SAINT TONIS COLLEGE, INC.

Formerly: Kalinga Christian Learning Center

Bulanao, Tabuk City, Kalinga
Philippines 3800

Course Subject /Code : NUTRITION AND DIET THERAPY (NCM 105)

Module No. : 4

Learning Content : Nutrition Care Process (ADIME Process)

Learning Outcomes:

At the end of the module the students should be able to learn to;
● Assess the nutritional status of a given client using relevant parameters and appropriate nutritional assessment
tools.
● Formulate with the client relevant nutrition diagnosis.

● Implement safe and quality interventions with the client to address the nutritional needs, problems and issues.

● Identify measures to analyze nutritional assessment status

● Document nutritional status accurately and comprehensively.

Introduction

In this module, you will learn about the nutrition care process which will help you to be more effective health care provider
to your clients. You will learn to assess the patient’s nutritional status thoroughly as your basis in formulating nursing
diagnosis, planning, intervention, monitoring and evaluation in promoting improved health of clients. You will also learn the
role of medical nutrition therapy in the health care setting.

This module is intended to help you as a student nurse to provide safe, quality nursing care and implement an individualized
approach of care that is relevant and appropriate to a client’s needs and situation.

Learning discussion
(Before you proceed to this module, please review your nursing process which you have taken in Fundamentals in
Nursing Practice)

What is the Nutrition Care Planning Process (ADIME)?

The Nutrition Care Process, is a systematic method that

dietetics and nutrition professionals use to provide nutrition care. It is
a process of planning and meeting the nutritional needs of a patient.
The nutrition care process includes four steps: assessment, diagnosis,
intervention, monitoring and evaluation (ADIME). While nurses use
the same problem-solving model to develop nursing or
multidisciplinary care plans that may also integrate nutrition, the
nutritional plan of care devised by dietitians is specific for nutrition
problems.
 Like the nursing process, the nutrition care process is a problem-solving method used to evaluate and treat
nutrition-related problems.

Continuation of module 3…
2. Physical Assessment

a. Anthropometric Measurements
The anthropometric method is the measurement of variations of the physical dimensions and gross composition
of the human body at different age levels and degrees of nutrition. It is the measurement of body size, weight and
proportions.

Common anthropometric measurements

● Length
A wooden measuring board (also called sliding board) is used
for measuring the length of children under two years old to the
nearest millimeter. Measuring the child lying down always gives
readings greater than the child’s actual height by 1-2 cm.

Height (for age)

This is measured with the child or adult in a standing position
(usually children who are two years old or more). The head
should be in the Frankfurt position (a position where the line
passing from the external ear hole to the lower eye lid is parallel
to the floor) during measurement, and the shoulders, buttocks
and the heels should touch the vertical stand. Assess linear
dimensions of the following; legs pelvis, spine, and the skull. It is
less sensitive and generally an indicator of past nutritional status
(chronicity of malnutrition)
Either a stadiometer or a portable anthropometer steel
rods fixed accurately and vertically to the wall can be used for
measuring. For infants (below 2 years), an infanometer is used. Measurements are recorded to the nearest
millimeter. Less sensitive to changes in growth rate.

Weight (for age)

● Uses weighing scale such as beam balance scales which are ideal, but a bar
scales could be used in their absence.
● Assess body mass

● A sensitive indicator of current nutritional status

● Uses reference values for age or height or both of population

● Key anthropometric measurement

Weight for height /length

A weighing sling (spring balance), also called the ‘Salter Scale’ is used for
measuring the weight of children under two years old, to the nearest 0.1 kg. In
adults and children over two years a beam balance is used and the measurement
is also to the nearest 0.1 kg. In both cases a digital electronic scale can be used if
you have one available. Do not forget to re-adjust the scale to zero before each
weighing. You also need to check whether your scale is measuring correctly by
weighing an object of known weight. It is the most accurate indicator of the
present or current state of nutrition and an expression of leanness or wasting of
the body.

● Body mass index (BMI) is an index of a person’s weight in relation to height used to estimate the relative risk of
health problems related to weight.
BMI can be calculated with a mathematical formula, tables and nomograms are available for convenience.
 Estimating the Desirable Body weight using BMI
BMI-Based Formula – widely used to identify lean, overweight, or obese individuals. The BMI range of 18.5-24.9
is generally considered normal. (WHO Standard).

Body Mass Index (BMI) – BMI is calculated using the following formula.
BMI = Weight in Kg
Height in M2

BMI Guideline : WHO Interpretation

● Measuring fat-free mass (muscle mass)

Mid upper arm Circumference (MUAC)

An accurate way to measure fat-free mass is to measure the Mid Upper Arm Circumference (MUAC).
The MUAC is the circumference of the upper arm at the midway
between the shoulder tip and the elbow tip on the left arm. The mid-
arm point is determined by measuring the distance from the shoulder
tip to the elbow and dividing it by two. A low reading indicates a loss
of muscle mass.

MUAC is a good screening tool in determining the risk of

mortality among children, and people living with HIV/AIDS. MUAC is
the only anthropometric measure for assessing nutritional status
among pregnant women. It is also very simple for use in screening a
large number of people, especially during community level screening
for community-based nutrition interventions or during emergency
situations.

● Fat-fold or Skin-fold thickness

This is an index of the body’s fat or energy stores. A low skinfold thickness
measurement may indicate malnutrition. This technique is used for both men and
women. The most common site for measuring skin-fold thickness is the triceps skin-fold
(TSF). The fold of the skin measured includes subcutaneous tissue but not the
underlying muscle. It is measured in millimeters using special calipers. To measure the
TSF, locate the midpoint of the upper arm (halfway between the acromion process and
the olecranon process, then grasp the skin on the back of the upper arm along the long
axis of the humerus. Placing the calipers 1 cm (0.4 in) below the nurse’s fingers,
measure the thickness of the fold to the nearest millimeter. Standard Values for TSF
(Adult) Male – 12mm, Female -20 mm.
  Other Sources of Data
o Malnutrition Universal Screening Tool (MUST)
o Subjective Global Assessment (SGA)
o Mini Nutritional Assessment (MNA)
o Geriatric Nutritional Risk Index (GNR)
_______________________________________________________________________________________________

b. Biochemical Assessment
Biochemical method makes basically of two obtainable body fluids: the blood and the urine. It can also be carried
out on a variety of body tissues, including liver, muscle and bone. It is a measurement of tissue desaturation, enzyme
activity or blood composition. It is the most accurate, directly tell what specific nutrient is deficient. Compared with
other methods nutritional assessment (anthropometric, clinical and dietary) biochemical test provide the most
objective and quantitative data on nutrition. The most common and useful biochemical techniques in evaluating
malnutrition employ measurements of hemoglobin, blood cell counts (hematocrit), nitrogen balance, and creatinine
excretion. The measurements are obtained from serum and plasma samples.

c. Clinical (Physical examination)

Clinical method is based on examination for changes, believed to be related to inadequate nutrition, that can be
seen or felt in superficial epithelial tissues, especially the skin, eyes, hair and buccal mucosa, or in organs near the
surface of the body, such as the parotid and thyroid gland.

