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Part I Introduction to Nutrition Care in Older Adults

and recording the appropriate outcomes relevant to the nutrition diagnosis and intervention strategies. The selection of nutrition care indicators is determined by the nutrition diagnosis and its etiology, along with the signs or symptoms and the nutrition interventions used. The resident’s/client’s/group’s medical diagnosis and health care outcome goals, quality management goals for nutri- tion, practice setting, and overall disease state may also influence and affect the selection of nutrition care indi- cators. The nutrition monitoring and evaluation step is essentially a “reassessment.” Therefore, standardized nutrition monitoring and evaluation terms are combined with the first four domains of the nutrition assessment terms (nutrition monitoring and evaluation does not use standardized terms from the client history domain of nutrition assessment). (See Box 5.9.)

BOX 5.9 Four Domains of Nutrition Moni- toring and Evaluation (Step 4)

● Food/Nutrition-Related History Outcomes ● Anthropometric Measurement Outcomes

●

Biochemical Data, Medical Tests, and Procedure Outcomes

● Nutrition-Focused Physical Finding Outcomes

Source: Academy of Nutrition and Dietetics. Nutrition assessment introduction. Nutrition Terminology Reference Manual (eNCPT): Dietetics Language for Nutrition Care. Nutrition Monitoring and Evaluation Snapshot. http://ncpt. webauthor.com/pubs/idnt-en/category-4. Accessed January 25, 2016.

Nutrition monitoring and evaluation allows the nutrition and dietetics practitioner to measure a resi- dent’s/client’s or group’s progress (that is, whether the implemented nutrition interventions are addressing the diagnosed nutrition problem). Based on the findings and the use of critical thinking, the RDN decides whether to actively continue nutrition care as ordered, revise the current plan of care, or discharge the resi- dent/client or group from nutrition care (discharge is warranted when necessary and appropriate nutrition care is completed or no further change is expected). (See Box 5.10.) If nutrition care is to be continued, the NCP cycle continues. The RDN gathers new assess- ment data to determine the relevance of established nutrition diagnoses and decides whether those diagno- ses should be changed or new diagnoses should be documented. Subsequently, the nutrition intervention plan and process of nutrition monitoring and evaluation are modified as appropriate. Even if nutrition care does not continue, the resident/client or group may still be monitored for changes in nutritional status and reentry

BOX 5.10 Critical Thinking Steps During Nutrition Monitoring and Evaluation

● Selecting appropriate indicators/measures ●

Using appropriate reference standards for comparison

●

Defining where resident/client is in terms of expected outcomes

● Explaining a variance from expected outcomes ●

Determining factors that help or hinder progress

●

Deciding between discharge and continuation of nutrition care

Source: Academy of Nutrition and Dietetics. Nutrition assessment introduction. Nutrition Terminology Reference Manual (eNCPT): Dietetics Language for Nutrition Care. Nutrition Monitoring and Evaluation Snapshot. http://ncpt .webauthor.com/pubs/idnt-en/category-4. Accessed January 25, 2016.

to nutrition care at a later date. Box 5.11 provides a summary of nutrition and evaluation components.

DOCUMENTATION

Documentation is crucial during every step of the NCP. The assessment data recorded must be relevant, accu- rate, and timely and must support the nutrition diagno- sis. The nutrition intervention documentation must indicate the care that is recommended by the RDN for the resident/client or group at the specific time. The monitoring and evaluation documentation should support the need for interventions, continued care, or the discharge of the resident/client or group from care. Documentation during this step should record changes in the resident’s/client’s or group’s level of understanding of the nutrition information provided, their behavior, and/or clinical and functional conduct, and it should include a statement about how well the res- ident/client or group is meeting expected outcomes. Quality documentation for nutrition monitoring and evaluation includes the following (10):

● date and time; ●

●

indicators measured, results, and the method for obtaining the measurement;

criteria to which the indicator is compared (eg, nutrition prescription/goal or a reference standard);

● ● ●

factors facilitating or hampering progress; other positive or negative outcomes; and

future plans for nutrition care, nutrition monitor- ing, and follow-up or discharge.