Saturday, September 22, 2018

Beginner vs Advanced Nutrition Diagnoses

Often a general nutrition diagnosis may be technically correct, but lacks the specificity that would reflect advanced critical thinking.

For example "Inadequate oral intake" reflects an accurate but basic understanding of a problem where a client is not consuming adequate nutritional intake.  It can represent a wide continuum of situations.  The intervention for "Inadequate oral intake" could be any intervention that increased oral intake of any kind.  This nutrition diagnoses also requires the least amount of nutrition assessment data to support the nutrition diagnosis.

Inadequate oral intake related to side effects of oncology treatment (or chemotherapy) as evidenced by less than 1/2  to 1 cup of food/beverage consumed per day

However an experienced dietitian may use a more precise nutrition diagnoses to reflect a specific target nutrient.  For example. "Inadequate energy intake" or "Inadequate protein intake" may  reflect more precise descriptions of the nature and severity of the client's condition.  The more specific nutrition diagnoses will direct the nutrition interventions' focus to the most important nutrient need or problem.  The more specific nutritional diagnoses also require more specific nutrient analysis and estimates of nutritional requirements as signs and symptoms to document the presence of the nutrition diagnoses.

Inadequate energy intake related to side effects of oncology and diagnosis of cachexia as evidenced by energy intake of less than 200 kcal versus estimated energy needs for cachexia of 2000 kcal.

The dietitian in this case might also have another nutrition diagnosis reflecting either the increased nutritional needs for cachexia and/or highlighting a focus on protein intake as well as energy.

Often students start with the more basic nutrition diagnoses and with experience will progress to routinely use more specific nutrition diagnoses reflecting a clear understanding of the medical condition and nutritional status of the individual patient.  While the first PES statement would be technically accurate it lacks the specificity and doesn't reflect the totality of the patient's medical condition.