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NUTR 482 Dietetic Practice > Lecture 2 NPG nutritional Diagnosis, Intervention and Monitoring & Evaluation > Flashcards

Lecture 2 NPG nutritional Diagnosis, Intervention and Monitoring & Evaluation Flashcards

1
Q

Components of the NCP

A
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2
Q

Describe nutrition diagnosis

A

Identify and describe a specific nutrition problem
* Articulated as a structured sentence: Nutrition diagnosis statement or “PES” statement
* Standardizes the diagnosis terminology used

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3
Q

Skills needed for nutrition diagnosis

A

Critical thinking
* Determine problem you can resolve (as a dietitian)
* Evaluate the etiology that can be addressed (through nutrition intervention)
* Select the assessment data that can be measured to indicate resolution or improvement of the problem

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4
Q

Describe the PES statement

A

3 components
* Problem (P): nutrition diagnosis
* Etiology (E): cause of nutrition problem
* Signs and Symptoms (S): based on objective evidence of the nutrition problem

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5
Q

How is the diagnosis written?

A

The diagnosis is a generic sentence is written as:
“Problem” related to “etiology” as evidenced by “signs and symptoms”.

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6
Q

Evaluating the PES statement

A
  • Problem: Can the RDN resolve or improve the nutrition diagnosis?
  • Etiology: Is this the root cause of the problem?
  • Signs and symptoms: Can these be monitored and documented and improved?
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7
Q

How is the terminology for nutrition diagnosis ‘PROBLEM’ organized?

A

organized in three domains (categories)
* IN - Intake
* NC - Clinical
* NB - Behavioural-environmental
* No nutrition diagnosis at this time

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8
Q

eNCPT

A

electronic nutrition care process terminology

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9
Q

Describe NI

A

Intake
* Nutritional problems related to energy, nutrients, fluids, or bioactive substances through oral diet or nutrition support

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10
Q

Describe NC

A

Nutritional problems related to medical or physical conditions

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11
Q

Describe NB

A

Nutritional problems related to knowledge, attitudes/beliefs, or physical environment

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12
Q

Correct or Incorrect?

A

Correct

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13
Q

Correct or incorrect

A

correct

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14
Q

Correct or incorrect?

A

Incorrect
* HbA1C would be S/S

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15
Q

Characteristics of a well written PES statement

A
  • Clear and concise
  • Specific to client
  • Accurately related to etiology
  • Based on reliable and accurate nutrition assessment data
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16
Q

What happens if intervention cannot resolve the etiology?

A

If the intervention cannot be aimed at resolving the underlying cause (e.g., physiologic-metabolic etiologies)ànutrition intervention targeted to minimize signs and symptoms of the nutrition problem.

17
Q

Considerations when making a PES statement

A
  1. Can the RD resolve the problem?
  2. Does the etiology make sense? Does it match the assessment data?
  3. Is there a reasonable intervention? Is the intervention within the scope of RD practice?
  4. Can you monitor this patient on the basis of the stated signs and symptoms?
18
Q

Multiple nutrition diagnosis

A

If there is more than one nutrition diagnosis identified, prioritize what is most pertinent to the patient at this time.
* Each nutrition diagnosis is documented in separate sentences.

19
Q

Describe the nutrition intervention

A

Planning + Implementation: Planned actions to resolve or improve nutrition related problem (behaviour, environment condition and/or aspects of health status).
* Advice
* Education
* Delivery of the food component or specific diet or meal plan
* Targeted to resolve the nutrition diagnosis and/or improve the signs and symptoms
* Detail nutrition prescription and identify strategies
* Determine patient-focused goals: SMART
* Nutrition prescription

20
Q

What is the nutrition prescription

A

Client’s individual recommended dietary intake based on current reference standards and dietary guidelines and the client’s health and nutrition diagnosis. Aimed at resolving the cause of the nutrition problem.
* i.e.,: 1900 kcal/day, 60-72g protein/day, reduce added sugars and salt

21
Q
  • Assessment data
  • PES statement
  • Current evidence
  • Policies and procedures
  • Client preferences
A

What does the nutrition prescription include?

22
Q

Nutrition Counselling

A

Counselling is HOW we deliver the intervention
* “Supportive process, characterized by a collaborative counselor-client relationship to establish food, nutrition and physical activity priorities, goals and individualized action plans that acknowledge and foster responsibility for self- care to treat an existing condition and promote health”
* May involve: education, goal setting, social support, problem solving, self-monitoring, etc
* Theoretical Basis/Approach Strategies

23
Q

Planning the nutrition intervention

A
  • Collaborate with the client to identify goals of the intervention and expected outcomes
  • Prioritize the nutrition interventions based on client preference, urgency, impact potential and available resources
  • Write a nutrition prescription
  • Determine a specific, science-based nutrition intervention strategy
  • Define time and frequency of care, including intensity, duration and follow-up
24
Q

Implementing the nutrition intervention

A
  • Collaborate with the client to carry out the plan of care (individualized)
  • Communicate the plan of nutrition care
  • Modify the plan of care as needed (continue data collection)
  • Follow-up and verify that the plan is being implemented
  • Revise strategies based on changes in condition or response to intervention
25
Q

What are the domains of the nutrition intervention?

A
  • ND: Food and/or nutrient delivery
  • E: nutrition education
  • C: nutrition counseling
  • RC: Coordination of nutrition care by a nutrition care professional
  • P: Population based nutrition action

For reference

26
Q

Evaluating the nutrition intervention

A

The etiology (or root cause) from the PES statement drives the selection of the intervention
* If RDN cannot resolve the problem by addresing the etiology, the RDN should aim to lessen the S/S with the nutrition intervention

27
Q

Nutrition intervention documentation

A
  • Are the goals identified and SMART?
  • Do the goals consider client needs and values?
  • Is the nutrition prescription written to help achieve client goals?
  • Is the intervention directed at changing the etiology of the PES statement?
28
Q

Describe monitoring and evaluation

A

Determine and measure the amount of progress made for the nutrition intervention and whether the nutrition related goals/expected outcomes are being met
* Monitor progress → measure outcomes → evaluate outcomes
* Follow-up and verify the implementation; revise nutrition intervention strategy if needed or continue if it is positive

29
Q

Monitoring progress

A
  • Check client’s understanding and adherence to the nutrition intervention.
  • Determine whether the intervention is being implemented as prescribed.
  • Identify other positive and negative outcomes.
  • Gather information, indication, reasons for lack of progress.
30
Q

What do Dieticians take part in during follow up?

A
  • Monitoring: evidence that the intervention is or not changing the client’s behaviour or status.
  • Measuring: collecting data on the appropriate nutrition outcome indicator.
  • Evaluating: compare current findings with: Previous data, Nutrition intervention goal, Reference standards (Evaluate the impact of the nutrition intervention on client’s health outcomes)
31
Q

How are progress notes charted?

A

ADIME
* A = Assessment
* D = Diagnosis
* I = Intervention
* M = Monitoring
* E = Evaluation

32
Q

Assessment from ADIME

A

Summary of the relevant assessment data

33
Q

Diagnosis for ADIME

A
  • PES statement
  • If more than one diagnosis, try to choose one or two most pertinent (to be addressed)
34
Q

Intervention for ADIME

A
  • Change in food-nutrient intake, nutrition education, counselling.
  • Pt’s SMART goals
35
Q

Monitoring and Evaluation for ADIME

A

What will be monitored to determine success?

NUTR 482 Dietetic Practice (5 decks)

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