This involves a detailed history, a thorough physical examination, and an interpretation of the signs and
symptoms associated with malnutrition. Signs are defined as observation made by a qualified examiner of which the
patient is usually unaware and symptoms are those that can be described only by the person experiencing it.

There are many clinical signs of good and poor nutrition. Although some of these signs are not related to a
person’s nutritional status, they serve as a general indicator of health. Data from a physical assessment are considered
objective data and helpful to the health practitioner.

Physical Indicators of Nutritional Status

Associated Disorder
Signs of Good
Body Area Signs of Malnutrition or Nutrient
Nutritional Status
Deficiency
1. Head to neck
a. Hair a. Shiny, lustrous; a. Dull, dry, thin, wire-like, sparse, a. Kwashiorkor; less
smooth healthy scalp brittle; scalp rough, flaky commonly marasmus

b. Skin smooth, moist, b. Pale or mottled, dark under eyes, b. Kwashiorkor

b. Face with uniform color, swollen, scaling or flakiness,
lumpiness, moon face

c. Bright, clear, moist

c. Pale conjunctiva, Bitot’s spot, dry c. Anemia (iron, etc.),
c. Eyes membranes, redness, fissures at Vitamin A,
corners, red rimmed, fine blood
vessels or scars at cornea,

d. Smooth, pink
d. Red, swollen, lesions or fissures
d. Riboflavin
d. Lips

e. Deep red, slightly e. Scarlet (bright red), magenta

rough surface (purplish color); raw, swollen,
smooth, e. Nicotinic acid,
e. Tongue Riboflavin

f. Straight; none missing, f. Cavities, black or gray spots,

no overlap, without erupting abnormally, missing
cavities f.Fluorosis
f. Teeth

g. Firm, pink, smooth, g. Spongy, bleed easily, inflammation,

no bleeding receded, atrophied
g. Ascorbic acid
g. Gums

2. Skin 2. Smooth, moist, 2. Dry, flaky dermatosis, scaling, 2. Riboflavin,

uniform color “gooseflesh,” swollen, grayish, bruises kwashiorkor, Vitamin
due to capillary bleeding under A, Vitamin C,
skin(petechia), no fat layer under skin, Nicotinic acid
pellagrous dermatosis

3. Glands 3. No thyroid 3. Front of neck and cheeks become 3.Iodine

enlargement: No lumps swollen lumps visible at parotid;
at parotid juncture goiter visible if advanced
hypothyroidism

4. Nails 4. Pink nail beds, 4. Brittle, ridged, pale nail beds, 4. Iron
smooth, firm, flexible, clubbed, spoon shaped or koilonychia
uniform shape
 5. Muscle and 5. Good posture, firm, 5. Flaccid, wasted muscles, weakness, 5. Starvation,
skeletal well-developed muscles, tenderness, decreased reflexes, kwashiorkor,
system good mobility; no difficulty in walking marasmus, Vitamin D
malformations of Children: beading ribs, swelling at end
skeleton of bones, abnormal protrusion of
frontal or parietal areas

6. Internal systems

A.Gastrointestinal
a. Flat abdomen, liver a. Distended, enlarged abdomen, a. Kwashiorkor
not tender to palpate, ascites, hepatomegaly (enlarged liver)
normal size Children: “potbelly”

B. Cardiovascular b. Pulse rate exceeds 100 beats/min,

b. Normal pulse rate abnormal rhythm, blood pressure b. Thiamine
Normal blood pressure elevated, mental confusion, edema

Sources : American Dietetic Association, 1992

Assignment: Research about Vitamin B and make an outline

B. Nutritional Diagnosis and Plan of Care

A diagnosis is made after assessment data are interpreted. Nursing diagnoses in hospitals and long-term care
facilities provide written documentation of the client’s status and serve as a framework for the plan of care that
follows. The diagnoses relate directly to nutrition when the pattern of nutrition and metabolism is the problem.
Other nursing diagnoses, while not specific for nutrition, may involve nutrition as part of the plan, such as teaching
the patient how to increase fiber intake to relieve the nursing diagnosis of constipation.

Nutrition Diagnosis
-A process which results to a diagnostic statement. It is the clinical act of identifying problems. To diagnose in
nursing, means to analyze assessment information and derive meaning from this analysis. It is a statement of
client’s potential or actual alteration of health status. It uses the critical- thinking skills and analysis and synthesis.
Uses PRS/PES format.
● P –Problem

● R- Related factors

● S –Signs and symptoms

● P- Problem

● E- Etiology

● S-Signs and symptoms

Purpose: To identify the client’s health care needs and to prepare diagnostic statements.

Activities During Diagnosing:

● Organize cluster or group data
 ● Compare data against standard. Ex. The standard color of schlera is white

● Analyze data after comparing with standards.

● Identify gaps and inconsistencies in data

● Determine the client’s health problems, health risks and strengths

● Formulate Nursing Diagnoses statements

The North American Nursing Diagnosis (2007) includes the following diagnostic labels for nutritional problems;
● Imbalanced Nutrition: More than body Requirements

● Imbalanced Nutrition: Less than body Requirements

● Readiness for Enhanced Nutrition

● Risk for Imbalanced Nutrition: More than Body Requirements

Many other NANDA nursing diagnoses may apply to certain individuals, because nutritional often affect other
areas of human functioning. In this case, the nutritional diagnostic label may be used as the etiology of other
diagnoses. Examples include
● Activity Intolerance related to inadequate intake of iron-rich foods resulting in iron-deficiency anemia.

● Constipation related to inadequate fluid intake and fiber intake

● Low Self-Esteem related to obesity

● Risk for infection related to immunosuppression secondary to insufficient protein intake.

Planning the Diet with Cultural Competency

Although identified by a specific ethnic and religious group, practices vary with area of origin and sect. Not
all individuals within these groups follow these practices.

