Nutrition CP Recap

Nutrition Care
Process
Elaine L. Banares, RND, MFSA
Discussion/s last meeting

Discussion/s last meeting

Functions of a Clinical
Nutritionist

Nutrition Care Process
A systematic approach to medical nutrition
therapy used by RNDs.
Steps of the nutrition care process:
1.Nutrition assessment
2.Nutrition diagnosis
3.Nutrition intervention
4.Nutrition monitoring and evaluation Elaine L. Banares, RND, MFSA
Vital Information in
Nutritional Assessment

It involves the collection and analysis of health-
related information for the purpose of identifying
specific nutrition problems and their underlying
causes.
A well-conducted assessment allows the dietitian to
devise a plan of action to prevent or correct nutrient
imbalances or to evaluate whether a particular care
plan is working.
Information may be obtained from the medical

record, physical examination, laboratory
analyses, medical procedures, interview with
the patient (or patient’s watcher), and
consultation with other health professionals.
The data should be comparable with reliable
standards to help with their interpretation.
Biochemical Data
Biochemical Assessment – Knowing the
normal values for laboratory tests indicative of
nutrition concerns.
You can look for reliable websites that provide
normal values. Always indicate your
references in your case study.
Biochemical Data
It provides information about protein-energy
malnutrition (PEM), vitamin and mineral status,
fluid and electrolyte balance, and organ function.
Most tests are based on analyses of blood or
urine samples, which contain proteins, nutrients,
and metabolites that reflect nutrition and health
status.
Biochemical Data
Interpreting laboratory values can be
challenging because several factors can
influence the test results.
E.g., serum protein values can be
affected by fluid imbalances, pregnancy,
infections, and some medications.
Biochemical Data
Similarly, serum levels of vitamins and
minerals are often poor indicators of
nutrient deficiency because the values
are affected by multiple variables.
A variety of tests are generally needed
to diagnose a nutrition problem.
Plasma Proteins
It can aid in the assessment of protein-
energy status, but the levels may
fluctuate for other reasons as well.
Plasma proteins are synthesized in the
liver, so plasma levels of these proteins
can reflect liver function.
Plasma Proteins
Metabolic stress can alter plasma
protein levels because the liver responds
by increasing its synthesis of some
proteins and reducing the synthesis of
others.

Albumin
It is the most abundant plasma protein
and routinely monitored during illness.
Many medical conditions influence
albumin, it is slow to reflect changes in
nutrition status because of its large body
pool and slow rate of degradation.
Albumin
In people with chronic PEM, albumin levels
remain normal for long periods of time
despite depletion of body proteins, and
levels fall only after prolonged malnutrition.
Albumin concentrations rise slowly when
malnutrition is treated, so albumin is not a
sensitive indicator of effective treatment.
Transferrin
In an iron-transport protein, and its concentrations
respond to both iron status and PEM.
Transferrin levels rise as iron status worsens and fall as
iron status improves, so using transferrin values to
evaluate protein-energy status is difficult if an iron
deficiency is also present.
Transferrin degrades more rapidly than albumin, but its
levels change relatively slowly in response to nutrition
therapy. Elaine L. Banares, RND, MFSA
Prealbumin & Retinol-
binding CHON
Levels of prealbumin (also called
transthyretin) and retinol-binding protein
decrease rapidly during PEM and respond
quickly to improved protein intakes.
These proteins are more sensitive than
albumin to changes in protein status.
Prealbumin & Retinol-
binding CHON
Like other plasma proteins, their usefulness in
nutrition assessment is limited because they are
affected by a number of different factors, including
metabolic stress, zinc deficiency, and various
medical conditions.
Prealbumin and retinol-binding protein are more
expensive to measure than albumin, so they are
not routinely included during nutrition assessment.
Examples of Clinical
Assessment

Clinical
Assessment
Nutritional
Assessment
Checklist
Importance of Nutritional
Diagnosis

