2015 Terminologi Intervensi - Food

NCP Step 3:
Nutrition Intervention
Nutrition Intervention Terms and Definitions
Term Term Number Definition
DOMAIN: FOOD AND/OR

ND Individualized approach for food/nutrient provision.
NUTRIENT DELIVERY
Meals are defined as regular eating episodes that

may include a variety of foods consisting of grains
Class: Meals and Snacks (1) ND-1 and/or starches, meat and/or meat alternatives, fruits
and vegetables, and milk or milk products. A snack
is defined as food served between regular meals.
Enteral nutrition is defined as nutrition provided

through the gastrointestinal (GI) tract via tube,
catheter, or stoma that delivers nutrients distal to the
oral cavity. Parenteral nutrition is defined as the
Class: Enteral and Parenteral
ND-2 administration of nutrients intravenously, centrally
Nutrition (2)
(delivered into a large-diameter vein, usually the
superior vena cava adjacent to the right atrium) or
peripherally (delivered into a peripheral vein,
usually of the hand or forearm).
Nutrition provided through the gastrointestinal (GI)

Enteral Nutrition ND-2.1 tract via tube, catheter, or stoma that delivers
nutrients distal to the oral cavity.
Administration of nutrients and fluids intravenously,

centrally (delivered into a large-diameter vein,
Parenteral Nutrition/IV Fluids ND-2.2 usually the superior vena cava adjacent to the right
atrium) or peripherally (delivered into a peripheral
vein, usually of the hand or forearm).
Foods or nutrients that are not intended as a sole

Class: Nutrition Supplement
ND-3 (only) item or a meal or diet, but that are intended to
Therapy (3)
provide additional nutrients.
Commercial or prepared foods or beverages

Medical Food Supplement intended to supplement energy, protein,
ND-3.1
Therapy carbohydrate, fiber, and/or fat intake that may also
contribute to vitamin and mineral intake.
Vitamin and Mineral A product that is intended to supplement vitamin or

ND-3.2
Supplement Therapy mineral intake.
Addition or change in provision of bioactive

Bioactive Substance substances (e.g., plant stanol and sterol esters,
ND-3.3
Management psyllium, food additives, other bioactive
substances).
Class: Feeding Assistance (4) ND-4 Accommodation or assistance designed to restore

the patient/client’s ability to eat independently,
support adequate nutrient intake, and reduce the
incidence of unplanned weight loss and dehydration.
Adjustment of the physical environment,

Class: Manage Feeding temperature, convenience, and attractiveness of the
ND-5
Environment (5) location where food is served that impacts food
consumption.
Modification of a drug or complementary/alternative

Class: Nutrition-Related
ND-6 medicine to optimize patient/client nutritional or
Medication Management (6)
health status.