Cultural/Religious Issues and Practices Influencing Nutritional Status

Cultural or Religious Group Practices/Issues

1. African- American >Traditional foods are high in fat, cholesterol, sodium, low in calcium
>Frying and adding fat to food is common
>Obesity, cardiovascular disease, diabetes are common
2. Native Americans >Diet varies with region
>Some use and other cultivated as staples; many attempt to live off
land
>Widespread poverty and use of food assistance programs (food
stamps, food distribution on reservations)
3. Hispanic (Mexico origin) >Traditional diet is vegetarian
>High in complex CHOs such as corn, beans, and squash
>High in calories, fats (saturated in particular), and sugar
>Use fat in food preparation or use fatty methods
>Obesity, diabetes, and high triglycerides are common
4. Asian >Traditional diet is plant-based. Low in fat, saturated fat and
cholesterol; rich in fiber and nutrients; may be high in sodium
>High risk for osteoporosis
5. Islam >No pork or birds of prey; No alcohol, tea, or coffee
>Fast during certain religious holidays

6. Judaism (those following strict dietary > Consume only kosher meat and poultry
rules) >No pork, shellfish or fishlike mammals
>Cannot consume milk or dairy at same time with meat or poultry
>Require separate utensils for preparing /serving meat and dairy

Nutrition intervention is accomplished in two distinct and interrelated steps: planning and implementing.

Planning
Goals and Outcomes
Goals and outcomes of care reflect a patient’s physiological, therapeutic, and individualized needs.
Nutrition education and counselling are important to prevent disease and promote health. When planning care, be
aware of all factors that influence a patient’s food intake.
Individualized planning is essential. Explore patients’ feelings about their weight and diet and help them set
realistic and achievable goals. Mutually planned goals negotiated among the patient, RD, and nurse ensure
success.

The major goals for client at risk for nutritional problems include the following:
● Maintain or restore optimal nutritional status

● Promote healthy nutritional practices

● Prevent complication associated with malnutrition

● Decrease weight

● Regain specified weight

Sample outcomes related to the above goals:

● The client’s daily nutritional intake meets the dietary recommended intake.

● The client will demonstrate behavior to attain or maintain weight.

● The client will attain desirable body weight with optimal maintenance of health.

● The client verbalizes a realistic self-concept or body image.

● The client will participate in development of and commit to, a personal weight loss program.

● The client will demonstrate appropriate changes in life style and behavior, including eating patterns, food
quantity/quality and exercise program to regain and maintain appropriate weight.
● The client will demonstrate progressive weight gain.

● The client will be free of signs of malnutrition

● Food quantity/quality and exercise program

Setting Priorities
After identifying patients’ nursing diagnoses, determine priorities to plan timely and successful interventions.
Ex.- A patient’s oral pain will be a priority over the intervention of diet education to improve nutrition if the patient
is unable to swallow and maintain adequate food intake. Deficient Knowledge regarding diet therapy will become a
priority to promote long-term and effective weight loss for a patient being discharged from a hospital.
- When patients have oral and throat surgery, they chew and swallow food in the presence of excision sites,
sutures or tissue manipulated during surgery. The priority of care is to first provide comfort and pain control. Then
address nutritional priorities and plan care to maintain nutrition that does not cause pain or injury to the healing
tissues.
The patient and family must collaborate with the nurse in planning care and setting priorities. This is important
because food preferences, food purchases and preparation involve the entire family. The plan of care cannot
succeed without their commitment to, involvement in and understanding of the nutritional priorities.

Planning for Home Care

To provide for continuity of care, the nurse considers the client’s need for assistance with nutrition. Some
clients may need assistance with eating, purchasing food, and preparing meals, while others may need instructions
about enteral and parenteral nutrition therapy.
Home care planning incorporates an assessment of the client and family’s ability for self-care, financial
resources, eating assistive devices, need for referrals and home health services. A major aspect of discharge
planning involves instructional needs of the client and family.

Client Teaching on Healthy Nutrition

● Instruct client s about the content of a healthy diet based on use of established nutritional standards as
the Food Guide Pyramid, Dietary Guidelines etc.
● Encourage clients, particularly older clients, to reduce dietary fat.
 ● Instruct strict vegetarian about proper protein complementation and additional vitamin and mineral
supplementation.
● Discuss foods high in specific nutrients required such as protein, iron, calcium, iodine, Vit. C, fiber.

● Discuss importance of properly fitted dentures and dental care.

● Discuss safe food preparation and preservation techniques as appropriate.

Dietary Alterations
● Explain the purpose of the diet.

● Discuss allowed and excluded foods

● Explained the importance of reading food labels when selecting package foods.

● Include family and significant others.

● Reinforce information provided by the dietitian or nutritionist as appropriate.

● Discuss herbs and spices as alternatives and substitutes for sugar.

For Overweight Clients

● Discuss physiologic, psychologic and lifestyle factors that predispose to weight gain.

● Provide information about desired weight range and recommended calorie intake.

● Discuss principles of a well –balanced diet and high and low calorie foods.

● Encourage intake of low-calorie, caffeine- free beverages and plenty of water.

● Discuss ways to adapt eating practices by using smaller plates, taking smaller servings, chewing each bite a
specified number of times and putting fork down between bites.
● Discuss ways to control the desire to eat by taking a walk, drinking a glass of water, or doing slow deep-
breathing exercises.
● Discuss the importance of exercise and help the client plan an exercise program.

● Discuss stress reduction techniques.

● Provide information about available community resources (ex. weight loss groups, dietary counselling,
exercise programs, self-help groups).

For Underweight Clients

● Discuss factors contributing to inadequate nutrition and weight loss.

● Discuss recommended calorie intake and desired weight range.

● Provide information about the content of a balanced diet

● Provide information about ways to increase calorie intake (ex. high calorie food, high Protein)

● Discuss ways to manage, minimize, or alter the factors contributing to malnourishment.

● If appropriate, discuss ways to purchase low-cost nutritious foods.

● Provide information about community agencies that can assist in providing food (ex. Meals on wheels).

Preventing Foodborne Illness

● Reinforce hygienic handling of food and dishes.
>Wash hands before touching and eating foods.
>Wash hands after handling raw foods especially meat, poultry etc.
>Wash fruits and vegetables thoroughly.
>Wash dishes and utensils with hot water.
>Defrost frozen foods in the refrigerator.
>Refrigerate leftovers promptly at 400F/50 C or less and keep no more than 3-5 days.
>Cook beef, poultry and eggs thoroughly.
 >Do not use foods from containers that have been damaged or have opened seals.
>Follow the rule ”keep hot foods hot and cold foods cold” and ”when in doubt, throw it.”
● Recommend the client to consider a preventive vaccination for hepatitis A.

