Running head: NUTRITION CARE PROCESS PROJECT 1

NUTRITION DIAGNOSIS, INTERVENTION, MONITORING AND EVALUATION

SNEHA LAKHOTIA
Marywood University
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Part 1

2. Choose a client/ Patient with a medical condition- Fifty-five-year-old male diagnosed with

Type 2 Diabetes Mellitus in December 2017, was chosen for this project. Malnutrition Universal

Screening Tool (MUST) was used. The score calculated was 1 indicating he is at medium risk.

3. Schedule an Assessment Appointment with your patient/ client and prepare for this

appointment by creating a list of interview questions- An Assessment appointment was

scheduled on 1st March 2018. List of questions that were asked during the appointment is as

follows- What is your full name, age, race, ethnicity and primary language? What is your highest

level of education/ occupation? What is your role in family? What is your chief complaint? Do

you have any previous medical conditions or surgeries? Any family history of Diabetes Mellitus

(DM) or any other condition? What medications do you take? What is the dosing? Do you take

any fiber or food supplement? If so, how much? How often do you take and what quantity? Who

prepares your meals? Who does the food shopping? Are you physically active? Describe your

daily routine? Do you consume alcohol or use tobacco products? If so, what types, how much

and how frequently? You mentioned that you have diabetes, right? What type do you have (type

1 / type 2/ pre-diabetes)? How was your appetite 3 months ago? What is your height, weight?

Have you lost or gained weight in the past without trying? Did you have any difficulty in

chewing or swallowing when you were diagnosed? Did you have symptoms of nausea, vomiting,

dry mouth, excess thirst, frequent urination, fatigue? Did you have constipation, diarrhea, heart

burn? How many meals did you ate? How many snacks? Do you follow fix timings? Do you

avoid any specific foods such as fruits, milk or dairy products, vegetables, meats? Do you have

any food allergies, preferences or intolerance? How much milk or yoghurt do you drink or eat

and what type? How many glasses of water you drank during that time? Any other beverage you
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consumed? Do you use any vitamin, mineral, herbal or other type of supplements? Can you

discuss with me what was your intake in December, when you were diagnosed as type 2 diabetes

mellitus? Can you give me the permission to do nutrition focused physical examination? Can I

have a look at your biochemical/ lab reports? Do you monitor your blood glucose and/or blood

pressure levels on regular basis? If so, what are the levels?

6.Calculate the Client’s Nutrition needs/ Goals appropriate for the Patient-

According to Mifflin St Jeor Method,

REE Males- 9.99 x weight (kg) + 6.25 x height (cm) – 4.92 x age (yr) + 5

(9.99*62) + (6.25*167)- (4.92*55) +5

619+1044-271+5 =1397

TEE=REE*AF

TEE=1397*1.375 (lightly active) =1921Kcal/ day

Protein= Adult maintenance 0.8-1g/kg

62*0.9=56g of protein/day

56g protein*4 kcal/1g protein=224 Kcal

224/1921=0.116*100=12% of Kcal

Fat=64g of fat*9kcal/1 g of fat=576Kcal

576/1921=0.299*100=30% of Kcal

CHO=279g of CHO*4kcal/1g of CHO=1114Kcal

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1114/1921=0.579*100=58% of Kcal

Daily fluid needs- Based on Chronological age method 55-75 years (30ml/kg)

30*62=1860ml/day.

6 a. Evaluate the adequacy of Client’s 24-hour recall-

TEE= 1185.21/1921*100=62%. Patient met only 62% of his TER.

CHO= He consumed only 144.16g of CHO. Calories consumed from carbohydrates are

144.16*4Kcal/g=577 kcal

577/1921*100=30%.

30% of calories came from carbohydrates which is lower than AMDR (45-65%) and lower than

actually required (58%). Dietary Fiber intake was also low (10%).

Protein= He consumed only 30.28g of protein through his diet. Calories consumed from protein

are 30.28*4Kcal/g=121Kcal

121/1921*100=6.3%.

6.3% of calories came from protein which is lower than AMDR (10-35%) and lower than

actually required (12%)

Fat= He consumed only 52.86g of fat through his diet. Calories consumed from fat are

52.86*9Kcal/g=476Kcal

476/1921*100=25%.

25% of calories came from fat which is within the range of AMDR (20-35%) and actually

required (</=30%).
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Daily fluid needs- The daily fluid needs as calculated is 1860ml/day. The client consumed

3.69L/day which is more than recommended indicating the client having symptoms of

polydipsia.

Micronutrients-The patient met the RDA for fat soluble vitamins except vitamin E (18%). He

also met the RDA for water soluble vitamins except niacin (18%), vitamin B6(17%), folate

(24%) and consumed excess of vitamin C (155%). He was deficient in minerals such as

potassium and zinc (24% and 22%) respectively but consumed excess of sodium (127%). He

also consumes multivitamin supplement once daily.

9 b. Assessment of your client Diet order- Before the diagnoses of DM my client was

consuming a low salt diet as he has a past medical history of hypertension. I partially agree with

his current diet regimen. But, by evaluating his biochemical data and he reporting symptoms of

polyuria, polydipsia, weight loss, generalized weakness I would recommend him a diabetic low

salt diet.

9 c. Determine your Client’s Nutrition Risk history- My patient would fall into moderate

nutrition risk category. This category was chosen because he had significant

(unintentional)weight loss, a reasonable A1C goal<7% would be required, maintain his blood

pressure <140/80mmHg and he is at the earlier stages of microalbuminuria which can be

controlled before he advances to macro albuminuria.

10. Assessment of your Assessment Appointment preparation-Before my Assessment

appointment with the client I had reviewed the encounter summary form. Kept in mind all the 5

domains and assessment tools that would be necessary to complete the full nutrition assessment.

I obtained all the information that was required to complete the step.
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Project Evaluation

This project gave hands on experience with Nutrition care process. It made us

demonstrate effective and professional oral, written communication and documentation. As we

were learning about the ADIME we were simultaneously applying our knowledge on the client

which made our concepts clearer. It helped us to make decisions, identify nutrition related

problems, determine and evaluate nutrition interventions. There were initial hiccups in getting a

client for this project and their biochemical data. But, eventually things went on smoothly. This

was just an entry into the professional practice but the challenge would be to complete this

process in a limited time frame for which more practice is needed.

I would definitely do this project again but focus more on anthropometrics and nutrition

focused physical findings. Overall, it was a well-designed project and in general the nutrition

care process gives consistency and clarity of dietetics related health records and possibility to

collect and research patient outcomes.

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