Nutrition Care Process

(ADIME Process)
Nutrition Diagnosis
 NUTRITION DIAGNOSIS AND
PLAN CARE
Purpose:
• To identify and describe a specific nutrition problem that
can be resolved or improved through treatment/nutrition
intervention by a food and nutrition professional. A
nutrition diagnosis (eg. Inconsistent protein intake) is
different from a medical diagnosis (eg. Kwashiorkor) and
a nursing diagnosis (eg. Imbalanced nutrition: less than
body requirements of dietary protein)
• It is identifying a disease or condition from its signs and
symptoms.
 NANDA Nursing Diagnosis Domain 2. Nutrition

• Imbalanced nutrition: less/more than body • Risk for unstable blood glucose level
requirements
• Risk for neonatal hyperbilirubinemia
• Readiness for enhanced nutrition
• Risk for impaired liver function
• Insufficient breast milk production
• Risk for metabolic imbalance syndrome
• Risk for overweight
• Risk for electrolyte imbalance
• Overweight
• Impaired swallowing • Risk for imbalanced fluid volume

• Readiness for enhanced breastfeeding • Deficient fluid volume (Nursing care Plan)
• Ineffective adolescent eating dynamics • Risk for deficient fluid volume
• Ineffective child eating dynamics • Excess fluid volume
 THE PES COMPONENT
PROBLEM – ETIOLOGY – CAUSE OR SIGNS & SYMPTOMS –
DIAGNOSTIC LABEL CONTRIBUTING FACTOR DEFINING
-Describes alteration in -Related factors that CHARACTERISTICS
clients nutritional status contribute to the problem -This is evidence that
-Use NANDA labels -Identifies cause of the the problem exists
-Example: Imbalanced problem -Linked to etiology with
Nutrition : More Than -Linked to problem by words as evidenced by
Body Requirements words Related to or r/t or (eb) or as manifested
-Example: Impaired -Etiology may not always by (amb)
swallowing… be clear Example: …as e/b
Example:… r/t history of a choking/gagging when
stroke or CVA swallowing
 EXAMPLES OF NURSING PES ON
NUTRITION
• Imbalanced Nutrition : More Than Body Requirements related to unhealthy
dietary patterns/lack of exercise (specify and elaborate for client) as evidenced by
Obesity (state weight, height, BMI for client)
• Imbalanced Nutrition : Risk for overweight (for someone whose exercise and food
habits may lead to obesity) related to unhealthy dietary pattern/increased
consumption of junk foods as evidenced by weight more than desired for age and
height
• Impaired swallowing, related to impaired GI function as evidenced by patient
choking
• Imbalanced Nutrition : Less Than Body Requirements related to
anorexia/nausea/vomiting secondary to Anorexia Nervosa as evidenced by intake
less than recommended amounts/weight loss (specify for client)
Yolanda survivor, Hilary Diane Andales from Tacloban City explains the theory of relativity and the equivalence of
reference frames. The doctor, nutritionist and nurse all look at the same person/client/patient from their viewpoint
(reference frame), together they work to resolve the person/client/patient needs. BTW, smart Hilary won the 2017
Breakthrough Junior Challenge for this. She has been accepted as a scholar at the esteemed Massachusetts Institute of
Technology (MIT).
Comparative Diagnosis
• Medical Dx (MD):Anemia
• Nutrition Dx (ND): Inadequate iron intake r/t lack of iron
in the diet/lack of access to iron as evidenced by
hemoglobin of <12g/dl
• Nursing Dx (NgD): Imbalanced Nutrition: Less than body
requirement of the mineral iron r/t lack of access to the
mineral iron in the diet as manifested by hemoglobin of
less than 12 and pale conjunctiva and nailbeds.
 Planning the Diet with Cultural
Competency
▪ Nurses need to have a greater understanding of cultural needs of their clients.
▪ Cultural traditions impact food choices and routines, and it is nurses’ responsibility
to consider these implications when planning and communicating nutritional goals
with clients.
▪ Avoid demonstrating ethnocentrism (the belief that one’s own cultural practices are
the only correct behaviors, beliefs, attitudes and values) for example bats and bugs
are food items in some cultures.
▪ Religion has profound influence on food, on food preparations (Kosher kitchens in
Orthodox Jewish homes, prescriptive guidelines for slaughtering animals for Jews
and Muslims)
▪ Fasting for religious holidays (Ramadan for Muslims, No meat on Ash Wednesday
and Fridays during Lent for Catholics)
 Some Cultural & Religious Issues &
Practices Influencing Nutritional
Status
• Asian – *Traditional Diet is Plant based, rich in fiber & nutrients but maybe
high in sodium, **High risk for osteoporosis
• American – *or Western Diet – varies with region, food high in fat &
cholesterol (meat eating) **Risk for Obesity, CVD, Diabetes common
• Hispanic – *Traditional Diet high in CHO such as corn, beans, & squash. Use
fat in food preparation ** Risk for obesity DM, High Cholesterol
• Christian – Catholics-no meat on Ash Wed or Friday in Lent & fasting on
some religious days
• Mormons - no coffee, tea alcohol or tobacco
• Seventh Day Adventists –lacto-ovo- vegetarian (milk & eggs added) no coffee,
tea, alcohol or strong seasonings, no snacking
• Islam – No pork or birds of prey. Fasting during religious times
• Judaism – Kosher meat or poultry
 RESOURCES NEEDED IN PLANNING AND
IMPLEMENTING DIETARY REGIMEN
• Providing nutrition resources to patients is a great way to support
healthy habits. International on line resources are available and some
of these are:
1. EatRight.org - from the Academy of Nutrition and Dietetics . This website
has a breakdown of the MyPlate dietary guidelines.
2. The Mayo Clinic Food Substitution Guide - Here, you can easily see which
ingredients could be swapped out for lower-fat or lower-sodium versions.
3. Food and Nutrition Information Center - This website provides food and
nutrition resources for dietitians, health professionals, educators,
Government personnel, and consumers.
4. Food and Nutrition Research Institute (FNRI) from the DOST Philippines
has a complete set of dietary guidelines for Filipinos from different age
groups.
Four aspects of changing eating behaviors that
should be considered when striving to achieve
compliance:
• People need evidence that the changes they make will be effective.
• Changes should allow for individual latitude in implementation.
• An accountability and reinforcement tool, such as a daily checklist
of goal achievement, is needed to help implement dietary
discipline.
• Consumers need individual encouragement and reassurance.
Where face-to-face contact is not possible, electronic follow-ups,
reports, and feedback can help.
Innovative approaches that will affect
implementation of dietary guidelines
• Simplify and stratify nutritional guidelines – Prioritize needs
according to specific groups
• Make dissemination of nutrition guidance information more effective
by building alliances and create collaborations among government
agencies, the media, and industry
• Nutrition messages to consumers must be filtered so that they reflect
how people think
• Integrate Physical Activity Guidelines with Dietary Guidance
• Create multiple communication tools to address multiple audiences
for dietary guidance messages
Video link on:
1. Factors that influence eating habits and food choices
https://www.youtube.com/watch?v=r6UezI_Pveg
2. Diagnosis PES Nursing Diagnoses: Problem, Etiology &
Symptoms including “secondary to” “unknown” and “complex”
https://www.youtube.com/watch?v=mQd109UV-N4