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Part I Introduction to Nutrition Care in Older Adults

expert reviewers, an NCP 101 tutorial explaining the various components of the NCP and how to implement the steps and utilize the standardized language, refer- ence journal articles, frequently asked questions, case studies, and sample audit tools (12).

NUTRITION CARE PROCESS FLOW

PATTERNS Figure 5.5 (see page 69) shows process flow patterns that illustrate the thought processes for the initial nutri- tion assessment and reassessment. These flow patterns are designed to guide the RDN in his or her decision-making during the development of a nutrition diagnosis. They are set up in the ADIME format to help practitioners learn how to use the NCP in medical record documentation. They can be used to assist in the application of NCP practice and in the workplace.

CASE STUDY 1

Note: The alpha-numeric codes in this case study and the next one are listed only for reference to the eNCPT and should not be included in the documentation.

Part 1: Initial Assessment JM is a 77-year-old woman, accompanied by her daugh- ter and seen in an RDN’s private practice nutrition clinic. She has a medical diagnosis of asthma and hypothyroid- ism. Her medications include fluticasone propionate (Flovent), albuterol, mometasone (Nasonex), and levothyroxine (Synthroid). She uses Flovent in the fall and albuterol and Nasonex as needed. Her daughter stated that JM is not using any asthma medications at this time and is doing well without them. Recent lab work included a complete blood count (CBC), comprehensive metabolic panel (CMP), thyroid function, and hemoglo- bin (HbA1c). All values were within normal limits (WNL), except her HbA1c was 6.1%. She is 62 in/157.4 cm tall and weighs 152.8 lbs/69.4 kg. She usually con- sumes three meals per day and at least two snacks daily and is currently not following any nutritional program. Her physical activity level is minimal during the day (limited to walking around the house and going out for the mail), and she usually watches TV while eating, anywhere from 4 to 6 hours per day. Her daughter lives nearby and does the grocery shopping. They go to the mall occasionally. JM is able to go for walks but is not motivated to do any physical activity. Her daughter feels that her mother should be more active and is willing to go on walks with her. JM wants to improve the elevated HbA1c to avoid taking any new medications. She is here to learn how to improve her eating habits. She does not always eat breakfast and snacks throughout the day on chips, cheese and crackers, and cookies, and she drinks juice

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and coffee with sugar and cream. When she does eat breakfast, it usually consists of hot cereal or toast with butter and jelly. She often snacks through lunch but does enjoy eating a sandwich with juice for lunch. Dinner is usually a standard meal consisting of protein, starch, vegetable, dessert, and coffee with sugar and cream. JM’s daughter assists with the dinner meal. JM sometimes snacks in the evening on chips or ice cream. She is unaware of the total volume of fluid she con- sumes each day. She does not want to miss her TV pro- grams to visit the restroom. JM is scheduled to return to see her physician in six months.

Nutrition Assessment The first step in utilizing the NCP is to systematically collect the nutrition assessment data:

Food/Nutrition-Related History (FH): ●

Food intake (FH-1.2.2): Meal/snack pattern (FH- 1.2.2.3): three meals per day and at least two snacks

Diet experience (FH-2.1.3): ➤ ➤ Previously prescribed diets (FH-2.1.2.1): None

Previous diet/nutrition education/counseling (FH-2.1.2.2): None

● Eating environment (FH-2.1.3): ➤

Location (FH-2.1.3.1): Watching TV in the living room

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Eats alone (FH-2.1.3.5): Daily Physical activity (FH-7.3):

➤ ➤

Physical activity history (FH-1.3.1): Minimal activity, limited to walking around the house and occasional trips to the mall with her daughter

➤

TV/screen time (FH-7.3.8): 4 to 6 hours reported per day

Anthropometric Measurements (AD): ●

➤ ➤ ➤

Body composition/growth/weight history (AD-1.1):

Height/length (AD-1.1.1): 62 in (157.4 cm) Weight (AD-1.1.2): 152.8 lbs (69.4 kg)

Body mass index (AD-1.1.5): 28 (overweight)

Biochemical Data, Medical Tests, and Procedures (BD): ●

Nutrition-Focused Physical Findings (PD): ●

Glucose/endocrine profile (BD-1.5): HbA1c (BD- 1.5.3): HbA1c 6.1%.

Overall appearance (specify) (PD-1.1.1): Well developed, well nourished, overweight, elderly female with a good appetite