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Part I Introduction to Nutrition Care in Older Adults

grouped in four domains (see Box 5.4). According to the eNCPT, “when all things are equal [among possible nutrition diagnoses], consider the Intake diagnosis as more specific to the role of the RDN” than other possi- ble problems.

BOX 5.4 Four Domains of Nutrition Diagnosis (Step 2)

● Intake ● Clinical

● Behavioral/Environmental ● Other

Source: Academy of Nutrition and Dietetics. Nutrition assessment introduction. Nutrition Terminology Reference Manual (eNCPT): Dietetics Language for Nutrition Care. Nutrition Diagnosis Terms and Definitions. http://ncpt. webauthor.com/pubs/idnt-en/page-041. Accessed January 25, 2016.

When developing these diagnosis statements, the RDN uses a format known as a PES (problem, etiology, signs and symptoms) statement, which is structured as follows: nutrition diagnosis (problem) related to “x” (eti- ology) as evidenced by “y” (signs and symptoms). When a nutrition diagnosis is determined, a PES state- ment is then written to describe the problem, its root cause(s), and the assessment data that provide evidence for the nutrition diagnosis.

Nutrition diagnosis has typically been the most problematic NCP step for dietetics practitioners. Using critical thinking skills, the RDN needs to determine the root cause of the nutrition diagnosis (see Box 5.5). He or she then has to ask, “Can services provided by the RDN resolve or improve the nutrition diagnosis?” In other words, “Can the etiology be addressed by a nutri- tion intervention?” Remember that the etiology is not the medical diagnosis. Next, the RDN must consider: “Will measuring the signs and symptoms indicate reso- lution or improvement to the problem/diagnosis? And do the nutrition assessment data support the PES state- ment?” It takes practice to develop the skills to identify the nutrition diagnosis and document a concise PES statement (see Box 5.6 for examples). When a nutrition diagnosis does not exist to justify a nutrition interven- tion or if the assessment data do not support a nutrition diagnosis, the RDN should document “No nutrition diagnosis at this time” (7).

Step 3: Nutrition Intervention The third step of the NCP, nutrition intervention, is the specific action used to remedy a nutrition diagnosis/ problem (8). These interventions can be used with

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BOX 5.5 Critical Thinking Steps During Nutrition Diagnosis

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Problem (P): Can you resolve or improve the nutrition diagnosis of the patient/client?

Etiology (E): Is this truly the root cause or the most specific area that you can address with a nutrition intervention that could resolve or at least lessen the signs and symptoms?

Signs and symptoms (S): Can you measure these signs and symptoms so you will be able to document resolution or improvement in the nutrition diagnosis?

Source: Academy of Nutrition and Dietetics. Nutrition assessment introduction. Nutrition Terminology Reference Manual (eNCPT): Dietetics Language for Nutrition Care. Nutrition Diagnosis Snapshot. http://ncpt.webauthor.com/ pubs/idnt-en/category-2. Accessed January 25, 2016.

BOX 5.6 Examples of Nutrition Diagnosis Problem-Etiology-Symptoms Statements

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Excessive energy intake (P) related to frequent consumption of large portions of high-fat meals (E) as evidenced by average energy intake exceeding recommended amount by 500 kcal and 12 lb weight gain in 18 months (S).

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Inadequate fluid intake (P) related to no water-flush orders (E) as evidenced by altered lab values (elevated BUN and calcium osmolality) (S).

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Unintended weight loss (P) related to inad- equate provision of energy by enteral products (E) as evidenced by 6 lb weight loss in 30 days (S).

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Excessive carbohydrate intake (P) related to consumption of large portions and snacking from vending machine daily (E) as evidenced by altered lab values (elevated glucose and HbA1c) and weight gain of 10 lb in 3 months (S).

individuals, groups, or the community at large. Interventions should target the etiology of the nutrition problem/diagnosis. If nutrition interventions cannot affect root causes, then they should aim to lessen the signs and symptoms of the problem. The RDN is the most qualified health care professional to put nutrition interventions into place. In most acute, extended, and ambulatory clinical care settings, the interdisciplinary team will meet with the resident/client and family