2015 EDITION
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Meals and Snacks (ND-1)

Definition
Meals are defined as regular eating episodes that may include a variety of foods consisting of grains and/or
starches, meat and/or meat alternatives, fruits and vegetables, and milk or milk products. A snack is
defined as food served between regular meals.
Details of Intervention
A typical intervention might be further described with the following details. Nutrition and dietetics
practitioners recommend, implement, or order nutrition interventions and the action(s) may be to initiate,
modify or discontinue a nutrition intervention(s):
 General/healthful diet
 Modify composition of meals/snacks
o Texture-modified diet
 Easy to chew diet
 Mechanically altered diet
 Pureed diet
 Liquid consistency-thin liquids
 Liquid consistency-nectar thick liquids
 Liquid consistency-honey thick liquids
 Liquid consistency-spoon thick liquids
o Energy-modified diet
 Increased energy diet
 Decreased energy diet
o Protein-modified diet
 Consistent protein diet
 Increased protein diet
 Decreased protein diet
 Decreased casein diet
 Decreased gluten diet
 Gluten free diet
 Amino acid modified diet
 Arginine modified diet
 Increased arginine diet
 Decreased arginine diet
 Glutamine modified diet
 Increased glutamine diet
 Decreased glutamine diet
 Histidine modified diet
 Increased histidine diet
 Decreased histidine diet
 Increased homocysteine diet
 Isoleucine modified diet
 Increased isoleucine diet
 Decreased isoleucine diet
 Leucine modified diet
 Increased leucine diet
 Decreased leucine diet
 Lysine modified diet
 Increased lysine diet
 Decreased lysine diet
 Methionine modified diet
 Increased methionine diet
 Decreased methionine diet
 Phenylalanine diet
 Increased phenylalanine diet
 Decreased phenylalanine diet
 Threonine modified diet
 Increased threonine diet
 Decreased threonine diet
 Tryptophan modified diet
 Increased tryptophan diet
 Decreased tryptophan diet
 Decreased tyramine diet
 Tyrosine modified diet
 Increased tyrosine diet
 Decreased tyrosine diet
 Valine modified diet
 Increased valine diet
 Decreased valine diet
o Carbohydrate-modified diet
 Consistent carbohydrate diet
 Increased carbohydrate diet
 Increased complex carbohydrate diet
 Increased simple carbohydrate diet
 Decreased carbohydrate diet
 Decreased complex carbohydrate diet
 Decreased simple carbohydrate diet
 Galactose modified diet
 Increased galactose diet
 Decreased galactose diet
 Lactose modified diet
 Increased lactose diet
 Decreased lactose diet
 Fructose modified diet
 Increased fructose diet
 Decreased fructose diet
o Fat-modified diet
 Increased fat diet
 Decreased fat diet
 Monounsaturated fat modified diet
 Increased monounsaturated fat diet
 Decreased monounsaturated fat diet
 Polyunsaturated fat modified diet
 Increased polyunsaturated fat diet
 Increased linoleic acid diet
 Decreased polyunsaturated fat diet
 Decreased linoleic acid diet
 Saturated fat modified diet
 Decreased saturated fat diet
 Trans fat modified diet
 Decreased trans fat modified diet
 Omega 3 fatty acid modified diet
 Increased omega 3 fatty acid diet
 Increased alphalinolenic acid diet
 Increased eicosapentanenoic acid diet
 Increased docosahexaenoic acid
 Decreased omega 3 fatty acid diet
 Decreased alphalinolenic acid diet
 Decreased eicosapentanenoic acid diet
 Decreased docosahexaenoic acid
 Medium chain triglyceride modified diet
 Increased medium chain triglyceride diet
 Decreased medium chain triglyceride diet
o Cholesterol-modified diet
 Decreased cholesterol diet
o Fiber-modified diet
 Increased fiber diet
 Decreased fiber diet
 Soluble fiber modified diet
 Increased soluble fiber diet
 Decreased soluble fiber diet
 Insoluble fiber modified diet
 Increased insoluble fiber diet
 Decreased insoluble fiber diet
o Fluid-modified diet
 Increased fluid diet
 Fluid restricted diet
 Clear liquid diet
 Full liquid diet
o Diets modified for specific foods or ingredients
o Vitamin-modified diet
 Vitamin A modified diet
 Increased vitamin A diet
 Decreased vitamin A diet
 Vitamin C modified diet
 Increased vitamin C diet
 Decreased vitamin C diet
 Vitamin D modified diet
 Increased vitamin D diet
 Decreased vitamin D diet
 Vitamin E modified diet
 Increased vitamin E diet
 Decreased vitamin E diet
 Vitamin K modified diet
 Increased vitamin K diet
 Decreased vitamin K diet
 Thiamine modified diet
 Increased thiamine diet
 Decreased thiamine diet
 Riboflavin modified diet
 Increased riboflavin diet
 Decreased riboflavin diet
 Niacin modified diet
 Increased niacin diet
 Decreased niacin diet
 Folic acid modified diet
 Increased folic acid diet
 Decreased folic acid diet
 Vitamin B6 modified diet
 Increased vitamin B6 diet
 Decreased vitamin B6 diet
 Vitamin B12 modified diet
 Increased vitamin B12 diet
 Decreased vitamin B12 diet
 Pantothenic acid modified diet
 Increased pantothenic acid diet
 Decreased pantothenic acid diet
 Biotin modified diet
 Increased biotin diet
 Decreased biotin diet
o Mineral-modified diet
 Calcium modified diet
 Increased calcium diet
 Decreased calcium diet
 Chloride modified diet
 Iron modified diet
 Increased iron diet
 Decreased iron diet
 Magnesium modified diet
 Increased magnesium diet
 Decreased magnesium diet
 Potassium modified diet
 Increased potassium diet
 Decreased potassium diet
 Phosphorus modified diet
 Increased phosphorus diet
 Decreased phosphorus diet
 Sodium modified diet
 Increased sodium diet
 Decreased sodium diet
 Zinc modified diet
 Increased zinc diet
 Decreased zinc diet
 Sulfur modified diet
 Fluoride modified diet
 Copper modified diet
 Increased copper diet
 Decreased copper diet
 Iodine modified diet
 Increased iodine diet
 Decreased iodine diet
 Selenium modified diet
 Manganese modified diet
 Chromium modified diet
 Increased chromium diet
 Molybdenum modified diet
 Boron modified diet
 Cobalt modified diet
 Modify schedule of food/fluids (e.g., timing of foods/fluids, number of meals)
o Modify schedule of intake to limit fasting
 Specific food/beverages or groups
o Fruit modified diet
o Vegetable modified diet
 Starchy vegetable modified diet
 Bean and pea modified diet
o Grain modified diet
 Diet modified for uncooked food starch
o Protein food modified diet
 Diet with foods modified to be low in protein
 Diet modified for egg
 Raw egg free diet
 Other, specify
Typically Used with the Following

