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Cystic Fibrosis Nutrition Monitoring and Evaluation Mind Map


Step 4 Nutrition Monitoring and Evaluating
During Nutrition Monitoring and Evaluation, patient and dietitian together determine criteria to measure whether the goals established during the consultation are being achieved. Criteria should be specific, measurable, actionable, realistic and time limited. Several clear outcomes/indicators are selected that reflect both short-term (usually Behavior, Knowledge/Beliefs/Attitudes or Food and Nutrient Intake) and long-term goals (Anthropometric). These are used to measure the effectiveness of the approach and strategies applied during the consultation and in follow-up visits.

OUTCOMES/INDICATORS/MEASURES
Schedule regular consultations (frequency negotiated) for a minimum of six months. In the short term, more frequent contact improves prospects of success.(3)
The following outcomes are examples of indicators that could be assessed in follow-up consultations.


Explanatory additions to the NCP Mind Map are in blue italics. NCP terms and codes are in black font. Codes are provided for the domains and the primary and secondary headings beneath each domain.

Select the Nutrition Assessment domain below to go directly to that section.
FOOD/NUTRITION-RELATED HISTORY (FH)
FOOD AND NUTRIENT INTAKE (FH-1)
·  Progress toward energy-intake targets

Food and beverage intake determination (FH-1.2)
·  Fluid intake, high-energy fluids
   -  Fluid intake as per recommendations
   -  Estimated fluid intake
       -  Liquid meal replacement estimated oral intake in 24 hours, oral nutrition support
·  Food intake
   -  Amount of food, changes in specific foods, assessment of under-eating
   -  Types of food, such as selection of high-energy foods
   -  Meal/snack pattern changes in distribution of food throughout the day
   -  Diet quality index

Bioactive constituent intake determination (FH-1.4) 
·  Alcohol intake, contribution of alcohol to energy intake where relevant(3) 

Macronutrient intake determination (FH-1.5), progress toward targets
·  Fat intake
·  Protein intake
·  Carbohydrate intake
·  Fiber intake

Micronutrient intake determination (FH-1.6)
·  Mineral/element intake, progress toward dietary calcium targets


FOOD AND NUTRIENT ADMINISTRATION (FH-2)
Diet history (FH-2.1)
·  Diet experience
   -  Previously prescribed diets, high-energy/high-protein
   -  Previous diet/nutrition education/counseling
·  Eating environment, regular mealtimes, including mid-meals
  -  Atmosphere
  -  Eats alone


MEDICATION AND COMPLEMENTARY/ALTERNATIVE MEDICINE USE (FH-3) 
Medications (FH-3.1)
·  Prescription medication use
·  Over the counter (OTC) medication use
·  Compliance/need for change such as encourage adherence to prescribed fiber regimen


KNOWLEDGE BELIEF ATTITUDE DETERMINATION (FH-4)
Food and nutrition knowledge (FH-4.1), may be accomplished at end of consultation or during the follow-up 
·  Nutrition knowledge of individual client, changes in nutrition knowledge about energy-dense foods, using self-monitoring tools, risk factors of underweight (any topics that were provided as nutrition education)
·  Emotions, changes in emotions prior to, or after eating

Food and nutrition skill (FH-4.2)

Belief and attitude determination (FH-4.3)
·  Behavioral beliefs, motivation/changes in self-rating of desire to change
   - Nutrition self-efficacy score (Self efficacy: the strength of one’s belief in one’s personal ability to complete tasks and achieve goals) 
     -  Self-rated, 1=very low confidence to 7 = very high confidence in ability
   - Readiness to change nutrition related behavior stage, changes in self-reported stage of change
      -  Precontemplation stage (present/absent)
      -  Contemplation stage (present/absent)
      -  Preparation stage (present/absent)
      -  Action stage (present/absent)
      -  Maintenance stage (present/absent)
      -  Relapse stage (present/absent)
   - Readiness to change nutrition related behavior score
      -  Self-rated on scale of 1 to 10; 1 = not ready to 10 = fully ready to change
  - Negative emotions about food and nutrition (present/absent), changes in emotions prior to, or after eating
  - Positive emotions about food and nutrition (present/absent), changes in emotions prior to, or after eating
  - Unrealistic nutrition related goals (present/absent), changes in perceptions about acceptable weight gain and time frames
  - Negative nutrition self talk (present/absent), changes in thoughts
  - Positive nutrition self talk (present/absent), changes in thoughts


BEHAVIOR DETERMINATION (FH-5)
Adherence behavior (FH-5.1)
·  Nutrition encounter ratio
·  Ability to recall nutrition goals
·  Nutrition self monitoring at agreed upon rate
·  Ability to implement changes, self-monitoring logs kept

Eating behavior (FH-5.4)
·  Frequency of food consumption
·  Serving sizes

Social network behavior (FH-5.5)
·  Ability to build and utilize social network
   -  Involvement of family and friends in supporting diet-related activities


