NCM 211 - NUTRITION AND DIET THERAPY

NUTRITION CARE PROCESS 🧑‍⚕️ DESIATA, LYRIZZA

NUTRITION CARE PROCESS Appropriate and essential data to be collected

during Nutritional Assessment
NUTRITION CARE PROCESS
● 5 DOMAINS
● A systemic approach to providing high
1. Food or Nutrition-Related History
quality nutrition care
● Food and Nutrient Intake
● This methodical problem solving process aims
● Food and Nutrient Administration
to resolve nutrition affiliated issues resulting to
● Medication or Alternative Medicine used
a more efficient and effective care
● Knowledge or Beliefs
● An essential tool that will help you assess,
● Food and supplies availability
diagnose, treat, and monitor your patient’s
2. Anthropometric Measurements
nutritional progress
● Height & Weight
● As a healthcare practitioner whether you’re a
● Body Mass Index (BMI)
registered nurse nutritionist or dietitian your
● Growth Pattern Indices
ultimate goal is to restore the state of
● Weight History
nutritional balance of your patient by
3. Biochemical Data, Medical Tests, and
providing safe high quality nutrition care, in
Procedures
order to achieve this goal you need a
● Lab Data (e.g., electrolytes, glucose)
standardized approach in order to achieve
● Lab Tests (e.g., gastric emptying time,
the desired outcome
resting metabolic rate)
● One essential tool is the nutrition care process
4. Nutrition-Focused Physical Findings
4 Steps
● Physical Appearance
1. Nutrition Assessment
● Muscle and Fat Wasting
2. Nutrition Diagnosis
● Swallow Function
3. Nutrition Intervention
● Appetite and Affect
4. Nutrition Monitoring and Evaluation
5. Client History
NUTRITION ASSESSMENT
● Personal History
● A systemic approach to collect, classify, and
● Medical/Health/Family History
synthesize important and relevant data
● Alternative Medicine Use
needed to identify nutrition-related problems
● Social History
and their causes
● An on-going d dynamic process which
involves initial data collection and continual
reassessment or analysis of the client’;s status
● To verify validity and reliability of data:
○ Data collection should be appropriate,
relevant ,and necessary
○ Selection of assessment tools and
procedures should match based on the
client’s health needs
○ Data has been validated through
interview, observation, measurements and
health record
NUTRITION DIAGNOSIS
● To identify and describe a specific nutrition
problem that can be resolved or improved
through treatment or nutrition intervention
Tasks in Nutrition Diagnosis
1. Identify the problem
2. Determine cause or risk factors associated
with the problem
3. Identify the characteristic symptoms the
patient is presenting with
3 (Domain) Categories of Nutrition-Related
Problem
1. Intake
○ Too much or too little of a food or nutrient
compared to actual or estimated needs
2. Clinical
○ Nutrition problems that relate to medical or
physical conditions
3. Behavioral or Environmental
○ Knowledge, attitudes, beliefs, physical
environment, access to food or food safety
P-E-S Format
● The Nutrition-Related Problem in the Nutrition
Diagnosis phase can now be translated into
PES
P: Problem or Nutrition Diagnosis Term
● Describes the alterations in the client’s
nutritional status
E: Etiology
● Causes or contributing risk factors and is
● Linked to the nutrition diagnosis by the
words “related to”
S: Signs and Symptoms
● Data or Indicators used to determine the
client’s nutrition diagnosis
● Linked to the etiology by the words “as
evidenced by”
Example of Nutrition Diagnosis Statement
Excessive Carbohydrate intake as related to
unregulated blood glucose levels as
evidenced by reported binge eating weight
gain and HbA1c levels of 8.7%
NUTRITION INTERVENTION
● Plan and implement appropriate nutrition
interventions that are tailored to the person’s
needs
● Select intervention to change nutritional
intake, knowledge, or behavior,
environmental condition, supportive care,
and services
Goals:
● Provide the basis for monitoring progress and
measuring the outcomes
NUTRITION MONITORING AND EVALUATION
Tasks in Nutrition Monitoring and Evaluation
● Determine and measure the amount of
progress made for the nutrition intervention,
and whether the nutrition related goals or
expected outcomes are being met
Purpose of Nutrition Monitoring
● Assess the effectiveness of nutrition
intervention.
● Measure outcomes by collecting data on
nutrition indicators
● Compare current findings with the previous
findings and evaluate impact of the
intervention
● Determine the amount of progress made and
whether goals or expected outcomes are
met
Ultimate goal of providing Nutrition Care is to
restore the state of nutritional balance by
influencing whatever factors are contributing
to the imbalance or altered state of nutritional
status
 NUTRITION CARE PROCESS (NCP) ● Clinical Data
○ Information about the individual's medical
