Practice Consideration
For patients with malnutrition whose circumstances differ from those of Mr Robertson, there are other possible Nutrition Diagnoses. They include:
Intake Domain(1)
» Inadequate oral intake (NI-2.1)(1)
– The diagnosis Inadequate oral intake (NI-2.1)(1) is in the Intake Domain: that is, the preferred one. Note that, if the dietitian has obtained a detailed diet history and calculated energy and protein and found them to be less than estimates of the patient’s requirements, it would be preferable to use Inadequate energy intake (NI-1.2)(1) or Inadequate protein intake (NI-5.6.1)(1). This is a more specific and more accurate description of the patient’s problem
» Inadequate protein-energy intake (NI-5.2)(1)
– The diagnosis Inadequate protein-energy intake (NI-5.2)(1) is a combined diagnosis, referring to the patient’s intake of both protein and energy. This is usually a precursor to malnutrition and indicates a more short-term inadequate intake of both nutrients that if continued and if it was severe enough would develop into malnutrition
» Inadequate intake of sodium (NI-5.10.1.7)(1)
– The dietitian usually encourages a low sodium intake for patients with hypertension. This was part of the Nutrition Monitoring and Evaluating plan in Mr Robertson’s previous visit. While it is important to document that Mr Robertson’s sodium intake is very low, the other diagnosis of Inadequate protein-energy intake (NI-5.2)(1) has higher priority. Patients who are being zealous in their avoidance of foods that contain sodium can, as a consequence, consume less than the minimum recommended amount of sodium. Certainly, in this case, the dietitian can confidently add favorite foods that are high in sodium back to the diet and explain that it is not necessary to avoid these foods at this stage. Planning a diet to increase Mr Robertson’s sodium, however, is not recommended
– One potential benefit of Mr Robertson’s low sodium intake is that he gains flexibility with food choices and this can be used to increase his energy intake
– It is important to appreciate that sodium is an essential nutrient and adequate intake is required during periods of growth (such as during childhood) or tissue synthesis
Clinical Domain(1)
» Altered nutrition-related laboratory values (NC-2.2)(1)
– This diagnosis could be used if Mr Robertson’s serum biochemistry or laboratory values are outside the normal range
– Factors such as disease state and inflammation can affect serum biochemistry or laboratory values so it may be a less desirable choice from the Intake Domain, where the impact of Nutrition Interventions can better assessed
– Where possible, choose a diagnosis from the Intake Domain
» Unintended weight loss (NC-3.2)(1)
– This is a good choice to use if Mr Robertson had lost weight and had not been assessed as malnourished. This is a less severe Nutrition Diagnosis and does not truly reflect the magnitude of the current problem
Behavioral-Environmental Domain(1)
» Food- and nutrition-related knowledge deficit (NB-1.1)(1)
– This diagnosis is a possibility if the person is unaware of good sources of energy and protein and you address this during your counseling session. Rather than using it as a diagnosis, you choose to use it as an Etiology for the inadequate protein intake
» Limited adherence to nutrition-related recommendations (NB-1.6)(1)
– Technically Mr Robertson meets some of the Signs and Symptoms for this Nutrition Diagnosis. However, Limited adherence to nutrition-related recommendations (NB-1.6)(1) is not really applicable due to the change in his health condition. The previous recommendations are no longer applicable
» Not ready for nutrition related behavior change (NB-1.3)(1)
– Mr Robertson has indicated that he stopped following all his previously established healthy lifestyle habits when he received his diagnosis of cancer. At that time, this was the correct diagnosis, however the dietitian can not be sure during this consultation that he is not ready to make changes diet/lifestyle changes.
References
1. Academy of Nutrition and Dietetics. Nutrition Terminology Reference Manual (eNCPT): Dietetics Language for Nutrition Care. Diagnosis. 2023; Accessed 16 August 2023. Available from: https://www.ncpro.org/pubs/2023-encpt-en/page-036