Nutrition Diagnostic
Terminology Used in PES Common Examples (not intended to be inclusive)
Statements
Nutrition Diagnoses  Increased energy expenditure (NI-1.1)
 Inadequate energy intake (NI-1.2)
 Inadequate oral intake (NI-2.1)
 Excessive fat intake (NI-5.5.2)
 Excessive carbohydrate intake (NI-5.8.2)
 Inconsistent carbohydrate intake (NI-5.8.4)
 Biting/chewing (masticatory) difficulty (NC-1.2)
 Growth rate below expected (NC-3.5)
 Limited access to food (NB 3.2)
 Underweight (NC 3.1)
 Lack of access to healthful food choices, e.g., current food access,

food provided by caregiver
 Physiological causes, e.g., increased energy needs due to increased
activity level, metabolic change, malabsorption, growth, extreme
weakness, critical illness
Etiology
 Psychological causes, e.g., disordered eating
 Neurological causes, e.g. difficulty chewing, swallowing”
 Food and nutrition knowledge deficit regarding foods they are
consuming
Biochemical Data, Medical Tests and Procedures
 Serum cholesterol level

 Hemoglobin A1C results
Anthropometric Measurements
 Weight change
Nutrition-Focused Physical Findings
 Dental caries
 Diarrhea
 Evidence of muscle and/or fat wasting
 Hunger
Signs and Symptoms Food/Nutrition-Related History
 Cultural or religious practices that do not support modified

food/nutrition intake
 Changes in physical activity
 Intake of less than optimal foods
 Food- and nutrition-related knowledge deficit concerning
appropriate amount or timing of carbohydrate intake
Client History
 Conditions associated with diagnosis or treatment, e.g., surgery,

trauma, sepsis, diabetes mellitus, inborn errors of metabolism,
digestive enzyme deficiency, obesity
 Chronic use of medications that increase or decrease nutrient
requirements or impair nutrient metabolism
Other considerations (e.g., patient/client negotiation, patient/client needs and desires, and readiness to
change)
 Compliance skills and abilities
 Economic concerns with purchasing food and/or special food items
 Willingness/ability to change behavior to comply with diet
 Ability to prepare food
 Availability/access to a qualified practitioner for follow-up and monitoring
References
1. Academy of Nutrition and Dietetics. Nutrition Care Manual. www.nutritioncaremanual.org.

Accessed June 15, 2015.
2. Academy of Nutrition and Dietetics. Pediatric Nutrition Care Manual.
http://peds.nutritioncaremanual.org. Accessed June 15, 2015.
2015 EDITION
Enteral Nutrition (ND-2.1)

Definition
Nutrition provided through the gastrointestinal (GI) tract via tube, catheter, or stoma that delivers nutrients
distal to the oral cavity.
 Modify composition of enteral nutrition (e.g., formula name or description, special additives
including supplemental fat, carbohydrate, or protein, fiber)
 Modify concentration of enteral nutrition (e.g., calories/kcal/kJ per mL)
 Modify rate of enteral nutrition (e.g., mL/hour)
 Modify volume of enteral nutrition (e.g., mL/day, mL/feeding)
 Modify schedule of enteral nutrition (e.g., number of hours per 24 hours, continuous, intermittent,
bolus)
 Modify route of enteral nutrition (e.g., nasoentric, oroenteric, percutaneous, or surgical access
with gastric, duodenal or jejunal placement)
 Insert enteral feeding tube
 Enteral nutrition site care (e.g., change dressings and provide enteral feeding tube site care)
 Feeding tube flush (e.g., type, volume mL/flush, frequency)
Note: Related nutrition interventions, e.g., checking gastric residual volume or elevating the head
of the bed are documented using Coordination of Nutrition Care
Statements
Nutrition Diagnoses  Swallowing difficulty (NC-1.1)
 Altered GI function (NC-1.4)
 Increased nutrient needs (NI-5.1)
 Inadequate protein-energy intake (NI-5.2)
 Inadequate protein intake (NI-5.6.1)
 Inadequate enteral nutrition infusion (NI-2.3)
 Altered gastrointestinal tract function, inability to absorb