● a systematic approach to providing high
history (acute and chronic illness, etc.,)
quality nutrition care
● Dietary Methods
● A systematic method that dietetics and
○ 24 Hour Recall
nutrition professionals use to provide nutrition
○ Food Frequency Questionnaire
care
NUTRITION DIAGNOSIS
● a standardized model intended to guide
1. Nutrition or Need
registered dietitian nutritionists and dietetic
2. Consideration when planning a diet
technicians, registered, in providing
● Economic
high-quality nutrition care
● Resources
● Nutrition Monitoring/Evaluation
● Availability
○ The final step of the process is monitoring
● Individuality
and evaluation, uses to determine if the
● Culture
client has achieved, or is making progress
● Religion
toward, the planned goals
● Etc.,
ADIME PROCESS
3. Ethico-moral principles related to cultural and
NUTRITION CARE PROCESS STEPS:
spiritual preferences
Step 1: Nutrition Assessment
A PES statement or Nutrition Diagnosis Statement
Step 2: Nutrition Diagnosis
● a structured sentence that describes the
Step 3: Nutrition Intervention
specific nutrition problem that you is
Step 4: Nutrition Monitoring and Evaluation
responsible for treating and working toward
resolving, the cause/s of the problem and the
NUTRITION ASSESSMENT
evidence that this problem exists.
Assessment of Nutritional States
PES Statement
1. Nutritional History
● This statement has a distinct format:
2. Physical Assessment
Problem related to Etiology as evidenced by Signs
3. Other Sources of Data
and Symptoms
Definition of Nutritional Status
● A PES statement is needed for all nutrition
● Nutritional Status
assessments except those with “no nutrition
○ The current body status, of a person or a
diagnosis.”
population group, related to their state of
● Three components make up the PES
nourishment (consumption and utilization
statement :
of nutrients)
1. Problem (P)– the Nutrition Diagnosis;
○ Determined by a complex of interaction
Nutrition Diagnosis term “related to”
between internal or constitutional factors
2. Etiology (E)– the cause/s of the nutrition
and external factors
problem (Nutrition Diagnosis); “as
■ Internal or Constitutional Factors:
evidenced by”
● Age, Sex, Nutrition, Behavior, Physical
3. Signs and Symptoms (S)– the evidence
Activity and Disease
that the nutrition problem (Nutrition
■ External Environmental Factors:
Diagnosis) exists;
● Food Safety, Cultural, Social, and
economic circumstances
Nutritional Assessment Methods
● Anthropometrics
○ Objective measurements of body muscle
and fat
● Biochemical Laboratory
○ Tests based on blood and urine (can be
important indicators of nutritional status)
○ Influenced by other nutritional factors
 Evaluating your PES statement
Medical Diagnosis:
● P(Problem): Can the RDN resolve or improve
Hypercholesterolaemia
the nutrition diagnosis? Consider the “intake”
nutrition diagnosis as the one more specific to
the role of the RDN
● E(Etiology): Determine if this is the “root
cause” for the problem. If addressing the
etiology will not resolve the problem, can the
RDN intervention lessen the signs and
symptoms?
● S(Signs and Symptoms): Will measuring the
signs and symptoms indicate if the problem is
resolved or improved? Are the signs and
symptoms specific enough that the RDN can
monitor and document the resolution or
improvement of the nutrition diagnosis?
Example PES statements
● Excessive Fat Intake related to limited access
to healthful options- frequent consumption of
high-fat, fast-food meals as evidenced by
serum cholesterol level of 230 mg/dL and
patient report of 10 meals per week of
hamburgers and fries
● Excessive Energy Intake related to
unchanged dietary intake and restricted
mobility while fracture heals as evidenced by
5 lb weight gain during last 3 weeks due to
patient report of consumption of 500
kcal/day more than estimated needs
● Swallowing Difficulty related to post stroke
complications as evidenced by results of
swallowing tests and reports of choking
during mealtimes
Nutrition Diagnosis
Inappropriate intake of
saturated and trans
fats related to daily
high fat fast food
choices as evidenced
by high total
cholesterol, LDL and TC
Nutrition Diagnosis Etiology
● Identifying the etiology leads to selection of
the nutrition intervention aimed at resolving
the underlying cause of the nutrition problem
● If the intervention cannot be aimed at
resolving the underlying cause, as is the case
in Physiologic-Metabolic etiologies, then the
nutrition intervention is targeted at minimizing
the signs/symptoms of the nutrition problem
Nutrition Diagnostic Terminology
● Three General Domains
○ Intake
■ Excessive or Inadequate intake
compared to requirements (actual or
estimated)
○ Clinical
■ Medical or physical conditions that are
outside normal
○ Behavioral-Environmental
■ Relate to knowledge, attitudes, beliefs,
physical environment, access to food,
or food safety