● Instruct clients to seek medical attention for prolonged vomiting, fever, abdominal pain or severe diarrhea
following a meal.

Home Care assessment on Nutrition

Client /Environment
● Self-care abilities: Assess ability to feed self, to purchase food and to prepare meals.

● Adaptive feeding aids required: Determine need for special drinking cups, plates or feeding utensils.

● Instructional needs: Consider nutritional requirements (ex. Food Guide Pyramid, Dietary Guidelines,
recommended lifestyle variations and management of enteral/parenteral nutrition.
● Physical Environment: Assess adequacy of water, electricity, refrigeration, and telephone facilities and
presence of clean, secure area to store and set up enteral/parenteral nutrition required.

Family
● Caregiver ability, skills and willingness: Primary and secondary persons able to assist with food purchase,
meal preparation, and feeding and able to comprehend and administer special diets or enteral/parenteral
nutrition required.
● Family role changes and coping: Effect on parenting and spousal roles, financial resources and social roles.

● Alternate potential primary or respite e caregivers: For example, other family members, volunteers,
church members, paid caregivers, or housekeeping services; available community respite care (adult day
care, senior centers) and so on.

Community
● Current Knowledge, use and experience with community resources: Nutritional counselling services;
home health agencies for enteral/parenteral nutrition support; dietitian or nutritionist for planning
appropriate meals for prescribed diet, ways to include ethnic food preferences into the diet, and
providing written meal plans; medical equipment and supply companies, financial assistance services; and
support and educational services such as;
>Weight management programs (ex. weight watchers)
>National Center for Nutrition and Dietetics for information on all nutrition topics.
>National Eating Disorder Information Center
>Meals on wheels
__________________________________________________________________________________
_______________
Group Activity:
1. Submit a nutritional health campaign materials (Creatively made) based from the priority need of the
community that you have assessed in your group work that you can use in providing nutrition education to a family
or community group.
_____________________________________________________________________________________________
____
Implementing
Nursing interventions to promote optimal nutrition for hospitalized clients are often provided in collaboration
with the primary care provider giving the diet order and the dietitian who informs clients about special diets. The
nurse reinforces this instruction and creates an atmosphere that encourages eating, monitor’s patient’s appetite
and food intake, administers enteral, and parenteral feedings and consults with the primary care provider and
dietitian about nutritional problem that will arise.
In the community setting, the role of the nurse is mostly educational. Example, the nurse promotes optimal
nutrition at health fairs, in schools, at prenatal classes, and with well or ill clients and support people in their
homes. In the home setting, nurses also do nutritional screens, refer client at risk to appropriate resources, instruct
client about enteral and parenteral feedings and offer nutrition counselling as needed. The nurse must help clients
integrate diet changes into their lifestyle and provide strategies to motivate them to change their eating habits.

Food Administration
● Oral Nutrition
 Oral diets are the easiest and most preferred method of providing nutrition. In most facilities,
patients choose what they want to eat from a menu representing the diet ordered by the physician. Oral
diets may be categorized as “regular,” modified consistency, or therapeutic.

Regular Diets (Full, General, House)

Regular diets are used to achieve or maintain optimal nutritional status in patients who do not have
altered nutritional needs. It is a normal diet planned to provide the recommended daily allowances for
the essential nutrients and to meet the caloric needs of a bedridden or ambulatory patient whose general
condition does not require general modification or dietary restrictions. All foods are allowed but it is
sound practice to serve simply prepared foods. Highly spiced foods, rich, fatty foods and gas formers
should also be avoided.

Soft Diet
This follows the pattern of a regular diet with modifications in consistency and texture. It is
designed to patients who are psychologically and physically unable to tolerate a general diet. Foods
allowed are low in fiber diet and connective tissues and are bland in flavor. Being a transition diet
between liquid and regular diet, it should be easy to digest. Fried foods and highly seasoned foods may
cause gastric distress in the immobile or post operative patient. The soft diet is usually prescribed in cases
of intestinal disorder and infection, and during convalescence.

Diet As Tolerated (DAT)

Routinely, the diet regimen ranges from full liquid to regular diet, allowing preference at
the dietician’s discretion. This type of order should be a temporary measure lasting for a day, until a
more specific diet is ordered, based on results of diagnostic tests and medical examination. Usually, when
a newly admitted patient has a problem with digestion, the DAT order is prescribed. The ultimate goal will
still be the same as for soft and regular diets. Foods must be nourishing and given in small feedings. This
order is interpreted according to the patient’s appetite and ability to eat and tolerate food.

The Liquid Diets

● Full liquid diet contains all foods that are room temperature or could be liquefied at body temperature
(can melt in the mouth or stomach). Milk beverages, plain sherbets and ice creams, Soft custard plain
gelatine, strained fruit juices, coffee or tea with cream and sugar, bland creamed soup, malt and
chocolate are allowed.
The full liquid diet is prescribed for patients who cannot tolerate solid foods due to any of the
following: fever, infections, lesions in the mouth, gastrointestinal disturbances, nausea and vomiting. It
may be used post-operatively as a transition between clear liquid and solid foods. It is useful for the
acutely ill patient or those with esophageal disorders, unable to chew and swallow foods following
surgery of the face, neck area and dental surgery and more complete than the clear liquid diet.

● Clear liquid consists of liquids without residue or fiber. It is intended to supply fluid and energy in a form
that require minimal digestion. Plain tea, black coffee, fat free broth, ginger-ale, plain gelatine, and
glucose solution are the usual liquids given. Other liquids such as fruit drinks, popsicles, fruit ices and clear
fruit juices are often allowed to supply additional calories. It is nutritionally inadequate supplying only
600-900 kcal per day, consist mainly of CHOs with some protein of low biological value and very little fat.
It should not be used more than two days. All liquid diets must be given in small, frequent feedings
considering the patient’s condition and capacity for food.
The clear liquid diet is often used just immediately before and after surgery. It aims to relieve
thirst, provide some fluid or preventing dehydration, to minimize stimulation of the GIT and to serve as
initial feeding following surgery or a period of intravenous feeding. It is nutritionally inadequate and must
not be used without supplementation for a prolonged period of time.