nutrients
 Inability to chew/swallow
 Decreased ability to consume sufficient energy, e.g., increased
nutrient needs due to catabolic illness
Etiology  Respiratory or other critical illness requiring mechanical
ventilation
 Disease process or complication of therapy which results in
excess fluid loss or retention (eg, CHF, liver failure, renal
failure)
 Weight loss
 Growth failure
 Insufficient maternal weight gain
Nutrition-Focused Physical Findings?
 Obvious muscle and/or fat wasting

 Poor skin turgor (tenting)
 Fluid retention (edema)
Signs and Symptoms
Food/Nutrition-Related History
 Intake < 75% of requirements (insufficient intake)

 Existing or expected inadequate intake for 7 to 14 days
Client History
 Aspiration
 Coma
change)
 End-of-life issues, ethical considerations, patient/client rights and family/caregiver issues

 Other nutrient intake (oral, parenteral nutrition), medications containing energy
 Enteral formulary composition and product availability
 Economic constraints that limit availability of food/enteral products
References
1. ASPEN Board of Directors and Standards Committee. Definition of terms, style, and conventions
used in ASPEN guidelines and standards. Nutr Clin Pract. 2005;20:281-285.
2. ASPEN Board of Directors and the Clinical Guidelines Task Force. Guidelines for the use of
parenteral and enteral nutrition in adult and pediatric patients. J Parenter Enteral Nutr.
2002;26:1SA-138SA.
3. McClave SA, Lowen CC, Kleber MJ, Nicholson JF, Jimmerson SC, McConnell JW, Jung LY. Are
patients fed appropriately according to their caloric requirements? J Parenter Enteral Nutr.
1998;22:375-381.
4. Mirtallo J, Canada T, Johnson D, Kumpf V, Petersen C, Sacks G, Seres D, Guenter P. Task force
for the revision of safe practices for parenteral nutrition. J Parenter Enteral Nutr. 2004;28:S39-
S70.
2015 EDITION
Parenteral Nutrition/IV Fluids (ND-2.2)

Definition
Administration of nutrients and fluids intravenously, centrally (delivered into a large-diameter vein,
usually the superior vena cava adjacent to the right atrium) or peripherally (delivered into a peripheral
vein, usually of the hand or forearm).
A typical intervention might be further described with the following details: Nutrition and dietetics
 Modify composition of parenteral nutrition (formula or description)

 Modify concentration of parenteral nutrition (e.g., percent, grams of solute per mL)
 Modify rate of parenteral nutrition (e.g., mL/hour)
 Modify volume of parenteral nutrition
 Modify schedule of parenteral nutrition (e.g., hours, timing, taper schedule)
 Modify route of parenteral nutrition (e.g., peripheral, central, and/or type of catheter)
 Parenteral nutrition site care (e.g., change dressings and provide line care for parenteral access)
 IV fluid delivery (e.g., type; amount mL/day, mL/hr, mL with medications)
Statements
 Inadequate parenteral nutrition infusion (NI-2.7)
Nutrition Diagnoses
 Impaired nutrient utilization (NC-2.1)
 Altered gastrointestinal tract function, inability to absorb nutrients,
or excessive loss of nutrients (e.g. severe vomiting, diarrhea, high
fistula output)
Etiology
 Decreased functional length of GI tract
 Bowel obstruction
 Unintentional weight loss

 Growth failure
 Insufficient maternal weight gain
Nutrition-Focused Physical Findings?

