If you haven’t checked out the step-by-step guide learning the Nutrition Care Process (NCP), you can read it here. I’ll walk you step-by-step through a nutrition care process sample to give you the confidence that you can do it!
Nutrition Care Process Sample
Remember we’re going to be following the ADIME format, like we did in the last post. I’ll go through a patient example, please note that none of the following is based on a real person. No personal information is real or represents anyone that I know. It is a made-up case-study.
The 5 Domains of the Nutrition Assessment
You are going to find all the above information in your patient’s nutrition assessment. Everything that you find should fit into one category.
If you don’t have a good nutrition assessment form, you need to find one! You can find the BEST nutrition assessment form by clicking here. This assessment form has everything in it – including the SGA form – diagnose malnutrition right in the form!
Now let’s go step-by-step through a nutrition care process sample, the nutrition assessment is step 1.
Let’s start the Nutrition Care Process Sample!
Nutritional Assessment (A)
You can see a summary here of all the steps and nutrition assessment data that went into it.
A few things should stand out to you here:
- Prolonged swallow and coughing after bites.
- BMI below what we recommend, even slightly below 23.0.
- Weight loss that has been progressive over the past 3 months. This is something to keep your eye on.
- Compared to last year, though the weight loss isn’t significant, it may become more progressive over time.
- When looking at the biochemical data, know what you can and can’t change. You can look to control the Diabetes related lab values. Those are the labs I would look to target. Though the eGFR is starting to decrease, we see this in almost every patient in our population.
- Sarcopenia – muscle wasting – fat wasting, not surprising considering intake has decreased, supper is skipped and weight loss.
- Family used to assist with meals – this could be a possible reason for decreased intake.
Nutrition Diagnosis (D)
Based on ALL the information above – I think this patient has protein calorie malnutrition.
What is protein calorie malnutrition?
This is defined as:
- Some muscle wasting, subcutaneous fat loss
- Nutritional intake less than 50% for 1 week
- Reduced functional capacity
- Weight loss of >1-2% in 1 week, 5% in 1 month, 7.5% in 3 months
Thanks to Wendy Phillips for her summary of this work. Find it here.
As you can see above in the nutrition assessment – the patient checks all these boxes.
Now that we know what diagnosis we want, we need to create a PES statement to go along with it. You can come up with a few derivations for protein calorie malnutrition PES statement, here’s what I came up with:
Protein Calorie Malnutrition related to poor intake as evidenced by intake 50% on average, BMI 22.8, progressive weight loss of 2.1 kg in 3/12, and sarcopenia.
Note that I included 4 signs/symptoms in my PES statement because I selected protein calorie malnutrition as my nutrition diagnosis. I like to back that one up with more information than I would other diagnoses.
Nutrition Intervention (I)
I like to use the standardised nutrition intervention terminology pdf, you can find it online usually for free which is great. Simply google and find one if you can’t afford to purchase right now.
First Intervention (Strategies – Problem Solving, C2.4)
For this patient, you would interview them to see if there is something going on with why they won’t eat at dinner. My clinical suspicion is that family used to assist at supper time, without that support they don’t want to eat.
Second Intervention (Meals and Snacks – Modify Distribution, Type, or Amount of Food and Nutrients Within Meals or at a Specified Time, ND 1.2)
You will next look at bringing those blood sugars down. Discuss this with the Doctor though. I prefer to do a food first approach and most Doctors do as well before implementing medication interactions. You need to be on the same page with the Doctor that you are going to implement nutrition interventions.
The nutrition goal is to bring the A1C down within 3 months.
I wouldn’t put my patient on a full controlled carbohydrate diet, because with weight loss I don’t want to restrict food.
I instead would look at reducing juices or fruit cups. Those are typically high trigger blood sugar risers in LTC. Most dessert portions are 15-25 grams of sugar, and won’t spike a blood sugar level.
Third Intervention (Feeding Assistance – Other: Staff to provide meal time assistance at supper time, ND 4.5)
My suspicion is that she isn’t eating at supper because she was used to having help from family at supper. It’s really important that during COVID, we offer as much assistance as we can. I know that most facilities are short staffed, so make sure assistance is offered to high risk patients.
Fourth Intervention (Meals and Snacks – Change fluids to mildly thick fluids)
The MOS is being performed, if you don’t know about a MOS, check out this resource here. I think that this resident for safety needs to be on thickened fluids until the results are in. The longer someone is on regular fluids + coughing, the higher risk of aspiration pneumonia.
Lots of interventions! But they’re all to reduce the signs and symptoms of the nutrition diagnosis/PES statement!
You’ll want to put in some nutrition goals here as well, so let’s set a few based on our nutrition interventions. Please note that these can be in your nutrition care plan!
I think this chart sums up all the nutrition goals that need to be set!
These are ready to go right into a nursing nutrition care plan.
Nutrition Monitoring and Evaluation (M & E)
So what will we be monitoring?
It’s pretty straight forward now that we have set out our nutrition interventions and nutrition goals.
Once again, once you have all your information organised, you can easily make nutrition monitoring plans. You need to be specific, what you are monitoring and how frequently. Everything in this ADIME note follows a perfect flow and all is connected!
Now our last step, nutrition evaluation!
You are going to look at all the information that I put up there in the chart. I have given specific timelines for each goal and monitoring point.
You’re Done the Nutrition Care Process Sample!
Do you want to know more about the Nutrition Care Planning process? We have some great articles that can help expand your knowledge in the area!
You can read the Basic Guide to Building the Perfect Care Plan here, and you can read a step by step example here!