PHYSICAL ACTIVITY AND FUNCTION (FH-7)
Physical activity (FH-7.3), changes in activity levels
·  Consistency
·  Frequency
·  Duration
·  Intensity
·  Type of physical activity
ANTHROPOMETRIC MEASUREMENTS (AD)
Body composition/growth/weight history (AD-1.1)
·  Weight
·  Weight change
·  Body mass
   -  Body mass index (BMI) (kg/m2), adult females BMI 22-27 kg/m2, adult females BMI 23-27 kg/m2 (3)
   -  Body mass index prime ratio (actual BMI to the upper limit BMI of 25)
·  Body compartment estimates 
   -  Body fat percentage (%)
   -  Subcutaneous fat stores including:
   -  Triceps skinfold thickness
      -  Orbital fat pads(3)
      -  Fat overlying lower ribs(3)
 -  Muscle stores
      -  Clavicles (pectoralis and deltoids)(3)
      -  Interosseous muscles(3)
      -  Scapula (latissimus dorsi, trapezius, deltoids)(3)
      -  Shoulders (deltoids)(3)
      -  Temples (temporalis muscle)(3)
      -  Thigh (quadriceps)(3)
BIOCHEMICAL DATA, MEDICAL TESTS AND PROCEDURES (BD)
Electrolyte and renal profile (BD-1.2)
 -  BUN
 -  Sodium
 -  Potassium
 -  Phosphorus

Gastrointestinal profile (BD-1.4)
 -  Fecal fat, 24 hours
 -  Fecal fat, 72 hours
 -  Potassium
 -  Phosphorus

Glucose/endocrine profile (BD-1.5)
 -  Glucose, fasting levels
 -  Glucose tolerance test
 -  Parathyroid hormone 

Mineral profile (BD-1.19)
 -  Serum caclium

Vitamin profile (BD-1.13)
 -  25 hydroxy-vitamin D levels
NUTRITION FOCUSED PHYSICAL FINDINGS (PD)
Nutrition focused physical findings (PD-1.1)
·  Digestive system (specify)
   -  Increased appetite, satiety
·  Vital signs (specify)
   -  Blood pressure, systolic (mmHg)
   -  Blood pressure, diastolic (mmHg)
ASSESSMENT, MONITORING AND EVALUATION TOOLS (AT)
NUTRITION ASSESSMENT, MONITORING AND EVALUATION TOOL RATINGS (AT-1)
Subjective global assessment (SGA) rating (AT-1.1)

The scored patient generated subjective global assessment (PG-SGA) rating (AT-1.3)
·  pt-global.org

The scored patient generated subjective global assessment (PG-SGA) score (AT-1.4)
ETIOLOGY CATEGORY (EY)

NUTRITION DIAGNOSIS ETIOLOGY CATEGORY IDENTIFICATION (EY-1)
The Etiology Categories are located in the Nutrition Assessment/Monitoring and Evaluation. However, these terms are used in the Nutrition Diagnoses section. The Nutrition Diagnoses Etiology Matrix from the Academy of Nutrition and Dietetics is available here.

Beliefs attitudes etiology (EY-1.1)

Cultural etiology (EY-1.2)

Knowledge etiology (EY-1.3)

Physical function etiology (EY-1.4)

Physiologic metabolic etiology (EY-1.5)

Psychological etiology (EY-1.6)

Social personal etiology (EY-1.7)

Treatment etiology (EY-1.8)

Access etiology (EY-1.9)

Behavior etiology (EY-1.10)
PROGRESS EVALUATION (EV)

INTERVENTION GOAL STATUS (EV-1)
The Nutrition Diagnosis Status' are located under Nutrition Assessment/Monitoring and Evaluation.
These terms are used to evaluate the progress towards meeting goals set in the course of Nutrition Intervention. 

New goal identified (EV-1.1)

Goal achieved (EV-1.2)

Goal discontinued (EV-1.3)

Goal not achieved (EV-1.4)

Some progress toward goal (EV-1.5)

Some digression away from goal (EV-1.6)



NUTRITION DIAGNOSIS STATUS (EV-2)
The Nutrition Diagnosis Status' are located under Nutrition Assessment/Monitoring and Evaluation.
These terms are used in the Nutrition Diagnoses section to clearly evaluate the status/progress of a nutrition diagnosis. 

New nutrition diagnosis (EV-2.1)

Active nutrition diagnosis (EV-2.2)

Resolved nutrition diagnosis (EV-2.3)

Discontinued nutrition diagnosis (EV-2.4)

 


References
1.  Academy of Nutrition and Dietetics. Nutrition Terminology Reference Manual (eNCPT): Dietetics Language for Nutrition Care. 2023. Accessed 2 May 2024. Available from: https://www.ncpro.org/. 
2.  Academy of Nutrition and Dietetics. Nutrition Terminology Reference Manual (eNCPT): Dietetics Language for Nutrition Care. NCP Step 4: Nutrition Monitoring and Evaluation. 2020; Accessed 21 January 2021. Available from: https://www.ncpro.org/pubs/2020-encpt-en/page-015a
3.  Nutrition Guidelines for Cystic Fibrosis in Australia and New Zealand. 2017; Accessed 29 November 2017. Available from: https://www.thoracic.org.au/journal-publishing/command/download_file/id/49/filename/Chapter_5_Nutrition_Assessment.pdf

 
Updated May 02, 2024

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