Process (NCP)
Step 2:Nutrition Diagnosis
Nutrition Counseling FNU 425
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1
Outline
Overview of nutrition diagnosis
Apply nutrition diagnoses terms
Create PES statements to 5 cases
Step 2: Nutrition Diagnosis
“ The identification and labeling of the specific nutrition problem that dietetics practitioners are responsible for treating independently”
Not a medical diagnosis!
Type 2 diabetes = medical diagnosis
Excessive carbohydrate intake resulting in elevated blood glucose levels = nutrition diagnosis
Step 2: Nutrition Diagnosis
The critical link in the NCP between nutrition assessment and intervention.
Nutrition diagnosis is written in PES statement
Categories of Nutrition Diagnoses
1. Intake (NI)
Excessive or Inadequate food/nutrient intake compared to actual or estimated needs
2. Clinical (NC)
Nutrition problems that relate to medical or physical conditions
3. Behavioral/environmental (NB)
Knowledge, attitudes, beliefs, physical environment, access to food, food safety
What is PES statement?...
PES statement
P
roblem: (Diagnostic Label)
E
tiology: (Cause/contributing risk factors)
S
igns/Symptoms: (Defining characteristics) Signs = objective data = observable, measurable changes
Symptoms = subjective data = changes pt feels and expresses
PES statement
Problem…
related to …Etiology…
as evidenced by
…Signs/symptoms
Note: The etiology explains why the problem exists.
The signs & symptoms are evidence of the problem.
PES Statement
Excessive calorie intake related to regular
consumption of large
portions of high-fat meals as evidenced by diet
history and weight status
Excessive Calorie intake
P
regular consumption of large portions of high-
fat meals E
diet history and wt status
S
Nutrition Assessment
Nutrition Diagnosis
Nutrition Intervention
Nutrition Monitoring &
Evaluation
Problem Etiology Signs & Symptoms
Evaluating Your PES Statement
There are no right or wrong PES statements But…
some are better than others!
Problem:
Can the RD resolve or improve the nutrition diagnosis?
Etiology:
Is the etiology the most specific root cause?
Will intervention resolve the problem by addressing the etiology? If not, can intervention at least improve the signs and symptoms?
Signs/Symptoms:
Will measuring the signs and symptoms tell you if the problem is resolved or improved?
Are the signs and symptoms specific enough that you can measure/evaluate changes at the next visit to document resolution or improvement of the problem (diagnosis)?
PES Overall:
Does your nutrition assessment data support the identified problem, etiology and signs and symptoms?
Practice Time!..
67 year old white male, lives alone in apartment, on disability, 5’6”, 135#.
Heart failure diagnosed 2 months ago, wt loss of 20#
from dyspnea, shortness of breath and inability to consume large meals.
Unable to shop or cook, uses many processed food with high sodium intake. Doesn’t like to eat alone.
Pt’s 24 hr recall shows 1000-1200 Kcal intake.
related history measurements examination findings history Food intake
Mineral: Na
Type of food/meal:
convenience frozen meals
Amount of food: unable to consume large meals Energy intake: ~1000- 1200 Kcal/day
Behavior:
Social network: doesn’t like to eat alone
Nutrition-related activities of daily living:
Physical ability to
complete tasks for meal preparation: unable to shop or cook
Ht: 5’6”
Wt: 135#
Wt change:
20# in 2 mon BMI: 21.8
Personal data:
67 y/o white male
Social history:
live alone in apartment, on disability Nutrition- oriented
medical/health history:
Cardiovascular:
heart failure in last 2 mon, SOB
None None
Case study:1 con’t
Inadequate energy intake (NI-1.4) RT dyspnea, SOB AEB 20 lb wt loss (why?)
Inadequate oral food/beverage intake (NI-2.1) RT inability to shop & cook AEB caloric intake of 500 Kcal less than estimated requirements and 20 lb wt loss in XX weeks.
Case study: 2
8 y/o white male child with food allergies. Referral from pediatric clinic
Allergy to peanuts & eggs. Usually eats 4-5 foods
Intake b/t 1200-1500 Kcal/day
Underweight (30th % for age now; ~ 44th a year ago) Poor appetite; recently more irritable & fatigued than usual.
Medical Dx of iron deficiency anemia.
Attend school (3rd grade). Parents separated recently; lives with mother. Needs to take lunches to school. Mother asks for guidance on what to pack & how to help her child gain wt.
Type of food/meal: take lunch to school
Food variety: limited to 4-5 foods
Energy intake: ~1200-1500 Kcal/day
Behavior:
Mealtime behavior: limited numbers of accepted foods Food & nutrition
knowledge:
Area & level of knowledge:
mom’s asking for help in menu planning to gain wt Beliefs & attitude: afraid to try new foods due to possible allergic reactions
Ht: 4’1” (1 yr ago= 4’0”) Wt: 15.5 Ibs (1 yr ago= 50 Ibs)
BMI for age percentile: ~ 30th % (1 yr ago= 44th %)
Personal data: 8 y/o white male child
Social history:
Hx of recent crisis: parents getting divorced Nutrition-
oriented
medical/health history:
Medical
diagnosis: iron deficiency
anemia Digestive
system: poor appetite
Nerves &
cognitions:
more irritable
& fatigued than usual None
Inadequate energy and iron intake (NI-1.4 & NI-5.10.1) RT fear of allergic reactions AEB underweight at 30th percentile wt for Ht and age and diagnosed iron deficiency anemia
Food and nutrition-related knowledge deficit (NB-1.1) RT fear of allergens in food AEB poor appetite and intake of only 4-5 foods in 24-hr recall and stated concern about food allergies.
What happen to your thinking
if
…-- Mom states that she has had 4-5 previous sessions w/ the dietitian regarding his diet?
-- Diet Hx reveals that Mom is giving the child a multivitamin w/
iron?
Case study: 3
34 y/o male with Hx of DMII, HTN, hyperlipidemia.
Ht: 5' 10"; wt:250 lbs; BMI= 36 (Obesity II).
Works night shift, eats 2 meals/day in
restaurants- fried foods, burgers, ice cream, soft drinks. Does not add salt to foods.
Plays golf 1x month.
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Nutrition Assessment
Food/Nutrition History (FH)
Biochemical Data (BD)
Anthropometric Measures (AD)
Physical Data (PD)
Client History (CH)
Eats 2 meals/day in restaurant; fried foods, burger, ice cream, soft drinks.
Doesn’t add salt to foods.
Plays golf 1x month.
Excessive energy intake (NI-1.5) R/T frequent use
of restaurant foods AEB high intake of caloric foods & BMI=36
ht: 5' 10"; wt:250 lb;
BMI=36 (obesity II)
34 y/o male;
DM II; HTN Hyperlipidemia;
Night shift work