 Fluid retention (edema, ascites)
 Diarrhea
 Vomiting
Signs and Symptoms
 Intake < requirements (insufficient intake)

 Existing or expected inadequate intake for 7 to 14 days
Client History
 Malabsorption, maldigestion
 Emesis
 Diffuse peritonitis, intestinal obstruction, paralytic ileus,
gastrointestinal ischemia, or perforated viscus, short-bowel
syndrome
change)
 End-of-life issues, ethical considerations, patient/client rights and family/caregiver issues

 Other nutrient intake (oral, enteral nutrition)
 Parenteral formulary composition and product availability
 Economic constraints that limit availability of parenteral products
References
1. ASPEN Board of Directors and Standards Committee. Definition of terms, style, and conventions
used in ASPEN guidelines and standards. Nutr Clin Pract. 2005;20:281-285.
2. ASPEN Board of Directors and the Clinical Guidelines Task Force. Guidelines for the use of
parenteral and enteral nutrition in adult and pediatric patients. J Parenter Enteral Nutr.
2002;26:1SA-138SA.
3. McClave SA, Lowen CC, Kleber MJ, Nicholson JF, Jimmerson SC, McConnell JW, Jung LY. Are
patients fed appropriately according to their caloric requirements? J Parenter Enteral Nutr.
1998;22:375-381.
4. Mirtallo J, Canada T, Johnson D, Kumpf V, Petersen C, Sacks G, Seres D, Guenter P. Task force
for the revision of safe practices for parenteral nutrition. J Parenter Enteral Nutr. 2004;28:S39-
S70.
2015 EDITION
Medical Food Supplement Therapy (ND-3.1)

Definition
Commercial or prepared foods or beverages intended to supplement energy, protein, carbohydrate, fiber,
and/or fat intake that may also contribute to vitamin and mineral intake.
 Commercial (prepackaged) beverage

 Commercial (prepackaged) food
 Modified (prepared) beverage
 Modified (prepared) food
 Purpose (e.g., to supplement energy, protein, carbohydrate, fiber, and/or fat intake)
Statements
 Inadequate fluid intake (NI-3.1)
 Increased nutrient needs (NI-5.1)
Nutrition Diagnoses
 Malnutrition (undernutrition) (NC-4.1)
 Growth rate below expected (NC-3.5)
Etiology  Neurologic deficit (stroke)

 Difficulty chewing or swallowing
 Food allergies or intolerance
 Altered GI function
 Disease or treatment-related anorexia (e.g., cancer, infection,
medication side effects)
 Small for gestational age, intrauterine growth restriction, lack
of appropriate weight gain, hyperemesis gravidarum
 Inborn errors of metabolism
 Delayed growth
 Unintended weight loss

 Insufficient usual intake
 Insufficient macro- and/or micronutrient intake
Client History
 Diagnosis consistent with elevated nutrient needs

 Potential for repletion of nutritional status
 Oral/facial trauma
change)
 Appetite sufficient to take medical food supplements

 System constraints that prevent meeting the client’s preferences for specific flavors, textures,
foods, and the timing of feedings
 Economic concerns and product/food availability
 Ability to procure medical food supplement
 Access to medical food supplement storage
References
1. Academy of Nutrition and Dietetics. Nutrition Care Manual. www.nutritioncaremanual.org.

Accessed June 15, 2015.
2. Academy of Nutrition and Dietetics. Pediatric Nutrition Care Manual.
http://peds.nutritioncaremanual.org. Accessed June 15, 2015.
2015 EDITION
Vitamin and Mineral Supplement Therapy (ND-3.2)

Definition
A product that is intended to supplement vitamin or mineral intake.
 Multivitamin/mineral supplement therapy (yes/no, specify dose, frequency)

 Multi-trace element supplement therapy (yes/no, specify dose, frequency)
 Vitamin supplement therapy:
o Vitamin A (specify form, µg or RE, frequency)
o Vitamin C (mg/ day, frequency)
o Vitamin D (specify form, µg or IU, frequency)
o Vitamin E (specify form, mg or IU, frequency)
o Vitamin K (µg, frequency)
o Thiamin (mg, frequency)
o Riboflavin (mg, frequency)
o Niacin (specify form, mg, frequency)
o Vitamin B6 (specify form, mg, frequency)
o Folate (specify form, µg, frequency)
o Vitamin B12 (µg, frequency)
o Pantothenic acid (mg, frequency)
o Biotin (µg, frequency)
 Mineral supplement therapy:
o Calcium (specify form, mg, frequency)
o Chloride (mg, frequency)
o Iron (specify form, mg, frequency)
o Magnesium (mg, frequency)
o Potassium (specify form, g or mg, frequency)
o Phosphorus (mg, frequency)
o Sodium (mg or g, frequency)
o Zinc (mg, frequency)
o Sulfate (g or mmol, frequency)
o Fluoride (mg, frequency)
o Copper (µg or mg, frequency)
o Iodine (µg, frequency)
o Selenium (specify form, µg, frequency)
o Manganese (mg, frequency)
o Chromium (specify form, µg, frequency)
o Molybdenum (µg, frequency)
o Boron (mg, frequency)
o Cobalt (µg, frequency)
Nutrition Diagnostic Terminology