Therapeutic Diets
Alterations in the client’s diet are often needed; to prepare for a special examination or surgery, to
increase or decrease weight, to restore nutritional deficits, or to allow an organ to rest and promote healing and to
treat disease process such as diabetes mellitus. Diets are modified in one or more of the following aspects:
consistency, texture, kilo calories, specific nutrients, seasonings, or consistency.
Therapeutic diets differ from a regular diet in the amount of one or more nutrients or food components
for the purpose of preventing or treating disease or illness.

Selected Therapeutic Diets: Characteristics and Indication

Type of Diet Characteristics Indications
“Diabetic” or Total daily carbohydrate content is consistent Type 1 and type 2 diabetes, gestational diabetes;
consistent with emphasis on general nutritional balance. impaired glucose tolerance; impaired fasting
carbohydrate Calories are based on attaining and glucose
maintaining healthy weight. A high-fiber
intake is encouraged, sodium may be limited,
and heart-healthy fats are encouraged over
saturated fat
Fat restricted Fat limited to <50 or >25 g fat/day Malabsorption syndromes, liver disease,
pancreatic disease, chronic cholecystitis,
gastroesophageal reflux
High Fiber A general diet with low-fiber foods replaced by To prevent or treat constipation, diabetes,
foods high in fiber. irritable bowel syndrome,
hypercholesterolemia, obesity
Low Fiber Fiber limited to 10 g/day Before surgery to minimize fecal residue; during
acute phases of intestinal disorders, such as
ulcerative colitis, Crohn disease, and
diverticulitis
High calorie, A diet rich in calorie-dense and/or protein-dense To meet increased nutritional requirements; also
high protein foods used in patients with poor intake
Calcium rich Calcium-rich foods are emphasized in a Used for patients with low calcium intake and
regular diet. those at risk for osteoporosis
Iron rich Iron-rich foods are emphasized in a regular diet. Used for patients with low iron intake and those
with high iron requirements, such as pregnant
women and endurance athletes
Potassium Potassium may be increased or restricted by Low-potassium diets may be used in the
modified manipulating potassium-rich foods, such as treatment of certain renal diseases, in
fruits, vegetables, whole grains, milk, and conjunction with certain medications, or in
meats. adrenal insufficiency; high potassium diets may
be used in conjunction with certain
medications and with certain renal diseases
Sodium Sodium limit may be set at 500mg/day 1000 Hypertension, congestive heart failure, acute
restricted mg/day, 2000 mg/day, or 3000 mg/day. and chronic renal disease, liver disease
Gluten free Sources of gluten (a protein in wheat, rye, oats, Celiac disease (celiac sprue, nontropical sprue,
and barley) are eliminated from the diet; gluten-sensitive enteropathy) and dermatitis
gluten-free grains, such as corn, potato, rice, herpetiformis rash
soy, and quinoa are encouraged as sources of
complex carbohydrates.
Lactose Limits foods with lactose (“milk sugar”) to the Lactose intolerance or lactase insufficiency, which
restricted amount tolerated by the individual may occur secondary to certain inflammatory
gastrointestinal disorders such as ulcerative
colitis and Crohn disease

Nutritional Supplements

Some patients are unable or unwilling to eat enough food to meet their requirements, either because intake
is poor or because their nutritional needs are so high that it is difficult to meet requirements in a normal volume of
food. For these patients, nutritional supplements with or between meals can significantly boost protein and calorie
intakes.

Assisting Client with Dysphagia

Dysphagia refers to difficulty in swallowing. Some clients may have no difficulty with choosing a healthy diet,
but be at risk for nutritional problems due to dysphagia. These clients may have inadequate solid or fluid intake,
be unable to swallow their medications, or aspirate food or fluids into the lungs- causing pneumonia. Clients at
risk for dysphagia are the elderly, those who have experienced stroke, cancer, head injuries, and others with
cranial dysfunction.

The nutrition management of dysphagia requires an interdisciplinary team-effort to develop a nutrition care
plan specific to the individual needs. The purpose of nutrition care is to; provide adequate energy, nutrients and
fluids in a consistency tolerated by the individual and adjusted according to their changing needs and to prevent
malnutrition, choking, aspiration causing pneumonia, dehydration that might result in a decreased immune
function and pressure ulcers. If the patient condition suggests dysphagia, the nurse should review the history in
detail;
 Interview the family the patient or family; assess the mouth, throat, and chest; observe the patient swallowing,
presence of the gag reflex (often thought to indicate that the client can swallow safely, has not been shown to be
a reliable indicator (Zagaria, 2005). Confirmation of the tendency for food to divert to the trachea is best done
through x-ray.

A multidisciplinary group has developed The National Dysphagia Diet (NDD), which delineates standards
of food textures (American Dietitec Association, 2003).

The four levels of liquid viscosities of food are;

o Thin- regular no changes
o Nectar-like- fluids that can be sipped from a cup or through a straw and will slowly fall off a spoon
that is tipped (Ex. buttermilk, eggnog, tomato juice).
o Honey-like – fluids that can be eaten with a spoon but do not hold their shape on a spoon. They
may be sipped from a cup but are too thick to be taken through a straw. (Ex. thick yogurt,
tomato sauce, honey).
o Spoon thick – very thick fluids that must be eaten with a spoon. They hold their own shape with a
spoon. (Ex. thick milk, pudding).

The four levels of semisolid/solid foods:

● The pureed diet- consist of thick, smooth, homogenous, semi-liquid textures. It is appropriate for persons
with severely reduced oral preparatory stage abilities; impaired lip and tongue control, delayed swallow
reflex triggering, oral hypersensitivity, reduced pharyngeal peristalsis and /or cricopharyngeal dysfunction.
The general diet description are the following: thick, homogenous textures are emphasized; pureed foods
should be “spoon- thick or pudding-like” consistency; no coarse textures, nuts, raw fruits or raw
vegetables are allowed, liquids or crushed medications be mixed with pureed fruits, and liquids and
liquids and water are thickened as needed with a thickening agent. The pureed diet may require
supplementation to meet the RENI. Fluid intake should be monitored.

