SAS 2

LESSON PREVIEW
Let the students answer the following Metric conversions word problems:

1. 8 tbs. = ½ cup
2. 350°F = 177°C
3. 12 ounces = 340g
4. 4 quarts = 1 gallon
5. 1 pint = 16 fluid oz.
6. Dakota has 4/10 kg of clay. He divides the clay to make 8 equal-sized pots. How many grams of clay are in each pot? 0.2 g
7. A birdbath contains ½ liter of water. A rainy day adds a 215 ml more water to the birdbath. How many total milliliters of water are
in the birdbath after it rained? 715 mL
8. Tomas has two boxes to be shipped. One box weighs 3 kg. The other box weighs 720 g. What is the combined weight of both boxes
in grams?
Answer: 3720 g
9. Tony made 14 L of lemonade for a party. His guests drank 9500 mL of the lemonade. How many milliliters of lemonade did Tony
have left over?
Answer: 4500 mL
10. Noah made 12 kg of trail mix for his family's hiking trip. His family ate 8,600 g of the trail mix on the hiking trip. How many
grams of trail mix did Noah have left? Answer: 3400 g
  The Nutrition Care Process (NCP) is a systematic approach to providing high quality nutrition care. The NCP consists of
four distinct, interrelated steps:
 Nutrition Assessment: The RDN collects and documents information such as food or nutrition-related history;
biochemical data, medical tests and procedures; anthropometric measurements, nutrition-focused physical findings
and client history.
 Nutrition Diagnosis: Data collected during the nutrition assessment guides the RDN in selection of the appropriate
nutrition diagnosis (i.e., naming the specific problem).
 Nutrition Intervention: The RDN then selects the nutrition intervention that will be directed to the root cause (or
etiology) of the nutrition problem and aimed at alleviating the signs and symptoms of the diagnosis.
 Nutrition Monitoring/Evaluation: The final step of the process is monitoring and evaluation, which the RDN uses to
determine if the client has achieved, or is making progress toward, the planned goals.

 Use of a care process provides a framework for the RDN to individualize care, taking into account the
clients needs and values using the best evidence available to make decisions.
 Other disciplines in healthcare, including nursing, physical therapy and occupational therapy have adopted care
processes specific to their discipline.
 In 2003, the Academy's House of Delegates adopted the NCP to provide RDNs with a framework for
critical thinking and decision-making — leading to more efficient and effective care and greater recognition of the
role of RDNs in all care settings.

What is the Nutrition Care Process and Model?

 The Nutrition Care Process is a standardized model intended to guide RDNs in providing high quality nutrition care.
NCP Step 1: Nutrition Assessment
 Purpose:
o Nutrition Assessment is an approach to collect, classify, and synthesize important and relevant data needed to
identify nutrition-related problems and their causes.
o This step also includes reassessment for comparing and re-evaluating data from the previous interaction to the next
and collection of new data that may lead to new or revised nutrition diagnoses based on the client’s status or
situation. It is an ongoing, dynamic process that involves initial data collection and continual reassessment and
analysis of the client’s* status compared to accepted standards, recommendations, and/or goals.
o This contrasts with nutrition monitoring and evaluation where nutrition and dietetics practitioners use the same data
to determine changes in client behavior, nutritional status, and the efficacy of nutrition intervention.
 Finding Nutrition Assessment Data:
o For individuals, data can come directly from the patient/client through interview, observation and measurements, a
health record, and the referring health care provider.
o For population groups, data from surveys, administrative data sets, and epidemiological or research studies are
used.
Terminology for nutrition assessment is organized in five domains (categories):
Nutrition-Focused
Food/Nutrition-Related Anthropometric Biochemical Data, Physical Findings Client History
History Measurements Medical tests and
Procedures
>Food and nutrient intake, >Height, >Lab data (e.g., > Physical > Personal history,
>food and nutrient >weight, electrolytes, glucose) appearance, >medical/health/family
administration, >body mass index and tests (eg, gastric > muscle and fat history, treatments and
>medication, (BMI), emptying time, wasting, >complementary/altern
>complementary/alternati >growth pattern resting metabolic >swallow ative medicine use, and
ve medicine use, indices/percentile rate) function,appetite, > social history
>knowledge/beliefs, ranks, and and affect
>food and >weight history
suppliesavailability,
>physical activity,
>nutrition quality of life

NCP Step 2: Nutrition Diagnosis Purpose:

o Nutrition Diagnosis is a nutrition and dietetics practitioner’s identification and labeling of an existing nutrition problem(s) that the practitioner is
responsible for treating.
o Nutrition diagnoses (e.g., inconsistent carbohydrate intake) are different from medical diagnoses (eg, diabetes).

Determining a Nutrition Diagnosis:

Nutrition and dietetics practitioners use standard nutrition diagnostic terminology to label the client’s nutrition diagnosis(es) through
organized nutrition assessment data that are clustered for comparison with defining characteristics list on the reference sheets. The eNCPT
provides a reference sheet for each nutrition diagnosis that includes its definition, possible etiology/causes, and common signs or symptoms
identified in the Nutrition Assessment step.
Terminology for Nutrition Diagnosis is organized in three domains (categories):
(P) Problem or Nutrition Diagnosis (E) Etiology (S) Signs/Symptoms
Term Data or indicators used to determine
Factors Linked to the nutrition diagnosis the client's nutrition diagnosis.
Term Describes alterations in the term by the words “related to.”
client’s nutritional status. Linked to the etiology by the words “as
evidenced by.”
No nutrition diagnosis at this time (NO-1.1) may be documented if the assessment indicates that no nutrition problem exists to justify a
nutrition intervention.