Common Examples (not intended to be inclusive)
Used in PES Statements
Nutrition Diagnoses  Inadequate vitamin intake (NI-5.9.1)
 Excessive vitamin intake (NI-5.9.2)
 Inadequate mineral intake (NI-5.10.1)
 Excessive mineral intake (NI-5.10.2)
 Excessive alcohol intake (NI-4.3)
 Predicted food–medication interaction (NC-2.4)
 Food- and nutrition-related knowledge deficit (NB-1.1)
 Undesirable food choices (NB-1.7)
 Poor intake of nutrient dense foods that contain vitamins and

minerals
 Excessive use of vitamin and mineral supplements
 Medical diagnosis or treatment impacting vitamin and
mineral requirements or utilization
Etiology
 Malabsorption of vitamins and minerals
 Combined ingestion or administration of medication and food
that results in undesirable/harmful interaction
 Long-term PN dependency
 Laboratory or radiologic indexes of vitamin-mineral depletion
Signs and Symptoms  Abnormalities consistent with vitamin and mineral deficiency
or excess
 Nutrient intake analysis reveals vitamin and mineral intake

more or less than recommended
change)
 Emerging scientific evidence to support the use of vitamin and mineral supplements in specific
populations, medical conditions and/or medical treatments
 Availability of a qualified practitioner with additional education/training in the use of vitamin and
mineral supplements in practice
 Economic considerations and product availability
References
1. Position of the American Dietetic Association: Nutrient supplementation. J Am Diet Assoc.

2009;109:2073-2085.
2015 EDITION

Bioactive Substance Management (ND-3.3)
Definition
Addition or change in provision of bioactive substances (e.g., plant stanol and sterol esters, psyllium, food
additives, other bioactive substances).
 Plant stanol esters (specify g, form, frequency)

 Plant sterol esters (specify g, form, frequency)
 Soy protein (specify g, form, frequency)
 Psyllium (specify g, form, frequency)
 ß-glucan (specify g, form, frequency)
 Food additives (those thought to have an impact on a patient/client’s health) (specify, e.g.,
amount, form, frequency)
 Alcohol (specify, oz/mL, form, frequency)
 Caffeine (specify, e.g., mg, oz/mL, form, frequency)
 Other substance (for which there is evidence of bioactivity) (specify, e.g., amount, form,
frequency)
Statements
 Inadequate bioactive substance intake (NI-4.1)
 Excessive bioactive substance intake (NI-4.2)
 Excessive alcohol intake (NI-4.3)
Nutrition Diagnoses  Predicted food–medication interaction (NC-2.4)
 Food- and nutrition-related knowledge deficit (NB-1.1)
 Undesirable food choices (NB-1.7)
 Food- and nutrition-related knowledge deficit concerning

recommended bioactive substance intake
 Lack of or limited access to food that contains a bioactive substance
 Contamination, misname, mislabel or lack of labeling, misuse,
recent brand change, recent dose increase, recent formulation
Etiology
change of substance consumed
 Combined ingestion or administration of medication and food that
results in undesirable/harmful interaction
 Adverse side effect related to bioactive substance
 Nutrient intake analysis reveals bioactive substance intake more or

less than recommended
 Intake reveals consumption of food additive to which the
patient/client is sensitive or intolerant
Client History
 Medical diagnosis associated with increased bioactive substance

need
change)
 Emerging scientific evidence to support the use of bioactive supplements in specific populations,
specific medical conditions and/or with medical treatments
 Availability of a qualified practitioner with additional education/training in the use of bioactive
supplements in practice
References
1. Position of the Academy of Nutrition and Dietetics: Functional foods. J Acad Nutr Diet.
2013;113:1096-1103.
2015 EDITION
Feeding Assistance (ND-4)

Definition
Accommodation or assistance designed to restore the patient/client’s ability to eat independently, support
adequate nutrient intake, and reduce the incidence of unplanned weight loss and dehydration.
 Adaptive eating devices (equipment or utensils) (e.g., specify)