Medical Diagnosis: Nutrition Diagnosis

T2DM Inconsistent CHO
distribution related to
lack of meal planning
as evidenced by diet
history and high blood
glucose

Medical Diagnosis: Nutrition Diagnosis

OBESITY Excessive energy
intake related to lack
of access to healthy
food choices
(restaurant eating) as
evidenced by daily
energy intake 2MJ over
estimated
requirements, and BMI
of 35
NCM 211 - NUTRITION AND DIET THERAPY
NUTRITION CARE PROCESS 2 🧑‍⚕️ DESIATA, LYRIZZA

NUTRITION CARE PROCESS 2 USE OF NUTRITION INTERVENTION BASED ON

PRACTICE SETTING
[INTERVENTION] 1. Food and/or Nutrient Delivery
● Institutional Settings (hospitals, long-term
NUTRITION INTERVENTION care)
● Is defined as purposefully planned actions ● Home Care
intended to positively change a 2. Nutrition Education-Content
nutrition-related behavior, environmental ● Institutional Settings
condition, or aspect of health status for an 3. Nutrition Education-Application
individual target group, or the community at ● Outpatient/Non-institutional Settings
large ● Private Practice
○ Directed to the etiology or ● Community
cause of the problem identified 4. Nutrition Counseling
in the PES statement ● Outpatient/Non-institutional Settings
○ Sometimes the intervention ● Private Practice
must be directed toward the ● Community
signs and symptoms if the RDN 5. Coordination of Care
can not impact the etiology ● All Practice Settings
PURPOSE SUMMARY
● To resolve or improve the nutrition diagnosis or Defined nutrition intervention terminology:
nutrition problem by provision of advice, ● Assists in communication within the
education, or delivery of food component of a dietetics profession and among other
specific diet or meal plan tailored to the health care providers
patient/client’s needs ● Allows documentation of the impact of
2 COMPONENTS the profession on specific diagnoses and
1. Planning etiologies in all patient/client populations
2. Implementation NUTRITION INTERVENTIONS
4 DOMAINS 1. Behavior Change Theories with Nutrition
1. Food and/or Nutrient Delivery Implementation
2. Nutrition Education 2. Nutrition Education & Counseling
3. Nutrition Counseling 3. Programs and Services
4. Coordination of Nutrition Care 4. Legal Mandates Related to Nutrition & Diet
Therapy
5. Food Administration (Oral, Enteral, and
Parenteral)
6. Selected Therapeutics Diet and Diet
Modifications
 NUTRITION CARE PLAN

PROBLEM GOAL STRATEGIES MONITORING AND

EVALUATION

OVERWEIGHT To achieve a weight To provide a 2925 24-hr recall

loss of 20-22 lbs in 10 kcal/ day; low Food Frequency
months sodium and low fat; Questionnaire
reduced diet Monthly weight
check up