NCP Step 3: Nutrition Intervention Definition:

A nutrition intervention is a purposely planned action(s) designed with the intent of changing a:
o nutrition-related behaviour,
o risk factor,
o environmental condition or
o aspect of health status to resolve or
o improve the identified nutrition diagnosis(es) or
o nutrition problem(s).
Terminology for Nutrition Intervention is organized in five domains (categories):
Food and/or Nutrition Education Nutrition Counselling Coordination of Population Based
Nutrient Delivery Nutrition Care Nutrition Action
Customized Instruct or train a A supportive process, Consultation with, Interventions
approach for client in a skill or to characterized by a referral to, or designed to improve
food/nutrient impart knowledge to collaborative counselor-client coordination of the nutritional well-
provision help clients relationship, to establish nutrition care with being of a population.
voluntarily manage food, nutrition and physical other health care
or modify food, activity priorities, goals, and providers, institutions,
nutrition, and action plans that or agencies that can
physical activity acknowledge and foster assist in treating or
choices and responsibility for self-care to managing nutrition-
behavior to maintain treat an existing condition related problems
or improve health and promote health

Use of Nutrition Intervention Terminology:

Nutrition intervention is accomplished in two distinct and interrelated steps: planning and implementing.

Planning the nutrition intervention involves:

•Prioritizing nutrition interventions based on urgency, impact, and available resources
•Collaborating with the client to identify goals of the intervention for each diagnosis
•Writing a nutrition prescription based on a client’s customized recommended dietary intake of energy and/or selected food or nutrients
based on current reference standards and dietary guidelines and a client’s health condition and nutrition diagnosis
•Selecting specific nutrition intervention strategies that are focused on the etiology of the problem and that are known to be effective based
on best current knowledge and evidence
•Defining the time and frequency of care, including intensity, duration, and follow-up.

Implementation is the action phase and involves:

• Collaborating with the client to carry out the plan of care
• Communicating the nutrition care plan
• Modifying the plan of care as needed
• Following up and verifying that the plan is being implemented
• Revising strategies based on changes in condition or response to intervention
NCP Step 4: Nutrition Monitoring and Evaluation
Collection and Use of Nutrition Monitoring and Evaluation Outcome Data:
This step consists of three components:
 monitoring, measuring, and evaluating the changes in nutrition care indicators.
 Practitioners monitor by providing evidence that the nutrition intervention is or is not changing the client’s behavior or
status.
 They measure outcomes by gathering data for outcomes/indicators.
 Finally, nutrition and dietetics practitioners compare the current findings with previous status, nutrition intervention goals,
and/or reference standards and evaluate the overall impact of the nutrition intervention on the client’s nutrition diagnosis(es)
and health outcomes.
 The use of standardized indicators and criteria increases the validity and reliability of outcome data collection,
communication, an aggregation of data for reporting outcomes of the nutrition and dietetics practitioner’s interventions.

CHECKING FOR UNDERSTANDING

Multiple Choice

1. e. a and d
Rationale: A PES statement is a nutrition diagnosis used in a clinical setting. It consists of the problem (P), the etiology (E) and the
signs or symptoms (S). Examples of Nutrition Diagnosis Statements (PES or PE): Excessive caloric intake (problem)
“related to” frequent consumption of large portions of high fat meals (etiology) “as evidenced by” average daily intake of
calories exceeding recommended amount by 500 kcal and 12-pound weight gain during the past 18 months (signs)

2. d. A and B
Rationale: At first the Nutrition Care Process may seem like a linear approach; however, during the course of an
interaction/appointment with a client, the RDN will often complete the assessment and diagnosis steps, and may begin a
 Nutrition Intervention when a client reveals another piece of new assessment data/information that will cause the RDN to
re-assess, and re-diagnose and perhaps modify the plan that he/she had started discussing with the client.

3. c. when nutrition goals are met

Rationale: The final step of the process is monitoring and evaluation, which the RDN uses to determine if the client has achieved, or is
making progress toward, the planned goals.

4. d. Assessment, Diagnosis, Intervention, Monitoring and Outcomes Evaluation

Rationale: The Nutrition Care Process (NCP) is a systematic approach to providing high quality nutrition care. The NCP consists of
four distinct, interrelated steps: Nutrition Assessment, Nutrition Diagnosis, Nutrition Intervention, Nutrition
Monitoring/Evaluation.

5. b. Intervention
Rationale: In Nutrition Intervention step, the RDN then selects the nutrition intervention that will be directed to the root cause (or
etiology) of the nutrition problem and aimed at alleviating the signs and symptoms of the diagnosis.

6. b. utilize critical thinking skills

Rationale: The Nutrition Care Process and Model (NCPM) provides registered dietitian nutritionists (RDNs) and dietetic technicians,
registered (DTRs) a framework to recognize, diagnose, and intervene upon nutrition-related health concerns. Within the NCPM,
nutrition assessment is essential to develop a comprehensive evaluation of the client’s nutrition history. The application of
critical thinking skills to nutrition assessment is imperative to ensure appropriate acquisition and interpretation of data.

7. c. Palpation
Rationale: Palpation is the examination of the body using the sense of touch, such as feeling patient for pulse.

8. a. Assessment
Rationale: The situation is an objective data that includes in the assessment step of ADIME charting.

9. d. intervention
Rationale: ADIME, or Assessment, Diagnosis, Intervention, and Monitoring/Evaluation, is a process used to ensure high quality
nutrition care to patients and clients from nutrition professionals, such as Registered Dietitians (RD) or Registered Dietitian
Nutritionist (RDN).
10. d. Keeping a record of what has been done for the patient
Rationale: Medical charts contain medically relevant events that have happened to a person. A good medical chart will paint a clear
picture of the patient. It also provides vital information to allow healthcare practitioners to make sound decisions based on the
information contained in the record.

LESSON WRAP-UP
CASE STUDY