 Feeding position (e.g, specify patient/client position in relationship to eating or degree angle for
enteral feeding)
 Meal set-up (e.g., specify actions to make food accessible for consumption)
 Mouth care (e.g. specify treatment to promote oral health and hygiene)
 Menu selection assistance (yes/no)
 Other (specify)

Nutrition Diagnoses  Inadequate energy intake (NI-1.2)
 Inadequate enteral nutrition infusion (NI-2.3)
 Unintended weight loss (NC-3.2)
 Self-feeding difficulty (NB-2.6)
 Physical disability
 Poor food/nutrient intake
Etiology  Neurological issues, e.g., decreased memory, concentration
problems
 Weight loss
 Dropping the utensils or food
Signs and Symptoms Client History
 Conditions associated with a diagnosis or treatment,

e.g.,cerebral palsy, stroke, dementia
 History of aspiration or conditions which increase risk of
aspiration
 Refusal to use prescribed adaptive eating devices, or follow
prescribed positioning techniques
change)
 Acceptance of feeding assistance/feeding devices

 Poor environment to foster adequate intake
 Lack of individual to provide assistance at meal time
 Lack of training in methods of feeding assistance
 Lack of available physical therapy, occupational therapy, or speech therapy evaluations
 Ability to understand the reasoning behind the recommendations and then want to make personal
changes
 Lack of assistance when translation of menu items is needed
References
1. Academy of Nutrition and Dietetics. Unintended weight loss in older adults evidence-based
nutrition practice guideline. http://andevidencelibrary.com/topic.cfm?cat=3651. Accessed June 15,
2015.
2. Academy of Nutrition and Dietetics. Critical illness evidence-based nutrition guideline,
http://andevidencelibrary.com/topic.cfm?cat=4800. Accessed June 15, 2015.
3. Position of the American Dietetic Association: Individualized nutrition approaches for older adults
in health care communities. J Am Diet Assoc. 2010;110:1554-1563.
4. Position of the Academy of Nutrition and Dietetics: Nutrition services for individuals with
intellectual and developmental disabilities and special health care needs. J Acad Nutr Diet.
2015;115:593-608.
5. Position of the Academy of Nutrition and Dietetics: Oral health and nutrition. J Acad Nutr Diet.
2013;113:693-701.
2015 EDITION
Manage Feeding Environment (ND-5)

Definition
Adjustment of the physical environment, temperature, convenience, and attractiveness of the location
where food is served that impacts food consumption.
 Lighting (e.g., specify)

 Odors (e.g., specify, minimize or enhance)
 Distractions (e.g., specify, minimize)
 Table height (specify)
 Table service (e.g., plates, napkins)
 Room temperature
 Meal service (type of service, e.g., service at table, buffet)
 Meal location (specify)
 Other

 Disordered eating pattern (NB-1.5)
Nutrition Diagnoses
 Self-feeding difficulty (NB-2.6)
 Dementia
 Inability to stick to task/easily distracted by others
 Familial, societal, biological/genetic, and/or
environmental-related obsessive desire to be thin
Etiology
 Avoidance behavior to strong food aromas
 Lack of developmental readiness to perform self-
management tasks
 Changes in appetite attributed to mealtime surroundings

 Easily distracted from eating
 Food sanitation and safety issues in environment
 Available foods not of the patient’s choosing
 Decline in patient/client ability to eat independently
 Avoidance of social events at which food is served
Client History
 Pacing, wandering, changes in affect
change)
 Resources available to improve/modify the feeding environment

 Acceptance of feeding environment changes
References
1. Position of the American Dietetic Association: Individualized nutrition approaches for older adults
in health care communities. J Am Diet Assoc. 2010;110:1554-1563.
2. Position of the Academy of Nutrition and Dietetics: Nutrition services for individuals with
intellectual and developmental disabilities and special health care needs. J Acad Nutr Diet.
2015;115:593-608.
2015 EDITION
Nutrition-Related Medication Management (ND-6)

Definition
Modification of a drug or nutrition-related complementary/alternative medicine to optimize patient/client
nutritional or health status.
 Prescription medication (e.g., insulin, appetite stimulants, digestive enzymes) dose, form,
schedule, route
 Over-the-counter (OTC) medication (e.g., antacids, aspirin, laxatives) dose, form, schedule, route
 Nutrition-related complementary/alternative medicine (e.g., peppermint oil, probiotics), dose,
form, schedule, route
Nutrition Diagnostic Common Examples (not intended to be inclusive)

