Lecture 3 Towards a Verifying Compiler: Verifying Object Invariants
Nutrition Care Process - jamieberray.weebly.com fileNutrition Assessment (Definition)! “A...
Transcript of Nutrition Care Process - jamieberray.weebly.com fileNutrition Assessment (Definition)! “A...
RelationshipBetween
Patient/Client/Group & Dietetics
Professional
-
Nutrition DiagnosisØ Identify and label problemØ Determine cause/contributing risk
factors Ø Cluster signs and symptoms/
defining characteristics
Nutrition AssessmentØ Obtain/collect timely and
appropriate dataØ Analyze/interpret with
evidence- based standardsØ
Ø Identify risk factorsØ Use appropriate tools
and methodsØ Involve
interdisciplinary collaboration
Screening & Referral System
Outcomes Management Sys tem
Ø Monitor the success of the Nutrition Care Process implementation
Ø Evaluate the impact with aggregate dataØ Identify and analyze causes of less than
optimal performance and outcomesØ Refine the use of the Nutrition Care
Process
AND NUTRITION CARE PROCESS AND MODEL
Ø Document
Nutrition Monitoring and EvaluationØ Monitor progressØ Measure outcome indicators Ø Evaluate outcomesØ Document
Nutrition InterventionØ Plan nutrition intervention• Formulate goals and
determine a plan of actionØImplement the nutrition intervention• Care is delivered and actions
are carried outØDocument
Document
AND’s Nutrition Care Process Steps
� Nutrition Assessment
� Nutrition Diagnosis
� Nutrition Intervention
� Nutrition Monitoring and Evaluation
Nutrition Assessment (Definition)
� “A systematic process of obtaining, verifying, and interpreting data in order to make decisions about the nature and cause of nutrition-related problems.”� Lacey and Pritchett, JADA 2003;103:1061-1072.
Nutrition Assessment Components
� Gather data, considering
� Compare to relevant standards
� Identify possible problem areas
Nutrition Assessment: Critical Thinking
� Observe
� Determining appropriate data to collect
� Selecting assessment tools
� Distinguishing relevant from irrelevant data
� Organizing data
� Determining when problems require referral
ADA’s Nutrition Care Process Steps
� Nutrition Assessment
� Nutrition Diagnosis
� Nutrition Intervention
� Nutrition Monitoring and Evaluation
Nutrition Diagnosis
� Nutritional problem
� Names and describes the problem
� Problem may already exist, or may be at risk of occurring
� Not a medical diagnosis
Nutrition Dx Domains: Intake
Defined as “actual problems related to intake of energy, nutrients, fluids, bioactive substances through oral diet or nutrition support (enteral or parenteral nutrition)
� Class: Calorie energy balance
� Class: Oral or nutrition support intake
� Class: Fluid intake balance
� Class: Bioactive substances balance
� Class: Nutrient balance
Nutrition Dx Domains: ClinicalDefined as “nutritional findings/problems
identified that relate to medical or physical conditions
� Class: functional balance
� Class: Biochemical balance
� Class: weight balance
Nutrition Dx Domains: Behavioral-Environmental
Defined as “nutritional findings/problems identified that relate to knowledge, attitudes/beliefs, physical environment, or access to food and food safety
� Class: knowledge and beliefs
� Class: physical activity, balance and function
� Class: food safety and access
Nutrition Diagnosis Components
� Problem � Describes alterations in pt’s nutritional status� Diagnostic labels� Impaired� Altered
� Inadequate/excessive
� Inappropriate � Swallowing difficulty
Nutrition Diagnosis Components
� Etiology � Related factors that contribute to problem� Identifies cause of the problem� Helps determine whether nutrition intervention will
improve problem� Linked to problem
Nutrition Diagnosis Components
� Etiology � Excessive calorie intake related to regular consumption of
large portions of high-fat meals � Swallowing difficulty related to stroke
Nutrition Diagnosis Components
� Etiology � Excessive calorie intake “related to” regular consumption
of large portions of high-fat meals as evidenced by diet history and weight status
� Swallowing difficulty related to stroke as evidenced by coughing following drinking of thin liquids
Nutrition Diagnosis
� Excessive calorie intake
� “related to” regular consumption of large portions of high-fat meals
� “as evidenced by” diet history & 12 lb wt gain over last 18 mo
Nutrition Diagnosis Components
� Food, nutrition and nutrition-related knowledge deficit R/T lack of education on infant feeding practices as evidenced by infant receiving bedtime juice in a bottle
� Altered GI function R/T ileal resection as evidenced by medical history and dumping syndrome symptoms after meals
Nutrition Diagnosis Components
Nutrition Diagnosis Statement should be:
� clear, concise
� specific
� related to one problem
� accurate
� based on reliable, accurate assessment data
Nutritional vs Medical Dx
Medical Diagnosis Nutritional Diagnosis
Diabetes
Trauma and closed head injury
Liver failure
Nutritional vs Medical Dx
Medical Dx Nutritional Diagnosis
Obesity
Dependence mechanical ventilation
Anorexia nervosa
AND’s Nutrition Care Process Steps
� Nutrition Assessment
� Nutrition Diagnosis
� Nutrition Intervention
� Nutrition Monitoring and Evaluation
Nutrition Intervention Definition� “Purposely-planned actions designed with the intent of
changing a nutrition-related behavior, risk factor, environmental condition, or aspect of health status for an individual, a target group, or population at large.” –� Lacey and Pritchett, JADA 2003;103:1061-1072
� Directed at the etiology or effects of a diagnosis
Intervention Objectives
Should be patient-centered� Must be achievable
� Stated in behavioral terms
� Pt and counselor must establish goals together
� What will the patient do or achieve if objectives met
Intervention Objectives
� Problem 2: Inadequate protein-energy intake 2° poor appetite
� Objectives:
1.
2.
Nutrition Intervention
� Intervention translates assessment data into strategies, activities, or interventions that will enable the patient or client to meet the established objectives.
� Interventions should be specific
Nutrition Intervention
� Problem 2: Inadequate protein-calorie intake 2° poor appetite� Intervention:1.
2.
3.
AND’s Nutrition Care Process Steps
� Nutrition Assessment
� Nutrition Diagnosis
� Nutrition Intervention
� Nutrition Monitoring and Evaluation
Nutrition Monitoring & EvaluationComponents
Evaluate outcomes
Compare current findings with previous status, intervention goals, and/or reference standards
What gets Measured?Nutrition Monitoring
and Evaluation
Types of Outcomes
End-result outcome
•Direct nutrition outcomes
•Clinical and health status outcomes
•Patient/client-centered outcomes
•Healthcare utilization
Intermediate-result outcome
Nutrition Goals and Objectives
� Are necessary in order to evaluate
� Should be achievable
� Should be directly or indirectly related to nutrition care
NCP Example: Acute Care
Nutrition Assessment
� Medical hx: 72 y.o. female admitted with decompensated CHF; heart failure team consulted; has been admitted with same dx x 2 in past month; meds: Lasix and Toprol; current diet order: 2 gram sodium; has lost 5 pounds in 24 hours since admission; Output > input by 2 liters
� Nutrition history: has been told to weigh self daily but has no scale at home. Does not add salt to foods at the table. Noticed swollen face and extremities on day prior to admission. Day before admission ate canned soup for lunch and 3 slices of pizza for dinner; does not restrict fluids; has never received nutrition counseling