Medical Nutritional Therapy

1. GANGA INSTITUTE OF HEALTH SCIENCES
COIMBATORE

4. NUTRITION CARE PROCESS
The nutrition care process(NCP) is a standardized
framework of professional activities for the provision of
nutrition care established by the Academy of Nutrition and
Dietetics Association (AND known as the Academy, formerly
the American Dietetic Association 9ADA). The NCP model has
been embraced by nutrition and dietetics professionals across
borders.

5. NUTRITION CARE PROCESS MODEL

6. OPTIMAL NUTRITIONAL STATUS ; A BALANCE BETWEEN NUTRIENT
INTAKE AND NUTRIENT REQUIREMENT

7. NUTITION CARE PROCESS:
Data sources
• Screening or referral form
• Interview of patients or key social support
• Medical and health records
• Community or organisation based surveys and focus groups
• Health surveillance data, reports, research studies.
Domains ( categories) of data collected
• Food/nutrition-related history
• Anthropometric measurements
• Biochemical data,medical tests and procedures
• Nutrition focus physical examination findings
• Client history
NUTRITION ASSESSMENT

8. Activities
• Review or collect assessment data that are vital, important
and relevant
• Using appropriate standards or criteria, interpret the data to
identify, discrepancies that affect nutrition and health
status.
• Determine whether the data patterns match the defining
charecteristics of particular nutrition diagnosis.

9. STATEMENT FOR NUTRITIONAL STATUS PROBLEMS
Concept: Nutrient deficiencies can be due to low Dietary intake
Inadequate mineral intake (iron.NI-5.10.1.3) related to knowledge deficit
regarding foods high in iron as evidenced by consumption of 30% of the RDA
for iron and low ferritin, Hct, and MCHC values.
Concept: Nutrient deficiencies can be due to poor Absorption of Nutrients
Altered gastrointestinal (GI) function (NC-1,4) related to Helicobacter pylori
infection-induced gastritis as evidence by refractory iron deficiency anaemia
despite 6 weeks of oral iron therapy.
NUTRITION DIAGNOSIS

10. Concept : Nutrient deficiencies can be due to high nutrient
requirement
Increased nutrients needs (iron,NI5.1) related to heavy menstrual
blood losses as evidence by iron deficiency anaemia(low ferritin, Hct
and MCHC values) despite adequate intake of highly bioavailable
heme iron (120%RDA)

11. DEVELOPMENT OF CLINICAL NUTRITION DEFICIENCY
AND DETECTION BY NUTRITION ASSESSMENT DATA

12. NUTRITION SCREENING
 The purpose of nutrition screening is to identify clients who are at nutrition risk and
thus should be referred to RDN for assessment of nutritional status. Nutritional
screening can be done in all settings; Hospital, clinics, long term care facilities,
schools and food bank.
 When available, population-specific, validated tool should be used for screening.
Regulatory agencies, including the joint Commission(TJC), include nutrition
screening in their standards.
 Most health care facilities have developed a multi disciplinary admission screening
process that is completed by nursing staff during admission to the facility. Nutrition
screening can be incorporated into this admission assessment. Facilities that use an
electronic health record (EHR) should built an automatic referral to the RDN when
screening criteria are met.

13.  Nutrition intervention are the action taken to treat nutrition problems by resolving
etiology and/or reducing/managing the related signs and symptoms.
 Nutrition intervention involves two steps : planning and implementation.
 Whenever possible, the nutrition intervention should target the etiology identify
during the assessment step of NCP. Thus if the nutrition diagnosis is excessive
carbohydrate and the etiology is the lack of knowledge about high carbohydrate
foods, then the appropriate intervention could be nutrition education, priority
modifications(Education focused on which foods are high in carbohydrates.
Nutrition Intervention

14. A nutrition prescription is a detailed
description of the nutrient needs of that
particular client. Typically, this can
include recommended needs for energy,
protein and fluid but also may include
nutrients pertinent to the client’s
condition such as carbohydrate needs in
diabetes , potassium needs in renal
disease, or sodium needs in hypertension
Nutrition
prescription

15. Nutrition intervention
terminology
The nutrition intervention terminology is organized in five
categories(domain) within the NCPT :
1.Food and/or nutrient delivery
2. Nutrition education
3.Nutrition counselling
4.Coordination of nutrition care by a professional
5. Population-based nutrition action.

16.  The fourth step in the NCP involves monitoring and evaluation of the effect of
nutrition interventions. This clarifies the effect that the RDN has in the specific
setting, whether health care, education, consulting, food services or research.
 During this step, the RDN first determines indicators that should be monitored.
These indicators should match the signs and symptoms identified during the
assessment process.
For example : If excessive sodium intake was identified during the assessment, then
an evaluation of sodium intake against criteria ( a comparative standard or a mutually
agreed goal level) is needed at a designated time for follow up.
In the clinical setting the objective of nutrition care is to achieve and maintain optimal
nutrition status for the client or population being served.
Monitoring and evaluation of nutrition care

17. INTEGRATIVE AND FUNCTIONAL MEDICAL NUTRITION
THERAPY