Chapter 5 Nutrition Care Process ●

Head and eyes (PD-1.1.6): She has upper and lower dentures, hears well, and wears glasses.

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Extremities, muscles and bones (specify) (PD- 1.1.4): She has physical therapy three times daily and is progressing well. She continues to use a wheelchair to move about the facility.

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Skin (specify) (PD-1.1.8): Her surgical wound is improving. She had a follow-up visit with her surgeon, and he plans to reverse her ileostomy soon.

Comparative Standards: ●

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Weight and growth recommendations (CS-5): IBW (CS-5.1.1): 115 +/– 12 lbs (52.2 +/– 5.4 kg) Reference BMI (CS-5.1.2): 23

● Energy needs (CS-1): ➤

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Estimated energy needs (CS-1.1.1): 1,909 kcal/d

Method for estimating needs (CS-1.1.2): Using Mifflin-St Jeor’s calculations, current esti- mated RMR is 1,129 kcal/d; estimated TDE is calculated as RMR × activity factor (1.3) × injury factor (1.3).

● Estimated protein needs (CS-2.2): ➤

Total protein estimated needs (CS-2.2.1): 52.2 to 67.9 g/d

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Method for estimating needs (CS-2.2.3): 1 g protein per kg IBW–1 g protein per kg desired body weight (13)

● Fluid needs (CS-3): ➤

Total fluid estimated needs (CS-3.1.1): 1,980 mL/d

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Method for estimating needs (CS-3.1.2): 30 mL per kg ABW

Note: The NCP Codes are listed only for reference and are not included in the documentation.

Nutrition Diagnosis

Both nutrition diagnoses documented at the initial encounter continue to be relevant, and AC is making progress toward their resolution.

Nutrition Intervention

The following nutrition prescription is documented: regular mechanical soft diet (provides 2,200 kcal, 92 g protein, and 1,500 mL fluid per day), plus enteral formula 1.5 one-can bolus (provides 355 kcal, 15.1 g pro and 180 mL water) at bedtime and if less than 50% eaten per meal, 100 mL water before and after feedings. To address the nutrition diagnosis of excessive enteral infusion, the following nutrition intervention is planned:

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Enteral nutrition: Enteral formula (ND-2.1.5): 1.5 one-can bolus at bedtime and if less than 50% eaten per meal. Goals: Decrease enteral feeding to allow increased oral intake at meal and main- tain UBWR; wean from feeding tube

Additionally, the following nutrition intervention is planned to address the nutrition diagnosis of excessive fluid intake:

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Enteral nutrition: Feeding tube flush (ND-2.1.9): 100 mL water before and after feedings. Goals: Hydration and patency of tubing

Monitoring and Evaluation

The RDN documents the following monitoring and evaluation indicators for the interventions planned for AC’s first nutrition diagnosis (excessive enteral infusion):

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Total energy intake (FH-1.1.1.1): Criteria: Intake record: Exceeds 50% per meal

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Enteral intake (FH-1.3.1.1): Criteria: Nursing notes: tolerance of bolus feeding at bedtime, fre- quency of bolus feedings at meals

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Weight (AD-1.1.2): Criteria: Weight: Stable weight in UBWR

The RDN documents the following monitoring and evaluation indicators for the interventions planned for AC’s second nutrition diagnosis (excessive fluid intake):

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Oral fluids (FH-1.2.1.1): Criteria: Intake record: Greater than 500 mL per meal

Feeding tube flush (FH-1.3.1.2): Criteria: Nursing notes: Tolerates tube feeding flushes

REFERENCES 1. Lacey K, Pritchett E. Nutrition Care Process and Model: ADA adopts road map to quality care and out- comes management. J Am Diet Assoc. 2003;103(8):1061-1072.

2. Writing Group of the Nutrition Care Process/Standard- ized Language Committee. Nutrition Care Process and Model Part I (the 2008 update). J Am Diet Assoc. 2008;108(7):1113-1117.

3. Academy of Nutrition and Dietetics. The Nutrition Care Process. eNCPT Nutrition Terminology Reference Manual: Dietetics Language for Nutrition Care 2014 ed. http://ncpt.webauthor.com/nutrition-care-process. Accessed December 17, 2015.

4. Academy of Nutrition and Dietetics. Nutrition assess- ment snapshot. eNCPT Nutrition Terminology Refer- ence Manual: Dietetics Language for Nutrition Care. 2014 ed. http://ncpt.webauthor.com/pubs/idnt-en/cate- gory-1. Accessed December 17, 2015.