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After taking the Nutrition Assessment, the dietitian formulates some preliminary Nutrition Diagnoses and considers which Nutrition Interventions to propose for the patient’s consideration. The initial Nutrition Diagnoses can be modified as the patient supplies more information and the true underlying causes or etiologies of the condition become clear. The dietitian’s final understanding of the nutrition problems will be outlined in the Nutritional Diagnosis Statement, consisting of the Problem/Etiology/Signs and Symptoms (PES) documented in the nutrition progress note or chart entry. The dietitian may have identified several possible Nutrition Diagnoses during the course of the consultation. However, if the patient is unwilling to address a particular Nutrition Diagnosis during counseling, the practitioner may discuss another.
The dietitian may have identified low priority nutrition problems such as inadequate intake of nutrients of concern (for example, calcium, iron, iodine) or excessive intake of nutrients of concern (such as sodium or saturated fat). The dietitian can record any low priority issues in progress notes as items to be addressed in subsequent consultations. Examples of criteria dietitians might use to select the most important Diagnosis are included in the Introduction chapter.
Hint — use the eNCPT Diagnosis Reference Sheets at www.ncpro.org to identify the Signs and Symptoms (Potential Indicators) necessary to document that a Nutrition Diagnosis applies to your patient.
Explanatory additions to the NCP Mind Map are in green italics. NCP terms and codes are in black font.
Nutrition Diagnosis Status Values
Dietitians are encouraged to use the labels below to communicate the status of each nutrition diagnosis identified. Definitions are provided to explain the meaning of the label on the Nutrition diagnosis status (EV-2) reference sheet.
Additional details can be found at Nutrition Monitoring and Evaluation Actions: Monitor, Measure, and Evaluate page. These concepts are on the Nutrition Assessment/Monitoring and Evaluation terminology list at eNCPT.
| NUTRITION DIAGNOSIS STATUS VALUES | |
| New nutrition diagnosis | Problem identified in nutrition diagnosis was not identified in any nutrition diagnoses made in the previous assessment. |
| Active nutrition diagnosis | The signs and symptoms in the nutrition diagnosis require nutrition intervention and monitoring and evaluation to meet the goal. |
| Resolved nutrition diagnosis | The signs and symptoms identified in the Nutrition Diagnosis have met or exceeded the goal. |
| Discontinued nutrition diagnosis | The nutrition diagnosis no longer exists because the client’s condition or situation has changed. The client’s current assessment data no longer support this nutrition diagnosis. |
Nutrition Diagnosis For Malnutrition(1,2)
| INTAKE NUTRITION DIAGNOSES (NI) |
|
ENERGY BALANCE NUTRITION DIAGNOSES (NI-1)
|
| CLINICAL NUTRITION DIAGNOSES (NC) |
|
FUNCTIONAL NUTRITION DIAGNOSES (NC-1)
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| BEHAVIORAL-ENVIRONMENTAL NUTRITION DIAGNOSES (NB) |
