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To provide the best quality of care as a dietitian we must remain aware and in some ways be a bit of a detective. The Nutrition Care Process provides a structured approach that can be personalized to meet the needs of all patients or clients.
The framework of the Nutrition Care Process supports decision-making and critical thinking while ensuring efficient and effective care is provided . When providing the utmost care and love to clients or patients there are always steps or a process to guide and ensure quality.
Steps in The Nutrition Care Process
The Nutrition Care Process walks through 4 steps to support the initial assessment all the way through planning the follow-up care. The 4 steps include :
- Nutrition Assessment and Reassessment
- Nutrition Diagnosis
- Nutrition Intervention
- Nutrition Monitoring/Evaluation
Step 1: Nutrition Assessment
The Nutrition Assessment has two parts. Part 1 is the initial assessment which is a time to collect imperative data, background, and history and then analyze and interpret the data . Part 2 is the reassessment and is where the cycle we call the Nutrition Care Process starts over .
The key date to be obtained/collected during the Nutrition Assessment include :
- Meal and snack patterns
- Adequacy of intake/change in appetite
- Nausea, vomiting
- History of bingeing, purging
- Physical activity patterns
- Food availability
- Food allergies/preferences
- Medications/supplement usage/diet pills
- Vital signs/history of current illness
- Socioeconomic status
- Bowel habits, history of laxative use
- Weight (current, usual, ideal)
- Body weight index (BMI)
- Unintentional or intentional weight change
Medical Procedures, Laboratory Data, and Test Results:
- Gastric emptying studies
- Bone scans
- Glucose/Hemoglobin A1C
- Lipid Panel
Nutrition-Focused Physical Examination:
- Overall musculature, adipose stores
- Oral (tongue, gums, lips, mucus membranes, etc.)
- General physical appearance
Once the initial data, history, and background are collected it is time to review and assess factors that affect nutrition and health status .
After data is assessed, the next step is identifying the nutrition problem or diagnosis.
Step 2: Nutrition Diagnosis
The Nutrition Diagnosis or Diagnoses identifies nutrition problems that the nutrition professional or dietitian is responsible for treating .
From the data collected and analyzed in the Nutrition, Assessment practitioners can identify what the nutrition diagnoses are.
Once diagnoses are understood recommendations can be presented to a patient. From there, a patient or clients can work with the practitioner to set goals to move towards for the betterment of their health .
When creating a nutrition diagnosis statement, specific nutrition diagnostic terms and the etiologies, signs, and symptoms will be identified .
There are three parts to a nutrition diagnosis statement :
- The problem or nutrition diagnosis describes alterations in the client’s status
- Etiology is a factor that contributes to a problem including pathophysiological, situational, developmental, cultural, and/or environmental
- Signs and symptoms supporting the existence of the nutrition diagnosis
Nutrition Diagnosis should be clear and concise and always specific to the patient or client being treated.
Example Nutrition Diagnosis: Disordered eating pattern related to harmful beliefs regarding food and nutrition as evidenced by the report of restrictive type behaviors and laxative abuse to rid the body of nourishment.
- Nutrition Counseling Guide
- Foods That Makes You Feel Good
- How Your Metabolism Functions
- The Physical Cues of Hunger/Satiety
- Dietitian Crafted Meal Plans for Treating EDs
- How to Regain Your Healthy Weight During Recovery
- Misconceptions of What Healthy Eating Is
- Mindful Eating and Appetite Awareness
Step 3: Nutrition Intervention
The Nutrition Intervention is a set of planned actions with the intention of aiding in the healing process. Interventions may support changing nutrition-related behavior, risk factor, environmental condition, or health status .
When determining nutrition interventions ask, is this directed towards resolving the nutrition diagnosis or nutrition etiology? From there start planning, making sure the client is involved, and then implementing nutrition interventions.
All nutrition interventions should be SMART:
Again, it cannot be stressed enough how important it is to include the client. Working with the client to overcome barriers and roadblocks is imperative.
Step 4: Nutrition Monitoring and Evaluation
Nutrition monitoring and evaluation is the time to implement the reassessment process. Essentially, this takes us back to the start.
In reassessing the client all self-monitoring data and records will be reviewed to assess progress and if current goals or interventions are being met. This leads back into the cycle we call the Nutrition Care Plan.
Back to Step 1: Reassessment
After the initial nutrition assessment is completed, the next step is scheduling and completing the reassessment.
During the reassessment all data will be reviewed, past goals looked at, and patient or clients worked with to explore what they feel is going well and what may have been more difficult .
When working with patients or clients make sure you are doing just that, working with them. As a practitioner, we are to act as a guide, while the patient or client is driving their recovery.
During the reassessment, the practitioner will reexamine if goals are being met and if there is a need for adjustment or revision to goals or Nutrition Diagnoses.
This cycle will continue if the nutrition professional identifies a need for ongoing nutrition care. This may also be a time to identify when a patient or client is ready to progress to a different level of care or discharge.
 Charney, P., Malone, A., & American Dietetic Association. (2009). ADA Pocket Guide to Nutrition Assessment. American Dietetic Association.  Swan, W. I., Vivanti, A., Hakel-Smith, N. A., Hotson, B., Orrevall, Y., Trostler, N., Beck Howarter, K., & Papoutsakis, C. (2017). Nutrition Care Process and Model Update: Toward Realizing People-Centered Care and Outcomes Management. Journal of the Academy of Nutrition and Dietetics, 117(12), 2003–2014. https://doi.org/10.1016/j.jand.2017.07.015
Author: Raylene Hungate, RDN,LD/N
Page Last Reviewed and Approved By: Jacquelyn Ekern, MS, LPC 12.21.21