Nutritional
Diagnosis
Nutritional Diagnosis
 After completing a nutrition assessment, the dietitian identifies
existing and potential nutrition problems.
 A step that requires a careful and objective analysis of the
patterns and relationships among the assessment data.
 Each nutrition problem receives a separate diagnosis, which
includes the specific problem (P), etiology (E) or cause, and
signs and symptoms (S) that provide evidence of the problem.
 A nutrition diagnosis is likely to change over the course of
illness due to either a successful nutrition intervention or
resolution of the medical problem.
Nutritional Diagnosis
Example:
Nutrition diagnosis might be “Involuntary weight gain”
(the problem)
Related to “chronic use of a medication, corticosteroids”
that causes weight gain (the etiology or cause)
As evidenced by an “unintentional weight gain of 10
percent of body weight over the past six months” (the
sign or symptom).
Examples of Nutrition
Intervention

Types of Diet

Nutritional
Intervention
Nutritional Intervention
After nutrition problems are identified, the
appropriate nutrition care can be planned and
implemented.
Nutrition interventions attempt to modify dietary and
lifestyle practices or environmental conditions that
interfere with nutrition status or health.
The intervention targets the etiology or cause of the
problem as identified in the nutrition diagnosis.
 It may include counseling or education about appropriate
dietary and lifestyle practices, changes in a medication or
other treatment, or modifications in the meals offered to a
hospital patient.
 To be successful, the intervention must consider the patient’s
food habits, lifestyle, and other personal factors.
 The nutrition interventions used by dietitians are evidence-
based (based on a scientific rationale and supported by the
results of high-quality research).
 The goals of nutrition interventions are stated in terms of
measurable outcomes, such as the results of laboratory or
anthropometric tests.
 For example, goals for an overweight person with diabetes might
include target ranges for blood glucose levels and body weight.
 Other desirable outcomes may include positive changes in dietary
behaviors and lifestyle
 For example, the diabetes patient may need to learn how to control
carbohydrate intake or portion sizes and may benefit from regular
exercise. These outcomes can be assessed during an interview
with the patient. Elaine L. Banares, RND, MFSA
Although many aspects of nutrition care fall within
the scope of dietetics practice, others require the
assistance of other health professionals.
For example, a physician’s help would be required
if a medication interfered with food intake; the
nursing or foodservice staff might be involved if
the feeding environment or meal delivery required
adjustment.
The need for monitoring &
evaluation

Nutritional
Monitoring &
Evaluation
Nutritional Monitoring
and Evaluation
The effectiveness of the nutrition care plan
must be evaluated periodically
The patient’s progress should be
monitored closely, and updated
assessment data or diagnoses may require
adjustments in goals or outcome
measures. Elaine L. Banares, RND, MFSA
and Evaluation
Sometimes a new situation alters
nutritional needs
For example, a change in the medical
treatment or a new medication may alter a
person’s tolerance to certain foods.
The nutrition care plan must be flexible
enough to adapt to the new situation.
and Evaluation
If progress is slow or a patient is unable or
unwilling to make the suggested changes, the
care plan should be redesigned and take into
account the reasons why the earlier plan was
not successful.
The new plan may need to include motivational
techniques or additional patient education.
and Evaluation
If the patient remains unwilling to modify
behaviors despite the expected benefits,
the health care provider can try again at
a later time when the patient may be
more receptive.

Case Analysis
Information about the patient
RRL about the disease
Nutritional assessment (ABCD, history,
medications, etc.)
Nutrition diagnosis (PES)
Nutrition intervention (short and long term)
Nutrition monitoring and evaluation
Thank you… – ELBañares,
RND

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Nutrition Care

Elaine L. Banares, RND, MFSA

Elaine L. Banares, RND, MFSA

Elaine L. Banares, RND, MFSA

Elaine L. Banares, RND, MFSA

Information may be obtained from the medical

Elaine L. Banares, RND, MFSA

Elaine L. Banares, RND, MFSA

Elaine L. Banares, RND, MFSA

Elaine L. Banares, RND, MFSA

Elaine L. Banares, RND, MFSA

Elaine L. Banares, RND, MFSA

Elaine L. Banares, RND, MFSA

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