Wednesday, December 30, 2015

Anticipatory guidance...Identifying nutrition problems that don't yet exist??

A key concept in the Nutrition Care Process is that dietitians identify an existing nutrition problem, called a nutrition diagnosis, by clustering existing signs and symptoms from the nutrition assessment that shows that the nutrition diagnoses exists.  So doesn't that eliminate the possibility of prevention and anticipatory guidance??

Nutrition Diagnoses/Problems
In 2011 (Third Edition International Dietetics & Nutrition Terminology) the nutrition diagnostic terminology was expanded to identify four nutrition diagnoses that provide the ability to "predict" future nutrition problems, thus supporting the concept of prevention and anticipatory guidance.

  • Predicted inadequate energy intake (NI-1.4)
  • Predicted excessive energy intake (NI-1.5)
  • Predicted inadequate nutrient intake  (NI-5.11.1)
  • Predicted excessive nutrient intake  (NI-5.11.2)
  • Predicted food-medication interaction (NC-2.4)
  • Predicted breast-feeding difficulty (NC-1.5)

The definition of these terms indicate that they are used to reflect future problems, e.g. intake of one or more nutrients that is anticipated  (predicted based on observation, experience, or scientific reason) to fall short of or exceed estimated nutrient requirements, established reference standards, or recommendations based on physiological needs.  

The types of etiologies that would be the "cause" of these nutrition diagnoses could be scheduled or planned medical therapy or medication that is predicted (based on research, experience or scientific reason) to either increase or decrease nutrient requirements, or change the ability to consume, absorb, or utilize nutrients.  In some cases cultural or religious practices could also be the "cause" of predicted problems.   In other cases etiology may be social issues such as housing or living conditions or potential for environmental emergency or catastrophe/disaster shown through research to be risk factors for intake problems.  

Signs and Symptoms
But what about the need to have signs and symptoms to document the presence of the nutrition diagnosis?  In the case of "predicted" nutrition diagnoses the reference sheets  indicate that you may use "estimated" needs or "estimates" of future intake.  

 The data used for these estimates may be findings of research projects as opposed to actual patient data.  History or presence of a condition for which research shows an increased prevalence of insufficient nutrient(s) intake in a similar population may be used as a sign and symptom.  For example the post surgery predicted energy needs for someone that is scheduled to undergo major surgery for cancer may be based on research findings related to the energy needed for future wound healing combined with research that documents a simultaneous decrease in intake could document a predicted gap between future intake and requirements.   This would then be used to set the stage for anticipatory guidance prior to surgery about coping with the future situation.

PES Statements might be:
Predicted excessive energy intake related to future immobilization of leg and lack of awareness of changes needed as evidenced current PAL of 1.8 expected to go to 1.2 and estimated current intake of 2800 kcal compared to reduced energy requirements of 1800 kcal during restricted mobilization scheduled for 4 weeks in December.
    ( intervention might be nutrition education on energy balance and meal planning for lower energy intake.)

Predicted suboptimal energy intake related to scheduled head and neck radiation therapy, lack of awareness of future dietary requirements, and anticipated changes in appetite as evidenced by scheduled radiation for next 3 months and usual weight loss of 5-10 KG/month for other patients receiving similar treatment (reference as appropriate).
    ( Intervention might be nutrition education on principles.) 

Predicted excessive carbohydrate intake  or Excessive carbohydrate intake related to strong family history of diabetes and lack of perceived susceptibility as evidenced by reports of all siblings and parents with Type 2 DM and current carbohydrate intake inconsistent with principles of diet for prevention of Type 2 DM.
     (Intervention might be nutrition counseling using health belief model and education on principles of prevention of DM EBNPG recommendations.)

Predicted excessive intake of nutrients in foods not tolerated related to potential diagnosis of food intolerances/allergies as evidenced by history of gastrointestinal distress and pain.
    ( Intervention might be nutrition education and use of self monitoring to test tolerance of foods.)

Full descriptions of the "predicted" nutrition diagnoses are available in the electronic NCPT.  Available at:  

No comments:

Post a Comment