11: Nutrition Care Process - Nutrition Diagnosis vs. Medical Diagnosis

05/07/2022 35 min
11: Nutrition Care Process - Nutrition Diagnosis vs. Medical Diagnosis

Listen "11: Nutrition Care Process - Nutrition Diagnosis vs. Medical Diagnosis"

Episode Synopsis

The Nutrition Care Process or NCP is the process dietitians follow when documenting in the medical record. There are 4 steps to the Nutrition Care Process: Nutrition Assessment (A) Nutrition Diagnosis (D)  Nutrition Intervention (I) Nutrition Monitoring and Evaluation (ME) These steps guide your documentation. The note format is called ADIME. In this episode, you'll learn:  The difference between the Nutrition Diagnosis and Medical Diagnosis The steps of the Nutrition Care Process What a PES statement is and what goes into each part of the statement (hint: P = Problem, E = Etiology, S = Signs/Symptoms)  How your documentation should flow like a story. The Nutrition Diagnosis is connected to the Nutrition Intervention and the Nutrition Monitoring and Evaluation are the goals for the patient - you follow-up on these to assess the effectiveness of the intervention. And you'll learn a helpful tip on what to do when the Nutrition Diagnosis is hard to figure out.  Here's a glance at this episode: [3:50] The assessment is where all the important information about the patient is gathered and evaluated [5:00] The NFPE is used to identify the presence of malnutrition [7:52] The difference between the medical and nutrition diagnosis [12:00] A breakdown of the Nutrition Diagnosis categories [18:20] An example on how to work through a case with multiple problems and how to choose the most pertinent nutrition diagnosis [22:00] A review of PES statements - the wording and format [32:00] What to document when a patient doesn't have a nutrition problem or diagnosis [33:12] A helpful tip to use when you're having a hard time figuring out the nutrition diagnosis