Relationship Between Patient/Client/Group Dietetics Professional - Nutrition Diagnosis Identify...
-
Upload
benjamin-dorsey -
Category
Documents
-
view
223 -
download
0
description
Transcript of Relationship Between Patient/Client/Group Dietetics Professional - Nutrition Diagnosis Identify...
Relationship Between
Patient/Client/Group & Dietetics
Professional
-
Nutrition Diagnosis Identify and label problem Determine cause/contributing risk
factors Cluster signs and symptoms/
defining characteristics
Nutrition Assessment Obtain/collect timely and
appropriate data Analyze/interpret with
evidence - based standards
Identify risk factors Use appropriate tools
and methods Involve
interdisciplinary collaboration
Screening & Referral System
Outcomes Management Sys tem
Monitor the success of the Nutrition Care Process implementation
Evaluate the impact with aggregate data Identify and analyze causes of less than
optimal performance and outcomes Refine the use of the Nutrition Care
Process
ADA NUTRITION CARE PROCESS AND MODEL
Document
Nutrition Monitoring and Evaluation Monitor progress Measure outcome indicators Evaluate outcomes Document
Nutrition Intervention Plan nutrition intervention
Formulate goals and determine a plan of action
Implement the nutrition intervention Care is delivered and actions
are carried out Document
Document
Nutrition Assessment Nutrition Diagnosis Nutrition Intervention Nutrition Monitoring and
Evaluation
“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.
Gather data, considering Compare to relevant standards Identify possible problem areas
Observe › Verbal and nonverbal cues
Determining appropriate data to collect› Only key information to be recorded
Selecting assessment tools Distinguishing relevant from irrelevant data Organizing data to relate to the nutrition
problem Determining when problems require referral
Nutrition Assessment Nutrition Diagnosis Nutrition Intervention Nutrition Monitoring and
Evaluation
Nutritional problem Names and describes the problem Problem may already exist, or may be at
risk of occurring Not a medical diagnosis
Defined as “actual problems related to intake of energy, nutrients, fluids, bioactive substances through oral diet or nutrition support (enteral or parenteral nutrition)
Class1: Calorie energy balance Class2: Oral or nutrition support intake Class3: Fluid intake balance Class4: Bioactive substances balance Class5: Nutrient balance
Defined as “nutritional findings/problems identified that relate to medical or physical conditions
Class1: functional balance Class2: biochemical balance Class3: weight balance
Defined as “nutritional findings/problems identified that relate to knowledge, attitudes/beliefs, physical environment, or access to food and food safety
Class1: knowledge and beliefs Class2: physical activity, balance and
function Class3: food safety and access
Problem Etiology Signs/Symptoms
› Signs › Symptoms
Problem › Describes alterations in pt’s nutritional
status› Diagnostic labels
Impaired Altered Inadequate/excessive Inappropriate Swallowing difficulty
Etiology › Related factors that contribute to
problem› Identifies cause of the problem› Helps determine whether nutrition
intervention will improve problem› Linked to problem
Etiology › Excessive calorie intake related to regular
consumption of large portions of high-fat meals
› Swallowing difficulty related to stroke
Signs/Symptoms › Evidence- that the problem exists › Linked to etiology- “as evidence by”
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
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
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 Statement should be: clear, concise specific related to one problem Accurate- related to E based on reliable, accurate assessment
data
Medical Diagnosis Nutritional Diagnosis
Diabetes Increased blood glucose level, excess calorie intake
Trauma and closed head injury
TPN, IV hydration line, increase energy needs (state of catabolism) R/T the trauma, as evidence by weight
Liver failure No insulin, blood glucose stability, R/T fact that the liver is not functioning, as evidence by increased blood glucose levels.
Medical Dx Nutritional Diagnosis
Obesity Intake energy imbalance or calorie increase R/T increased calories or obesity or lack of healthy foods or SES, AEB weight, BMI
Dependence mechanical ventilation
Increased carbohydrates, excessive calories R/T high TPN, AEB vent settings
Anorexia nervosa Decreased calorie intake, R/T history of anorexia and self limiting behavior, AEB weight and diet history
Nutrition Assessment Nutrition Diagnosis Nutrition Intervention Nutrition Monitoring and
Evaluation
“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
Should be patient-centered Must be achievable Stated in behavioral terms, quantifiable
terms Pt and counselor must establish goals
together What will the patient do or achieve if
objectives met
SMART goals!
Problem 1: Involuntary weight loss› Objectives:
1. Increase calorie intake, very specific 2. Gain X pounds in X month
Problem 2: Inadequate protein-energy intake 2° poor appetite› Objectives:
1.Increase nutrient dense foods high in protein
2.Divide up protein rich foods throughout the day
3.Improve socialization of eating foods
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
Problem 1: Involuntary Weight loss› Intervention:
1. Instruct client on (high protein, high calorie feeding)
2. Gradually increase plan
3.
4.
Problem 2: Inadequate protein-calorie intake 2° poor appetite› Intervention:
1. Begin with nutrient dense foods
2.
3.
Nutrition Assessment Nutrition Diagnosis Nutrition Intervention Nutrition Monitoring and
Evaluation
Evaluate outcomesCompare current
findings with previous status, intervention goals, and/or reference standards
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
Are necessary in order to evaluate Should be achievable- and based on
scientific evidence Should be directly or indirectly related
to nutrition 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
Nutrition Diagnosis- PESS1. Fluid intake concerns, R/T dietary discretion
AEB symptoms
2. Excessive Na intake R/T foods eaten AEB diet history
3. Knowledge deficit R/T no previous nutritional education AEB inability to name Na foods
4. Self monitoring deficit R/T
Nutrition Intervention 1. Low Na diet 2. Go to senior center to eat 3. Attend diet program 4. Find someone to help the woman to get scale
Monitoring and Evaluation
1. Monitor BP and tell her to keep a weight log and food log
2. Case manager will monitor readmissions
3.