ALTERED NUTRITION The patient will To provide diet low To monitor patient
RELATED LABORATORY achieve lower in lipids (saturated laboratory values
VALUES laboratory values to fat and cholesterol)
reach a normal range and to increase daily
● Cholesterol=140-199 physical activity
mg/dL levels
● LDL-C=<130mg/dL
● HDL-C=>40mg/dL To educate patient
● TG=35-160mg/dL on choosing foods
low in saturated fat,
cholesterol and
triglycerides
 LEGAL MANDATES RELATED TO NUTRITION & REPUBLIC ACT 7394 (1992)
CONSUMER ACT OF THE PHILIPPINES

DIET THERAPY ● Designed to prevent business that engage in

fraud or specified policies from gaining an
TERMINOLOGIES (ABBREVIATIONS)
advantage over competitors and provide
● Mandate
additional protection for the weak and those
● Executive Order (E.O)
unable to take care of themselves
● Presidential Decree
CONSUMER RIGHTS
● Republic Act (R.A)
● Right to basic needs
● Food Fortification
● Right to safety
● Letter of Instruction (LOI)
● Right to information
● Section (s.)
● Right to choice
LOI 441
● Right to representation
● Mandated the Integration of Nutrition
● Right to redress
Education on the scool curriculum
● Right to consumer education
PRESIDENTIAL DECREE NO. 491 (1974)
● Right to a healthy environment
NUTRITION ACT OF THE PHILIPPINES
REPUBLIC ACT 7600 (1992)
● The National Nutrition Council was created as
THE ROOMING-IN AND BREASTFEEDING ACT
the country’s policy-making and coordinating
● An act providing incentives to all government
body on nutrition
and private health institutions with rooming-in
● Council was reorganized through E.O No. 234
and breastfeeding practices and for other
s. 1987 and Administrative Order No. 88 s. 1988
purposes
● The month of July was designated as
● This law is in promotion of the State Policy to
NUTRITION MONTH under section 7 to create a
encourage the practice of breastfeeding in
greater awareness among people on the
the Philippines
importance of nutrition
REPUBLIC ACT 8172 (1995)
EXECUTIVE ORDER 51 (1986)
ACT FOR SALT IODIZATION NATIONWIDE
NATIONAL CODE OF MARKETING OF BREASTMILK
(ASIN LAW)
SUBSTITUTES, BREASTMILK SUPPLEMENTS AND OTHER
● To protect and promote the health of the
RELATED PRODUCTS
people, to maintain an effective food
● To ensure that safe and adequate nutrition for
regulatory system and to provide the entire
infants is provided, to protect and promote
population especially women and children
breastfeeding and to inform the public about
with proper nutrition
the proper use of breastmilk substitutes and
● Contribute to the elimination of the
supplements and related products through
micronutrient malnutrition in the country,
adequate, consistent and objective
particularly iodine deficiency disorders,
information and appropriate regulation of the
through cost -effective preventive measure of
marketing and distribution of the said
salt iodization
substitutes, supplements and related products
REPUBLIC ACT 8976 (2000)
FOOD FORTIFICATION ACT
● This program shall consist of (1) Voluntary Food
Fortification and (2) Mandatory Food
Fortification
● Section 5. Voluntary Food Fortification
○ Under the Sangkap Pinoy Seal Program
(SPSP)
○ The Department shall encourage the
fortification of all processed foods or food
products based on rules and regulations
which the DOH through the BFAD shall issue
after the effectivity of this act
○ Manufacturers who opt to fortify their
processed foods of food products but do
not apply Sangkap Pinoy Seal shall fortify
their processed food or food products
based on acceptable standards on food
fortification set by the DOH through the
BFAD
● Section 6. Mandatory Food Fortification
(a) The fortification for staple foods based
on standards sets by the DOH through
the BFAD is hereby made mandatory
NATIONAL FOOD FORTIFICATION DAY
● November 7 (annually)
● Pursuant to Executive Order 382
○ Recognizes the persistence of micronutrient
deficiencies as a public health problem that
has affected a significant proportion of the
population, resulting in adverse physical,
mental, social, and economic
consequences to individuals, communities,
and country
KEY AGENCIES IN THE PROGRAM
● Department of Health (DOH)
○ Responsible for law implementation and
monitoring
● National Nutrition Council
○ Serves as the policy-making body,
particularly relative to determining what
food vehicles should be fortified and with
what nutrients
● Department of Trade and Industry
○ Which assist manufactures in upgrading their
technologies by providing financial