● Mechanically altered diet (ground/minced)- is designed for patients who can tolerate a minimum amount
of easily chewed foods and appropriate for persons with moderately impaired oral preparatory stage
abilities, edentulous oral cavity, decreased pharyngeal peristalsis and /or cricopharyngeal muscle
dysfunction. The general description of the diet are: no coarse textures, nuts, raw fruits except very
ripe/mashed bananas or vegetables are allowed, except as noted; pureed if necessary; liquid or crushed
medications may still be required and liquid and water are thickened as needed to recommended
consistency with a thickening agent.
Supplementation may be required and more frequent feedings are recommended and fluid intake
should be monitored

● Mechanically soft/Easy -to- Chew Diet – is based on mechanical diet and consist of soft foods prepared
without blenderizing or pureeing. It is designed for patients who may have difficulty in chewing and
swallowing certain foods. The general description of the diet are: textures are soft with no tough skins; no
nuts or dry, crispy, raw or stringy foods are allowed; meats should be minced or cut in small pieces; liquid
or crushed medications may still be required and liquids and water are thickened as needed to
recommended consistency.
Depending on individual selections and amounts consumed, this diet is designed to provide an
adequate quantity of nutrients indicated by the RENI.

● Modified Regular/General Diet- this diet is designed for patients who chew soft textures. This is based on
a soft diet and may be appropriate for persons with mild oral preparatory stage deficits. The general
description of the diet are: soft textures that do not require grinding or chopping are used; no nuts or
crisp, deep -fried foods are allowed; all liquids and medications are used as tolerated and liquids and
water may need to be thickened as needed to recommend consistency.
The diet is designed to provide an adequate quantity of nutrients as indicated by RENI.

Assisting the Client Meet His/ Her Nutritional Needs

● Maintain and improve the client’s appetite

✔ Provide physical comfort to the client

✔ Provide mental comfort or reduce psychologic stress.

 ● Pointers to remember when assisting the client to eat

✔ Position client as near upright position (if allowed) or comfortable position as possible and support
head adequately to facilitate ease in swallowing.
o Provide equipment to make eating more pleasant
✔ Ask client if he/she is accustomed to saying grace, if so allow him to pray.

✔ Inquire from client the order of eating his/her food.

✔ Permit client some feeding activities, if allowed. Special utensils may be needed. Provide straw to
obtain liquids if client finds it difficult drinking from a glass or cup.
✔ Sit with the client throughout the meal if necessary, try to appear unhurried.

✔ Use some method of signaling when the next mouthful is ready or when it is wanted, if the client being
fed is blind or his eyes are bandaged. The nurse can also use the clock system to describe location of
food on the plate for blind clients.

● Proper Tray Service When Feeding Clients

✔ Check the tray correctly identified with the client’s name, bed number, ward and room number and
right diet prescription.
✔ See that the size of the tray suitable to the amount and kind of the diet.

✔ Serve meals on time regularly.

✔ Never give the patient a sense of haste.

✔ Serve food at another time if the patient does not eat sufficient amount at mealtime.

✔ Remember the patient’s like and dislikes concerning food.

✔ Serve in clean dishes, glass and silver wares in proper order.

✔ Make a pleasing /appetizing arrangement of foods and small servings.

✔ Serve hot foods hot and cold foods cold

✔ Observe how much and what the client has eaten and the amount of fluid intake.

✔ Record the amount of food eaten and any pain, fatigue or nausea experienced for clients on special
diet or is having problems in eating.

Vegetarian Diet
The diet is designed to utilize combination of vegetable protein providing a similar quantity and quality of
protein as in animal protein. People follow vegetarian diets for health, political, cultural, or economic reasons or a
combination of these.
Vegetarian diets are usually low in saturated fatty acids and cholesterol. It has high fiber content and is
generally less expensive than diets with meats, fish and poultry. The disadvantage of the diet is the inadequate or
low level of Vit. B12, iodine, calcium, zinc, riboflavin, and Vit. D. The deficiency can be prevented by proper
supplementation. With proper menu planning and vitamin-mineral supplementation, strict vegans can have
nutritionally adequate diet.

The three classifications of vegetarian diets;

1. Vegan diet (Total vegetarian or strict vegetables). Foods allowed are strictly of plant origin excluding of
any animal products. Foods included are fruits, vegetables, whole grains, soybeans, legumes, nuts, bred,
cereals and processed foods made from these items (Ex. meat-like gluten). Foods avoided are, all animal
and animal products like milk and dairy, cheese, ice cream, eggs, fish and poultry, meats etc.
2. Ovo-vegetarian. Eggs and eggs products are allowed in addition to food from plants.
3. Lacto-ovo-vegetarian. Milk, eggs and their products are both allowed in addition to food from plants.

Aside from the three classification other types of vegetarian exist;

✔ Semi-vegetarian. The only foods allowed are the following; fruits, vegetables, grains, legumes, nuts
and seeds, milk and milk products, eggs, chicken and fish.
 ✔ Pesco-vegetarian. In this regimen, fish and fish products are added to the list of items of plant origin,
all animal meats are excluded.

ENTERAL NUTRITION

● Enteral (tube) feedings are used only for patients who have enough functioning of the GI tract to digest
and absorb their food.
● EN is also referred to as total enteral nutrition, is provided when the client is unable to ingest foods or the
upper GIT is impaired and the transport of food to the small intestine is interrupted.
● They are also used when the patient cannot eat enough regular food to promote healing, even though the
GI tract is functional.
● Enteral feedings are administered through nasogastric and small-bore feeding tubes, or through
gastrostomy or jejunostomy.

A tube feeding is a nutritionally adequate diet of liquefied foods administered through a tube into the
stomach or duodenum. These foods are commercially available. From the standpoint of accuracy in measuring,
sanitation, and convenience, most hospitals prefer commercial mixtures. These mixtures can be milk-based
formulas, lactose-free formulas, meat-based formulas, and residue-free formulas. Tube feedings usually furnish
one calorie per milliliter. A 24-hour intake of three liters would furnish 3000 calories.