Terminology Used in PES
Statements
 Altered nutrition-related laboratory values (NC-2.2)
Nutrition Diagnoses
 Food–medication interaction (NC-2.3)
 Predicted food–medication interaction (NC-2.4)
 Insufficient appetite resulting in inadequate nutrient intake

 Frequent hypo- or hyperglycemia
 Pancreatic insufficiency
 Malabsorption of fat, protein, lactose, or other carbohydrates
Etiology  Polypharmacy and medication abuse
 Combined ingestion or administration of medication and food that
results in undesirable/harmful interaction
 Reported misuse or lack of use of medication
 Frequent hypo- or hyperglycemia
 Alterations of anthropometric measurements based on medication

effect and patient/client conditions, e.g., weight gain and
corticosteroids
Signs and Symptoms  Thin, wasted appearance

 Diarrhea
 Report of nutrition-related complementary/alternative medicine

use
Client History
 Diabetes with poorly controlled blood glucose

 HIV, cancer
change)
 Availability/access to a clinical pharmacist

 Availability of a qualified practitioner with appropriate pharmacology training and/or education
References
1. Position of the American Dietetic Association: Integration of medical nutrition therapy and
pharmacotherapy. J Am Diet Assoc. 2010;110:950-956.
2015 EDITION

2015 Terminologi Intervensi - Food

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NCP Step 3:

Nutrition Intervention Terms and Definitions

Term Term Number Definition

DOMAIN: FOOD AND/OR

Meals are defined as regular eating episodes that

Enteral nutrition is defined as nutrition provided

Nutrition provided through the gastrointestinal (GI)

Administration of nutrients and fluids intravenously,

Foods or nutrients that are not intended as a sole

Commercial or prepared foods or beverages

Vitamin and Mineral A product that is intended to supplement vitamin or

Addition or change in provision of bioactive

Class: Feeding Assistance (4) ND-4 Accommodation or assistance designed to restore

Adjustment of the physical environment,

Modification of a drug or complementary/alternative

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Meals and Snacks (ND-1)

Typically Used with the Following

 Lack of access to healthful food choices, e.g., current food access,

Biochemical Data, Medical Tests and Procedures

 Serum cholesterol level

Nutrition-Focused Physical Findings

Signs and Symptoms Food/Nutrition-Related History

 Cultural or religious practices that do not support modified

 Conditions associated with diagnosis or treatment, e.g., surgery,

1. Academy of Nutrition and Dietetics. Nutrition Care Manual. www.nutritioncaremanual.org.

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Enteral Nutrition (ND-2.1)

Typically Used with the Following

 Altered gastrointestinal tract function, inability to absorb

Nutrition-Focused Physical Findings?

 Obvious muscle and/or fat wasting

 Intake < 75% of requirements (insufficient intake)

 End-of-life issues, ethical considerations, patient/client rights and family/caregiver issues

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Parenteral Nutrition/IV Fluids (ND-2.2)

 Modify composition of parenteral nutrition (formula or description)

Typically Used with the Following

 Unintentional weight loss

Nutrition-Focused Physical Findings?

 Obvious muscle and/or fat wasting

 Intake < requirements (insufficient intake)

 End-of-life issues, ethical considerations, patient/client rights and family/caregiver issues

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Medical Food Supplement Therapy (ND-3.1)

 Commercial (prepackaged) beverage

Typically Used with the Following

Etiology  Neurologic deficit (stroke)

Nutrition-Focused Physical Findings

 Obvious muscle and/or fat wasting

Signs and Symptoms Food/Nutrition-Related History

 Diagnosis consistent with elevated nutrient needs

 Appetite sufficient to take medical food supplements

1. Academy of Nutrition and Dietetics. Nutrition Care Manual. www.nutritioncaremanual.org.

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Vitamin and Mineral Supplement Therapy (ND-3.2)

 Multivitamin/mineral supplement therapy (yes/no, specify dose, frequency)

Typically Used with the Following

Nutrition Diagnostic Terminology

 Poor intake of nutrient dense foods that contain vitamins and

Biochemical Data, Medical Tests and Procedures

 Laboratory or radiologic indexes of vitamin-mineral depletion

Nutrition-Focused Physical Findings