assistance and other non-monetary
assistance
● Department of Science and Technology
(DOST)
○ Helps in developing and implementing
comprehensive programs for the acquisition,
design, and manufacture of machines and
technologies and their transfer to
manufacturers
● Land Bank of the Philippines and Livelihood
Corporation
○ Assist manufacturers by providing
preferential loans at preferential rates
REPUBLIC ACT 9711 (2008)
FOOD AND DRUG ADMINISTRATION ACT
● An act strengthening and rationalizing the
regulatory capacity of the bureau of food and
drugs (BFAD) by establishing adequate testing
laboratories and field offices. Upgrading its
equipment, augmenting its human resource
complement, giving authority to retain its
income, renaming it the food and drug
administration (FDA), amending certain
sections of republic act no. 3720, as amended
and appropriating funds thereof.
REPUBLIC ACT 10028 (2009)
EXPANDED BREASTFEEDING PROMOTION ACT
● An act expanding the promotion of
breastfeeding, amending for the purpose
republic act no. 7600
PROVISIONS
● Lactation stations in every private enterprises,
government agencies, government-owned
and controlled corporations
● "Lactation periods" for breastfeeding
employees, in addition to time-off for meals, to
allow them time to express their breast milk.
● Breast milk banks in health institutions to store
pasteurized breast milk donated to
breastfeeding mothers.
● Inclusion of breastfeeding in the curriculum of
schools (under relevant subjects).
REPUBLIC ACT 10611 (2013)
FOOD SAFETY ACT
● The Food Safety Act of 2013 shall be the
framework for implementing the farm to fork
Food Safety Regulatory System.
● To strengthen the food safety regulatory
system in the country
FOOD SAFETY AWARENESS ANAPHYLAXIS
● Preventing Food Borne Illnesses ● A serious allergic reaction that is rapid in onset
and may cause death
4 SIMPLE STEPS TO FOOD SAFETY ● The most common causes of anaphylaxis are
1. CLEAN food, medications, insect stings, and latex
2. SEPARATE ● COMMON WARNING SIGNS AND SYMPTOMS
3. COOK ○ Tingling, itchiness, or metallic
4. CHILL taste in the mouth
○ Hives
FOOD SAFETY AWARENESS WEEK ○ Difficulty Breathing
● A yearly campaign in the Philipipnes aimed at ○ Swelling and/or itching of the
the importance of safe and clean food. mouth nad throat area
● Week-long celebration every October; ○ Diarrhea
proclaimed on August 1999 by virtue of ○ Vomiting
Proclamation No. 160, signed by President ○ Cramps and Stomach Pain
Joseph Estrada ○ Paleness (due to drop in BP)
FOOD SAFETY ○ Loss of consciousness
● The assurance/guarantee that food will not ALLERGY AWARENESS MONTH
cause harm to the consumers when it is ● May
prepared and/or eaten according to its ● A great time to learn more about food
intended use allergies and how to keep those with allergies
FOOD AND WATER-BORNE DISEASES safe
● .a group of illness caused by any infectious
(bacteria, virus, and parasites) and REPUBLIC ACT 10862 (2015)
non-infectious agents (chemical, animal, and NUTRITION AND DIETETICS LAW OF 2016
plant toxins) ● An act regulating the practice of Nutrition and
FOOD ALLERGY AWARENESS Dietetics in the Philippines
● Foods that most often cause an allergic ● recognizes the important role of registered
reaction nutritionist-dietitians (RNDs) in nation building
○ Peanuts and in human development through
○ Tree nuts adequate nutrition
○ Wheat ● promote the sustained development of RNDS
○ Soy whose competence has been determined by
○ Milk honest and credible licensure examinations,
○ Eggs and whose standards of professional service
○ Fish and practice are internationally recognized
○ Shellfish and considered world-class, brought about by
● Less common foods can also cause allergic regulatory measures, programs and activities
reaction that foster growth and advancement of the
● Reactions can range from mild to deadly profession
REPUBLIC ACT 11148 (2018)
KALUSUGAN AT NUTRISYON NG MAG-NANAY ACT
● President Rodrigo Roa Duterte signed on 29
November Republic Act 11148 "An Act Scaling
up the National and Local Health and Nutrition
Programs through a Strengthened Integrated
Strategy for Maternal, Neonatal, Child Health
and Nutrition in the First One Thousand (1,000)
Days of Life" strengthens the national and local
health and nutrition programs for pregnant
and lactating women, adolescent girls, infants
and young children in the first 1,000 days.
NCM 211 - NUTRITION AND DIET THERAPY
NUTRITION CARE PROCESS 3/3 🧑‍⚕️ DESIATA, LYRIZZA