Advantages and Disadvantages of Various Feeding Routes

Route Indication Advantages Disadvantages
Nasogastric Inability to safely and Easy to place and remove Contraindicated for clients at high risk
(NG) adequately consume tube for aspiration
oral intake Uses stomach as reservoir Potentially irritating to the nose and
Short-term feeding (<6 Can use intermittent feedings esophagus
weeks) with functional Dumping syndrome less likely than May be removed by uncooperative or
gastrointestinal tract with NI feedings confused patients
Not advised for feeding Not appropriate for long-term use
clients w/o intact gag Unaesthetic for patient
& cough reflexes
Nasointestin Short-term feeding for Less risk of aspiration, especially Increased risk of dumping syndrome
al (NI) patients at high risk of important for patients who have Not appropriate for intermittent or
aspiration, delayed impaired gag or cough reflex, bolus feedings
gastric emptying, or decreased consciousness, Not appropriate for long-term use
gastroesophageal ventilator dependence, or a Unaesthetic for patient
reflux disease (GERD), history of aspiration pneumonia
decreased level of
consciousness, poor
gag & cough reflex
Gastrostomy For long-term use in Same advantages as NG but more Percutaneous endoscopic gastrostomy
patients with a comfortable and aesthetic for insertion contraindicated for clients
functional patient who cannot have an endoscopy
gastrointestinal tract Confirmation of tube placement Risk of aspiration pneumonia in clients
Frequently used for easier with GERD
patients with impaired Cannot be misplaced into the Stoma care required
ability to swallow trachea Danger of peritonitis
Tubes are placed Potential for tube dislodgment
surgically or by
laparoscopy through
the abdominal wall
into the stomach.
Jejunostomy For long-term use in Low risk of aspiration Small-diameter tubes easily become
patients at high risk No risk of misplacing tube clogged
for aspiration into the trachea Peritonitis can occur from tube
pneumonia and in More comfortable and aesthetic for dislodgment.
clients with altered clients than transnasal tubes Cannot be used for intermittent or
gastrointestinal Because motility resumes more bolus feedings
integrity above the quickly in the intestines than in Stoma care required
jejunum the stomach after gastrointestinal
 For short-term use after surgery, feedings can begin sooner
gastrointestinal than other feedings.
surgery

Enteral feedings have several advantages, including the following:

1. It is more economical to feed enterally than intravenously, considering equipment, time, and foods used.
2. It is safer to feed enterally than intravenously. The risk of fluid and electrolyte imbalances and infection is
less than for intravenous feedings.

Some disadvantages of enteral feedings include the following:

1. Nutritional inadequacy for certain patients (not enough protein and calories)
2. Over nutrition for certain patients (excess calories and formula)
3. Diarrhea or constipation
4. Vomiting
5. Problems of preparation and safety. Bacterial contamination can be a factor if preparation is not carefully
controlled.
6. Home-prepared tube feedings are not recommended. Prepared formulas are preferred over the use of
home blenderized diets, which can clog tubes, are not sterile, and in which nutrient composition is not well
defined.

Depending on the patient and the circumstances, some or all of the above problems can be avoided or remedied.

There is an increasing movement back toward use of more enteral feedings. Recent studies indicate that the
intestinal bacteria will translocate to other areas, become pathogenic, and create sepsis when they are not fed.
Enteral feedings depend on enteral formulas.

There are three categories of commercial enteral formulas:

1. Standard, intact, or routine enteral formulas
2. Elemental or defined enteral formulas
3. Disease-specific enteral formulas

Standard enteral formulas have existed for many years with a few commercial products coming to the market
30 years ago. Now, there are more than 35 products in the market. They are used for routine feedings for patients
who need them as prescribed by physicians. Each product is made of regular foods and individual nutrients.

Defined enteral formulas contain specific nutrients or modified nutrients, including simple and complex
carbohydrates, amino acids, peptides, fatty acids, triglycerides, and so on. There are about 15 or so in the market.

Disease-specific enteral formulas are available for five or more clinical disorders such as those of the kidney,
liver, pancreas (diabetes), lung, and the immune system.

Testing Feeding Tube Placement and Patency

● Introduce 5-20ml of air into the NGT and auscultate at the epigastric, gurgling sound is heard.

● Aspirate gastric content, which is yellowish or greenish in color

● Immerse tip of the tube in water, no bubbles should be produced

● Measure the pH of the aspirated fluid which should be acidic

● Ask the client to sing or hum

● Observe the client for coughing and choking.

● The most effective method of checking NGT placement is radiograph verification then, checking the pH of
aspirated gastric content, then aspiration of gastric content.

Managing Clogged Feeding

● To prevent clogged feeding tubes, flush liberally (at least 30 ml water) before, between and after each
separate medication is instilled.

PARENTERAL NUTRITION
 ● Parenteral nutrition (PN), is also referred to as total parenteral nutrition (TPN) or intravenous hyper
alimentation (IVH), is provided when the GIT is non-functional because of an interruption in its continuity
or because its absorptive capacity is impaired.
● PN is administered intravenously such as through a central venous catheter to the superior vena cava.

PARENTERAL FEEDINGS VIA PERIPHERAL VEIN

Nutrient fluids entering a peripheral vein (peripheral parenteral nutrition) can be Saline with 5%–10%
dextrose (clinically represented by D5W or D10W); amino acids; electrolytes; vitamins; and medications.
Intravenous fluids may be isotonic, hypotonic, or hypertonic. Both hypotonic and hypertonic solutions create a
shift in body fluids. Hypotonic solutions draw fluid from the blood vessels into the interstitial spaces and cells.
Hypertonic solutions create the opposite effect; they draw fluids out of interstitial spaces into the blood. It is a
short term use.

When enteral feedings are contraindicated, feeding by a peripheral vein is often used. This type of feeding
is safer than feeding by a central vein, but it fails to provide adequate calories and other nutrients for repair and
replacement of losses. The dangers of overloading with fluid in order to meet caloric needs are inherent in using
solutions via the peripheral vein.

PARENTERAL FEEDING VIA CENTRAL VEIN

When a patient is severely depleted nutritionally or if the GI tract cannot be used, parenteral feeding via a
catheter inserted into a central vein (usually the subclavian to the superior vena cava) can provide adequate
nutrition. The solution for TPN is a sterile mixture of glucose, amino acids, and micronutrients. The net dextrose
content of total parenteral nutrition (TPN) is 25%. The intralipids are not given in this solution and may be
administered via a peripheral vein. The amounts of micronutrients added are based on the individual’s blood
chemistry. Multivitamin preparations can be added to the TPN solutions, except for B, K, or folic acid, which are
given separately. It is a long term use.

TPN has many advantages. It can be used for long periods of time to meet the individual body’s total
nutritional needs. The solutions can be adjusted according to individual needs by increasing or decreasing any or all
of the nutrients. TPN also has many disadvantages. The solutions are very expensive, and they support rapid
growth of bacteria and fungi. The rate of infusion must be adhered to rigidly, around the clock. Dressing changes
are done using sterile technique. Careful monitoring of the patient’s response and corrective measures when
needed are mandatory for safe administration of these solutions.