| KNOWLEDGE AND BELIEFS NUTRITION DIAGNOSES (NB-1) Food and nutrition related knowledge deficit (NB-1.1) · Parental or caregiver knowledge may contribute to underfeeding Belief finding that hinders food and/or nutrition behavior change (use with caution) (NB-1.2) · Parental or caregiver attitudes and beliefs may contribute to underfeeding; oncology patients may have been enticed by claims for supplements or herbal remedies with no scientific support Disordered eating pattern (NB-1.5) Limited adherence to nutrition related recommendations (NB-1.6) · Especially in follow-up consultations if patient has been unable to follow recommendations formulated at previous consultation PHYSICAL ACTIVITY AND FUNCTION NUTRITION DIAGNOSES (NB-2) Physical inactivity (NB-2.1) · Muscle wasting may occur in malnourished individuals who are inactive Excessive physical activity (NB-2.2) · May contribute to malnutrition in people with eating disorders Inability to manage self care (NB-2.3) Impaired ability to prepare foods for eating (NB-2.4) · Elderly individuals may have decreased ADLs contributing to malnutrition Poor food and/or nutrition quality of life (NB-2.5) (4,5) Self feeding difficulty (NB-2.6) FOOD SAFETY AND ACCESS NUTRITION DIAGNOSES (NB-3) Intake of unsafe food (NB-3.1) Limited access to nutrition related supplies (NB-3.3) Limited access to potable water (NB-3.4) |
EXAMPLE PES STATEMENTS FOR MALNUTRITION AND ONCOLOGY(1,2)
| DOMAIN | TERMS | PES |
| INTAKE NUTRITION DIAGNOSES (NI) | ORAL OR NUTRITION-SUPPORT INTAKE NUTRITION DIAGNOSES (NI-2) Inadequate oral intake (NI-2.1) |
Inadequate oral intake (NI-2.1) (P) related to radiation therapy (E) as evidenced by – Fatigue, nausea and vomiting – An average daily energy intake of 1 200 kcal (4 800 kJ) failing to meet recommended intake by 1 500 kcal (6 000 kJ) – Weight loss of 24 lb (10 kg) in six months (S) |
| CLINICAL NUTRITION DIAGNOSES (NC) | FUNCTIONAL NUTRITION DIAGNOSES (NC-1) Swallowing difficulty (NC-1.1) |
Swallowing difficulty (NC-1.1) (P) related to near-esophageal obstruction (E) as evidenced dysphagia and a 24 lb (10kg) weight loss in six months (S) |
| BEHAVIORAL-ENVIRONMENTAL NUTRITION DIAGNOSES (NB) | FOOD SAFETY AND ACCESS NUTRITION DIAGNOSES (NC-3) Intake of unsafe food (NB-3.1) |
Intake of unsafe food (NB-3.1) (P) related to eating contaminated food while neutropenic (E) as evidenced by severe diarrhea and a positive stool culture (S) |
OTHER NUTRITION DIAGNOSES(2)
Other common nutrition, behavioral and clinical diagnoses in patients with malnutrition and oncology are as follows:
| DOMAIN | TERMS |
| INTAKE NUTRITION DIAGNOSES (NI) | ENERGY BALANCE NUTRITION DIAGNOSES (NI-1) Inadequate energy intake (NI-1.2) Predicted inadequate energy intake (NI-1.4) NUTRIENT INTAKE NUTRITION DIAGNOSES (NI-5) Increased nutrient needs (specify) (NI-5.1) Inadequate protein-energy intake (NI-5.2) Protein intake nutrition diagnoses (NI-5.6) - Inadequate protein intake (NI-5.6.1) |
| CLINICAL NUTRITION DIAGNOSES (NC) | BIOCHEMICAL NUTRITION DIAGNOSES (NC-2) Altered nutrition-related laboratory values (specify) (NC-2.2) WEIGHT NUTRITION DIAGNOSES (NC-3) Underweight (NC-3.1) Unintended weight loss (NC-3.2) MALNUTRITION DISORDERS DIAGNOSES (NC-4) Malnutrition (undernutrition) (NC-4.1) - Starvation related malnutrition (NI-4.1.1) - Chronic disease or condition related malnutrition (NC-4.1.2) - Acute disease or injury related malnutrition (NC-4.1.3) |
| BEHAVIORAL-ENVIRONMENTAL NUTRITION DIAGNOSES (NB) | KNOWLEDGE AND BELIEFS NUTRITION DIAGNOSES (NB-1) Disordered eating pattern (NB-1.5) Limited adherence to nutrition-related recommendations (NB-1.6) |
References
1. Academy of Nutrition and Dietetics. Nutrition Terminology Reference Manual (eNCPT): Dietetics Language for Nutrition Care. 2023. Accessed 4 July 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 2: Nutrition Diagnosis. 2023. Accessed 4 July 2024. Available from: https://www.ncpro.org/pubs/2020-encpt-en/page-036.
3. Barr JT, Schumacher G. The need for a nutrition-related quality-of-life measure. J Am Diet Assoc. 2003; 103: 177-180.
4. Barr JT, Schumacher G, Myers EF. Case Problem: Quality of Life Outcomes Assessment. J Am Diet Assoc. 2001; 101: 1064-1066.