NUTRITION CARE PROCESS 3/3 MONITORING

● Ensure patient understands goals and.
The purpose of Nutrition Monitoring and
their importance. (Not doing it “Just
Evaluation is to determine and measure the
Because”
amount of progress made for the nutrition
● Discuss problems, questions, and
intervention and whether the nutrition-related
concerns with patients regarding goals
goals/expected outcomes are being met.
● Adhering? To continue on path or Need
to change
MONITORING AND EVALUATION
● Continue to document, update data to
● The final two steps
patient's file and continue to measure in
● Plan set in motion by the nutrition
order to assess progress
professional is not only appropriate for
EVALUATING
that patient but attainable and
● Compare new data to old and Compare
maintainable
the obtained results to the desired goals
● RD will assess whether the goals and plan
● Assess whether goals are being
set in motion is appropriate and how to
obtained, and if they are truly helping to
adjust it as time passes
improve the health of the patient
NUTRITION MONITORING
● If not, discuss alternatives
● Preplanned review and measurement of
selected nutrition care indicators of DON’T FORGET!
patient/client’s status ● Monitor Progress
● Measure Outcomes
NUTRITION EVALUATION
● Evaluate Outcomes
● The systematic comparison of current
● Document
findings with the previous status
3 COMPONENTS OF MONITORING AND
EVALUATION
● Monitoring
○ Provide evidence that the
nutrition intervention is
changing or not changing
patients behavior or status
● Measuring
○ Measure outcomes by
collecting data on nutrition
outcome indicators
● Evaluating
○ Compare current findings to
intervention goals or reference
standards and evaluate overall
impact
○ Decide to discharge patient or
continue counseling
 RELATIONSHIP BETWEEN: PATIENT, CLIENT, GROUP &
DIETETICS PROFESSIONAL
NUTRITIONAL STATUS MONITORING
● Anthropometry and Body Composition
○ Body weight; Body Height; Body
Mass Index (BMI); Middle Arm
Circumference; Triceps Skinfold
Thickness; Muscle
Circumference; Muscle area
○ Bioimpedance analysis
● Clinical Evaluation
○ Biochemical Data; Creatinine
and Clearance; Blood Urea;
Potassium; Sodium; Phosphorus;
Bicarbonate; Albumin;
Transferrin; Cholesterol;
Glycemia; Urinary Urea (To
estimate protein catabolic
rate); Urinary Protein; and
Sodium excretion from 24-hr
collection
● Dietetic Evaluation
○ Dietary recall; food journal;
food frequency questionnaire;
brief questionnaire:
● Nutrition Assessment & Reassesment
○ Obtain/Collect timely and
appropriate data
○ Analyze/Interpret data with
Evidence-Based Standards
○ Document
● Nutrition Diagnosis
○ Identify & Label Problem
○ Determine Cause/Contributing
Risk Factors
○ Cluster Signs & Symptoms,
Defining CHaracteristics
● Nutrition Intervention
○ Plan: Formulate goals and
determine plan of action
○ Implement: deliver care and
carry out plan
○ Document
● Nutrition Monitoring & Evaluation
○ Monitor Progress
○ Measure Outcome Indicators
○ Evaluate Outcomes &
Document