NURSING IMPLICATIONS
The responsibilities or implications for nutritional support by the nursing staff are varied and many. A brief
summary of some of these implications follows:
1. Discard all unused, cloudy, or sedimented fluids.
2. Do not add drugs and other mixtures to a solution containing protein.
3. Refrigerate solutions until they are used.
4. Be aware that dates should be on tube feedings, and that they should not be given past 24 hours of date.
5. Be alert for signs of gas, regurgitation, cramping, and diarrhea, and be prepared to intervene.
6. Take necessary precautions when using nutrient solutions because they are excellent sources for bacterial
growth.
7. Be especially alert for signs of hypo- or hyperglycemia when TPN is used and intervene if necessary.
8. Assist the patient in adjusting to an alternate feeding method. Many patients experience stress due to fear
and concern of unfamiliar feeding methods.
9. Encourage and practice good oral hygiene measures with the patient, even though he or she is not eating by
mouth.
10. Encourage early ambulation, which makes use of the muscles and increases the use of calcium and protein.
Physical activity also raises morale.

D. Monitoring Nutritional Status

All patients should be reassessed or monitored at appropriate intervals. Some patients require continuous
monitoring while others require reassessment daily. The following are suggested information for monitoring.

● Observe intake whenever possible to judge the adequacy.

● Document appetite and take action when the client does not eat.

● Order supplements if intake is low or needs are high.

 ● Request a nutritional consult.

● Assess tolerance (i.e., absence of side effects).

● Monitor weight.

● Monitor progression of restrictive diets. Clients who are receiving nothing by mouth

● (NPO), who are restricted to a clear liquid diet, or who are receiving enteral or parenteral nutrition are at
risk for nutritional problems.
● Monitor the client’s grasp of the information and motivation to change.

Strategies to Address Age-related Changes Affecting Nutrition (Refer to assisting client meet nutritional needs)
The two groups of people frequently require help with their meals are the elders who are weakened and
persons with disabilities (ex. blind, those who cannot use their hands etc.).
The elderly needs to eat certain foods in adequate amount s for good health. Usually, the elderly needs less
energy foods due to less physical activities but more protein foods to repair worn out tissues. Calcium, iron, vit A
and C commonly found lacking in the diet because of low intake of meat, milk, green leafy vegetables and fruits.
About 6 to 8 glasses of water should be consumed daily and fiber rich food should be eaten regularly. The kidneys
can function efficiently in eliminating waste solids if there are sufficient fluids. Water also stimulates peristalsis,
combating constipation.

Common Problems among the Elderly Possible solutions

1. Difficulty in chewing due to loss of teeth and not
getting used to dentures.
2. Lack of appetite due to less saliva production and
swallowing of food is difficult. The sense of smell and taste
are less acute.
3. Unwanted weight and due to lack of physical activity
and /or to overeating
4. Anxiety, confusion, insecurity or loneliness
5. Poor digestion leading to constipation, gas pains, or
diarrhea
6. Poor absorption leading to anemia and other vitamin
deficiencies
7. Difficulty in sleeping
> Chop meat or flake fish
>Slice or chop vegetables into bite sized pieces for easy
chewing.
>Do light exercises like walking and gardening to improve
appetite and keep the body fit.
>Eat in pleasant surroundings to make your meal
enjoyable.
>Make the food attractive by varying color, shape and size.
>Exercise regularly
>Eat only the lean part of meat o4 fish. Avoid fatty portion.
>Take in moderate amounts of energy food. Steam, boil, or
broil foods. Avoid rich sauces, salad dressings and pastries
or cake with heavy icings.
> Start the day right with a good breakfast
> Have a hobby
>Keep up with a group. Join a club and participate in a
community activities.
>Include fruits and vegetables in your daily meals to
prevent constipation
>Have 4 light meals, the heaviest meal at noon
>Drink 6 -8 glasses of water/fruit juices everyday
>If having diarrhea, take in simple foods like tea, crackers,
broth of boiled banana and camote, “lugaw” or toast.
Avoid fibrous fruits and vegetables.
>Eat iron-rich foods like liver, lean meat, eggyolk, saluyot,
kulitis and seaweeds
>Eat vitamin C-rich foods like papaya, mango, dalanghita
will help absorb iron and speed up healing
>Take in foods like milk, milk products, dilis, alamang and
other leafy vegetables. These foods contain calcium
needed for strong bones. Exposure to sunlight helps
maintain the bone structure.
>Drink warm milk just before going to bed to assure a
restful night.
>Avoid tea or coffee late in the day, if these affect your
sleep.

Recording and Reporting of Nutrition Status

Document all relevant information during assessments and interventions. Ex. If a client is on special diet or is
having problem on eating, record the amount of food eaten and any pain, fatigue or nausea experienced.
 In tube feeding insertion. Document the insertion of the tube, the means by which correct placement was
determined, and client responses.
If suction is applied, keep accurate records of the client’s fluid intake. Document the type of tube inserted,
date and time of tube insertion, type of suction used (if suction is applied) color and amount and characteristics of
the drainage. Document the type of tube inserted, the date and time of tube insertion, the type of suction used,
color and amount of gastric contents, and the client’s tolerance to the procedure.
In removing NGT, record the removal of the tube, the amount and appearance of any drainage, if the tube was
connected to a suction, and any relevant assessment s of the client.
In tube feeding, document all relevant information. Record the feeding, including amount and kind of solution
taken, duration of the feeding and assessment of the client. Record the volume of the feeding and water
administered on the client’s intake and output record.

E. Evaluation
The goals established in the planning phase are evaluated according to specific desired outcomes. If the
desired outcomes are not achieved, the nurse should explore the reasons. The following questions might be
considered:

● Was the cause of the problem correctly identified?

● Was the family included in the teaching plan? Are family members supportive?

● Is the client experiencing symptoms that cause loss of appetite (Ex. pain, nausea, fatigue) ?

● Were the outcomes unrealistic for this person?

● Were the client’s food preferences considered?

● Is anything interfering with digestion or absorption of nutrients (ex. diarrhea)?

● Is the client and family knowledgeable of community resources that promotes assistance in nutrition?

Summary
The Nutrition Care Process is similar to the nursing process which is the cornerstone of the nursing
profession. It is a systematic method that dietetics and nutrition professionals use to provide nutrition care. It is a
process of planning and meeting the nutritional needs of a patient. The nutrition care process includes four steps:
assessment, diagnosis, intervention, monitoring and evaluation (ADIME). While nurses use the same problem-
solving model to develop nursing or multidisciplinary care plans that may also integrate nutrition, the nutritional
plan of care devised by dietitians is specific for nutrition problems. The collaborative role of health care
professionals continues to be aimed at the identification of clients at nutritional risk, but also communicating with
each other to institute, the appropriate steps, with the goal of optimal health status among clients.