosocial,
development, etc. problems. This contributes to the selection of nutrition intervention aimed at
solving the root cause of nutritional problem as much as possible. It is preceded by “related to”
and most major and minor etiologies are derived from medical, environmental and genetic
factors. Signs and symptoms are those defining characteristics that provide evidence that a
certain problem/nutritional diagnosis exist. This are preceded by the words, “as evidenced by”
and signs are assessed by a trained medical director/doctor. Symptoms are those changes
experienced by the patient and must be reported to the attending physician/clinician. A nutrition
diagnostic statement must be clear and concise, specific to a patient/client, limited to a single
client problem, accurately related to one etiology and base don the signs and symptoms from
the assessment data from the nutrition diagnostic sheets. These steps need a suspending
judgment, the problem must be stated clearly and singularly, RNDs should also find patterns
and relationships from the gathered data and identify possible causes, making inferences and
interdisciplinary connections and also ruling out in various nutritional diagnosis. Because the
nutrition diagnosis step involves naming and describing the problem, it will then be followed by
the determination of continuation nutritional care for the patients. If a food and nutrition
professional does not find a nutrition diagnosis, a patient/client may be referred back to the
primary provider. If the potential exists for a nutritional diagnosis to develop, an RND may
establish an appropriate method and interval for follow – up.
The third step of the NCP is the Nutrition Intervention, it is the planned actions intended
to positively change the nutrition focused behavior, environmental condition and aspect of
individual health status. The nutrition intervention aims to aid/solve the nutritional
diagnosis/problem and the nutritional etiology. The American Dietetic Association’s Evidence –
Based Nutrition Practice Guides and Analysis Library are considered to be the data
sources/references for interventions, along with the current research literature and results of the
outcome management studies. The nutrition intervention is divided into two interrelated
components, the planning and implementation. Planning prioritizes the nutrition diagnoses,
reviews practice guidelines (EAL) and policies, confers with patient, setting goals and determine
expected outcomes, defining the specific nutrition intervention strategy and define time and
frequency of care. Implementation does to ventures on the communicating and carrying out care
plan and maximizes continued data gathering process. It also modifies/revises the intervention
strategy if needed to, RNDs must also follow – up and verify the implementation plan of care. In
nutritional intervention, it is also important to know the four domains namely, the food and
nutrient delivery, nutrition education, nutrition counselling and coordination of nutrition care as
these methods are practically useful in various practice setting. In this step, we must also know
how to set goals and prioritize nutritional decisions, making interdisciplinary connections and
matching the care of plan with patient’s/client’s needs and nutrition diagnosis. We must also
define the nutrition prescription, and choose alternative on the course of action specifying the
time and date of administered care. In determining the continuation of care, if the patient has
also achieved its intervention goals or doesn’t ready to make changes, the RND may discharge
the client/patient in his care of plan as part on the intervention.
Lastly, the step 4 of the process is called the Nutrition Monitoring and Evaluation. In this
step, RNDs are able to determine whether the patient is meeting/achieving its intervention goals
or desired outcomes or identifying the progress based on the actions made. It also identifies
outcomes relevant to the nutrition diagnosis and intervention strategies and goals. We are
measuring outcome of nutrition-related history, anthropometric measurements, biochemical
data, medical tests and procedures and nutrition – focused physical findings derived from self –
monitoring data, anthropometric, biochemical and clinical tests, medical tests and procedures,
patient’s survey, pretests, posttests, questionnaires and mail/telephone follow-up. Nutrition
Monitoring and Evaluation components include monitoring of progress towards a nutrition
intervention or goal, as to which RNDs are able to check patient understanding and does she/he
follow the prescribed plan, provide evidence that the strategy is or is not altering patient’s
behavior or status and identify various positive or negative outcomes. Next will the
measurement of outcomes, as we measure the appropriate nutrition care indicators to the
nutritional diagnosis, goals and outcomes. Lastly, we will evaluate the outcomes, in which we
are making comparison on the current nutritional findings to the previous status intervention
goals or the appropriate standards selected during the nutrition care planning. Through this
step, we are able to select appropriate indicators and reference standards of comparisons,
explaining variances of possible outcomes and defining the expected outcomes of the nutritional
plan implemented. Through the findings of the RND, she/he may actively continue the care or
the care of plan is complete or their no change is being set, he/she can now discharge the
client/patient. If the RND decided to continue the nutrition care, refinement must be done in
determining the problem or making of intervention strategies. If the care will be stopped, the
client is still subjected for monitoring specifically on his/her change in status and can be
administered with nutrition care later on.

References:

Jamorabo-Ruiz, A., Serraon- Claudio, V., & Exevea- Decastro, E. (2011). Medical
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Bookstore Inc.

Mahan, L.K. & Raymong, J.L. (2017). Krause’s Food and Nutrition Care Process
(14 th ed).Phildelphia, PA: Elsevier/Saudders.

Rayos, J. M. (2019). DoH educates nutritionists-dieticians on nutrition care process.

Http://Balikas.Net/Doh-Educates-Dutritionists-Dieticians-on-Nutrition-Care-Process/.
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Stewart, R., Vivante, A., Myers, E., (2013). Nutrition Care Process and Terminology: A
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Swan, W., Vivanti, A., Hakel - Smith, N., Hoston, B., Orrevall, Y., Trostler, N., Howarter,
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People-Centered Care and Outcomes Management. Journal of the Academy of Nutrition and
Dietetics , 1(1), 2–5.
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Tanchoco, C., & Serra, N. (2009). Fundamentals in Medical Nutrition Therapy (2009

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