Nutrition Care Process Model
Tutorials
Nutrition Care Process and Terminology Committee
Academy of Nutrition and Dietetics
Nutrition Care Process Terminology
2015 Edition
Nutrition Intervention:
Examples in Two Case Studies
Objective
The objective of this presentation is to review
the use of nutrition intervention terminology
and development of the nutrition prescription
in case study material. By the end of the
module, the participant will be able to
understand use of nutrition intervention
terminology and the nutrition prescription in
two case examples:
• A 67 year old Hispanic male with heart failure
• An 8 year old white male child with iron
deficiency anemia and food allergies
Case #1
Referral from Family Practice Clinic to RDN:
67 year old Hispanic male with Heart Failure
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Case #1
Description of patient:
• 67 year old Hispanic male
• medical diagnosis of heart failure (diagnosed 2 months
prior)
• retired engineer
• lives alone in apartment
• height: 5’6” ; weight: 135 lbs.
• weight loss of 20 lbs. from dyspnea
• inability to consume large meals
• unable to shop or cook
• 24-hour recall indicates he uses many frozen and
processed foods; intake between 1000 – 1200
kcal/day
Case #1: Relevant Data
Review the PES statement(s) and the relevant
signs and symptoms that could potentially be
resolved with the appropriate nutrition
prescription.
Nutrition Intervention
What are potential Nutrition Prescriptions for
this 67 year old male based on the etiology
of the PES Statements identified in the
Nutrition Diagnosis module?
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Nutrition Intervention
1. Inadequate energy intake related to
shortness of breath as evidenced by 20 lbs.
of weight loss in 2 months.
Nutrition Intervention
2. Inadequate oral intake related to inability to
shop and cook as evidenced by a calorie
intake of 500 kcals less than estimated
requirements and 20 lbs. of weight loss in 2
months.
Nutrition Intervention
PES statements connect the nutrition
assessment, intervention, and monitoring
and evaluation steps. The problem states the
nutrition diagnosis. The etiology tells you
what type of intervention you need. The
signs and symptoms tell you what you will
need to monitor and evaluate.
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Nutrition Prescription Focus
Inadequate oral intake related to inability to
shop and cook as evidenced by a kcal intake
of 500 kcals less than estimated
requirements and 20 lbs. of weight loss in 2
months.
The RDN can address the etiology of the
patient’s inability to shop and cook and plan
an intervention that can correct the kcal
intake. The signs and symptoms of low kcal
intake and weight loss can be effectively
monitored.
Nutrition Prescription Example
For this patient the nutrition prescription is:
Referral to community agencies/programs
(RC-1.6) for meal service of an Increased
energy diet (ND-[Link])
Case #2
Referral from Pediatric Clinic to RDN – request for
RDN consultation for assistance with meal planning
8 year old white male child with Fe deficiency anemia
4
Case #2
Description of patient:
• 8 year old white male child
• allergies to eggs and peanuts
• diagnosed with Fe deficiency anemia
• growth recently slowed with current BMI at the 30th percentile
(44th percentile one year ago)
• food history questionnaire indicates an intake of 1200 – 1500
kcal/day
• poor appetite
• food variety limited; intake of only 4 or 5 different foods.
• mother states he is more irritable and more fatigued than usual.
Mother requests assistance for planning bag lunches and other
meals that will help her child gain weight.
Case #2: Relevant Data
Review the PES statement(s) and the relevant
signs and symptoms that could potentially be
resolved with the appropriate nutrition
prescription.
Nutrition Intervention
What are potential PES statements for this 8
year old male child based on the nutrition
assessment data?
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Nutrition Intervention
1. Inadequate energy intake related to fear of
allergic reactions as evidenced by
underweight at the 30th percentile for height,
weight, and age.
Nutrition Intervention
2. Inadequate iron intake related to fear of
allergic reactions as evidenced by medical
diagnosis of iron deficiency anemia.
Nutrition Intervention
3. Food and nutrition related knowledge deficit
related to fear of allergens in foods as
evidenced by poor appetite and reported
intake of only 4-5 foods in 24 hour food
recall, and stated concern about food
allergies.
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Nutrition Intervention
PES statements connect the nutrition
assessment, intervention, and monitoring
and evaluation steps. The problem states the
nutrition diagnosis. The etiology tells you
what type of intervention you need. The
signs and symptoms tell you what you will
need to monitor and evaluate.
Nutrition Intervention Focus
Food and nutrition related knowledge deficit related
to fear of allergens in foods as evidenced by poor
appetite and reported intake of only 4-5 foods in 24
hour food recall, and stated concern about food
allergies.
All three PES Statements are accurate but the RDN
will focus on the third PES statement. Addressing
the food and nutrition related knowledge deficit
and assistance with planning meals for bag lunches
and an increased energy diet, should result in
improved iron intake. Both calorie and iron intake
can be monitored in follow-up interviews.
Nutrition Prescription Example
For this patient the nutrition prescription is:
Nutrition education for Nutrition relationship
to health/disease (E-1.4) and Increased
energy diet (ND-[Link])
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Summary
In this presentation we have reviewed the
nutrition intervention terminology and
nutrition prescription development for two
case studies:
• A 67 year old Hispanic male with heart
failure
• An 8 year old white male child with iron
deficiency anemia and food allergies
Summary
This concludes the nutrition intervention
tutorial.
Please proceed to the nutrition monitoring nd
evaluation tutorial for the presentation of the
monitoring and evaluation step for both case
studies.
