Chapter 15
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Nutrition care Process
It is an approach used to identify and meet each person’s nutrients and
nutrition education needs.
Consists of five steps
1) Assess nutrition status
2) Analyze assessment data to determine nutrient requirements
3) develop plan of action for meeting nutrition needs
4) implement the nutrition care plan
5) Evaluate the effectiveness of the nutrition care plan through ongoing
assessment and make changes as needed.
1) Assess nutrition status
Assessment provides information needed to determine how well a client’s
nutrient needs are met.
This process includes- Historical information-diet history
- Physical examination-clinical
- Anthropic data-
- Biochemical analyses-lab tests
A) Historical information
consists of-health history
-drug history
- socioeconomic history
- diet history
1) health history- health factors influencing nutrition status
-appetite and food intake- loss of appetite commonly accompanies illness
-eg. Anxiety stimulates release of stress
hormones that suppresses digestive activity=
loss of appetite
-digestion and absorption-illness may cause malabsorption of
nutrientscystic fibrosis,pancreatitis, IBS
-metabolism- illness alters metabolism or organ function- liver disease,
diabetes, renal failure,cancer, Aids
- excretion- illness can cause excessive retention- kidney disease- or
excretion of nutrients-diarrhea
- emotional and mental health- malnourished people may suffer with
mental symptoms of nutrient deficiencies.
B vitamin deficiency can cause confusion, apathy,
fatigue and irritability
2) Drug history- medication and nutrient supplements affecting nutrition status
-medication can alter food intake and the absorption, metabolism and
excretion of nutrients.
- food and nutrients can alter the absorption, metabolism
and excretion of medication.
3) socioeconomic history- includes personal, financial, and environmental
influences on food intake and nutrient needs
-Persons occupation provides clues to the person’s
education and income . It also reveals his eating
habits and
level of physical activity.
4) Diet history- reveals nutrient intake excesses or deficiencies and the
reason for imbalances
-provides record of eating habits and food intake and help
identify possible nutrient imbalances. It can also serve as a
tool to develop realistic and attainable nutritional goals.
The assessor needs to ask questions about- portion sizes
- how the food is prepared
- about beverage consumption-
alcohol and caffeine
We distinguish-24 hour recall
- the usual intake record
- the food frequency check list]
- the food record
- direct observation of food intake
a) 24 hour Recall- used in nutrition surveys to obtain estimates of the typical
food intakes for a population
It is information about pt food intake specific to
those 24 hours. It's purpose is to find out about
intake of specific amount of nutrient within specific
amount of time. For instance how many kcal is the
patient getting within 24 hours. Its main feature is
that it is very specific information.
advantage-easy to obtain
- more accurate
disadvantages- not enough information to make accurate generalization about
individual’s usual food intake
- this limitation can be eliminated by collecting multiple 24 hour
recalls
b) Usual intake- -helps to verify food intake when 24 hour recall has been
atypical
- helps verify usual eating habits
c) Food Frequency Checklist- shows frequency with which an individual eats
different types of foods
- can be used when persons food intake is not regular and usual intake
cannot be performed.
-provides information on how often an individual eats specific type of
food
- helps to pinpoint and identify nutrient deficiencies or excesses in
diet
-helps to double check the information obtained from 24 hour recall or
food frequency.
D) food records- diary of foods and beverages consumed
e) observing food intake- performed in health facilities-hospitals or nursing
homes
-serves as means of estimating nutrient intake
-also called kcal count
Analysis of food intake data
-intakes are compared with standarts-dietary guideline or nutrient recommendation
- accessor often uses exchange system to estimate nutrient intake
Limitation of food Intake Data
- intake of foods does not reflect exact absorption of nutrient.
- there are many factors that can affect absorption of nutrients
- reported serving sizes may not be accurate
Interpretation of Food intake Data
-adequate intake does not necessary reflects adequate nutrition status and vice
varsa.
Instead it alerts accessor to possible problems
- nutrient intake identified through diet histories is only one part of puzzle
that
together with other parts helps to determine nutrition status of an individual
2) Physical examination
-many tissues and organs may reflect sign of malnutrition
-malnutrition occurs most rapidly in parts where cells replacement occurs at
the highest rate- hair, skin and digestive tract-including the mouth and tongue
Limitation of Physical Findings
- many signs reflecting nutrient deficiencies may be due to condition not
related to
nutrition eg cracked lips may be caused by sunburn, wind burn, dehydration or
by deficiency of vitamin B.
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