Bài giảng Dinh dưỡng cho các lớp Sau đại học 2014 - Bài 5: Chẩn đoán đánh giá can thiệp dinh dưỡng

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Bài giảng cung cấp cho người học các kiến thức: Chẩn đoán đánh giá can thiệp dinh dưỡng, chăm sóc sức khỏe, thể trạng cơ thể, mức độ dinh dưỡng,... Hi vọng đây sẽ là một tài liệu hữu ích dành cho các bạn sinh viên đang theo học môn dùng làm tài liệu học tập và nghiên cứu. Mời các bạn cùng tham khảo chi tiết nội dung tài liệu.

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Nội dung Text: Bài giảng Dinh dưỡng cho các lớp Sau đại học 2014 - Bài 5: Chẩn đoán đánh giá can thiệp dinh dưỡng

Diagnosis, Intervention, Evaluation, and Documentation
ADA NUTRITION CARE PROCESS AND MODEL Screening & Referral System   Identify risk factors   Use appropriate tools and methods   Involve interdisciplinary collaboration Nutrition Diagnosis  Identify and label problem Nutrition Assessment  Determine cause/contributing risk  Obtain/collect timely and factors appropriate data  Cluster signs and symptoms/  Analyze/interpret with defining characteristics evidence based standards  Document  Document Relationship Between Patient/Client/Group Nutrition Intervention & Dietetics  Plan nutrition intervention Professional Formulate goals and determine a plan of action  Implement the nutrition intervention Nutrition Monitoring and Care is delivered and actions Evaluation are carried out   Monitor progress  Document   Measure outcome indicators   Evaluate outcomes   Document Outcomes Management Sys tem  Monitor the success of the Nutrition Care Process implementation   Evaluate the impact with aggregate data   Identify and analyze causes of less than optimal performance and outcomes  Refine the use of the Nutrition Care Process
Nutrition Assessment Leads to Nutrition Diagnosis • Nutrition Assessment • Nutrition Diagnosis • Nutrition Intervention • Nutrition Monitoring and Evaluation
Nutrition vs Medical Dx Medical Dx Nutrition Diagnosis Diabetes Excessive CHO intake related to evening visits to Coldstone Creamery as evidenced by diet hx and high hs blood glucose Trauma and Increased energy expenditure related to closed head multiple trauma as evidenced by results injury of indirect calorimetry Liver failure Altered gastrointestinal function related to cirrhosis of the liver as evidenced by steatorrhea and growth failure
Nutritional vs Medical Dx Medical Dx Nutrition Diagnosis Obesity Excessive energy intake related to lack of access to healthy food choices (restaurant eating) as evidenced by diet history and BMI of 35. Dependence Excessive energy intake related to high mechanical volume PN as evidenced by RQ >1 ventilation Anorexia Inappropriate food choices related to nervosa history of anorexia nervosa and self- limiting behavior as evidenced by diet history and weight loss of 5 lb
PES Statement • Problem: nutrition diagnosis label • Etiology: the focus of the intervention • Signs and symptoms: change when nutrition problems are successfully treated; the focus of monitoring and evaluation
Problem (Diagnostic Label) Falls into three general domains: • Intake (NI) • Excessive or Inadequate intake compared to requirements • Clinical (NC) • Medical or physical conditions that are outside normal • Behavioral/environmental (NB) • Knowledge, attitudes, beliefs, physical environment, access to food, food safety
Etiology • Etiology (Cause/Contributing Factors) • Related factors that contribute to problem • Identifies cause of the problem • Helps determine whether nutrition intervention will improve problem • Linked to problem by words “related to” (RT) • Note: etiology may not always be clear
Etiology • Etiology (Cause/Contributing Factors) • Excessive energy intake (problem) “related to” regular consumption of large portions of highfat meals (etiology)… • Swallowing difficulty (problem) RT recent stroke (etiology)… • Involuntary wt gain RT decrease in exercise…
Diagnostic Labels Can Be Problems or Etiologies • Inadequate energy intake (NI1.4) related to food nutrition knowledge deficit (NB1.1) • Foodnutrition knowledge deficit (NB1.1) related to lack of previous nutrition education • Involuntary weight loss (NC3.2) related to inadequate energy intake (NI1.4) • Inadequate oral foodbeverage intake (NI2.1) related to swallowing difficulty (NC1.1)
Signs and Symptoms • Signs/Symptoms (Defining characteristics) • Evidence that problem exists • Linked to etiology by words “as evidenced by” • Evaluation and monitoring of effectiveness of intervention is done by reviewing signs and symptoms
Nutrition Dx with S/S • Excessive energy intake (NI1.5) (P) • “related to” regular consumption of large portions of highfat meals (E) • “as evidenced by” diet history & 12 lb wt gain over last 18 mo (Signs)
Nutrition Assessment Identifies Etiology and S/S • Problem: excessive energy intake • Etiology: reviewing the diet history, we learn that • Patient eats in fast food restaurants 2x day • Patient supersizes portions because it’s a bargain • Patient has only 15 minutes for lunch
PES Statement Excessive energy intake P Related to eating frequently in fast food E restaurants As evidenced by BMI of 30 and diet S history
Etiology Guides Intervention! • The clinician determines what the intervention is by looking at the root cause of the nutrition problem. • If the cause of excessive energy intake is eating frequently in fast food restaurants, how would you intervene?
Signs and Symptoms Direct Intervention and Evaluation Intervention/ Eval P Excessive energy intake E RT eating Intervention: Counsel frequently in fast patient about best choices food restaurants in fast food restaurants (C 2.4) S As evidenced by Eval: Recheck weight (S BMI and diet 1.1.4) and diet history (BE history 2.1.1.) at next visit
PES Statements • Excessive fat intake (NI5.6.2) related to high intake of fried foods and bakery goods as evidenced by diet history and hyperlipidemia • Excessive energy intake (NI1.5) related to high intake of fried foods and snack items as evidenced by diet history and BMI • Food/nutrition related knowledge deficit (NB1.1) related to lack of education on cholesterol lowering diet as evidenced by history and patient selfreport
Nutrition Diagnosis Statement Should Be • Clear, concise • Specific • Related to one problem • Accurate – related to one etiology • Based on reliable, accurate assessment data
Evaluating Your PES Statement • There are no right or wrong PES statements • But some are better than others
Evaluating Your PES Statement • Can the RD resolve or improve the nutrition diagnosis? • Can your intervention address the etiology and thus resolve it or improve the problem? • Or can your intervention address the signs and symptoms?