Developing A Nutrition Care Plan

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               Analyzing Assessment data

    Nutrition care plan
-After nutrient needs has been assessed and analyzed , the dietitian develops 
 plan of 
 action that identifies clients,  and short term nutrition needs, and develops 
 strategy for meeting these needs
   The plan specifies- objectives of the dietary recommendation
                     - the content of the counseling sessions
                     - time frame for accomplishing each objective


     For each nutritional problem the dietitian must first identify the cause 
and then develop strategy to tackle it. Eg. If client has a diarrhea and you
find that the cause is medication your action will include supplying the
patient with adequate fluids to prevent diarrhea while the physician will 
choose different medication that will not cause diarrhea.
      If the cause for diarrhea is Milk intolerance then your action will be to
eliminate the milk products from patients diet . Part of this plan will be also
nutritional education to instruct patient on nutritionally adequate diet that
eliminates milk products.

Implementing the nutrition care plan
 After developing the care plan, next step is to implement it by providing both
appropriate diet and education

Evaluating the nutrition care plan
   Dietitian must keep tract of how the program is working. If weight reduction
program is not working he must ask what is the problem? -is the client eating 
                                                         too much?
                                                        - is the client too 
                                                          inactive?
  
     The best program ,however will not work if the client is not willing to 
comply . In that case the best strategy is to wait till client is more 
receptive.

     
               Medical Nutrition therapy
   Its goal is to provide clients with adequate Kcal, protein, CHO, fat
vitamin, mineral and trace elements

Diet orders- Diet orders are prescribed by physician and written into medical 
             records.

Diet manual- it describes food allowed and not allowed on each diet outlines 
             rationales for each diet, provide nutrition information o adequacy 
             of each diet and offers sample menus.

Standard and modified diets

-Standard or regular diet- includes all foods, and provides all the nutrients 
                           appropriate for healthy people
-Modified diets- used when standard diets fail to meet the specific needs of 
                 clients
               - modifying standard diet is much like tailoring a suit 
                 -it involves altering the standard diet into specific needs of 
                  a client. This may include changing the consistency, 
                  adjusting amounts of individual nutrients, energy or fluid 


      
                   Diet planning
Exchange list
     Foods in exchange system are sorted into three groups based on their 
proportion of CHO fat and protein. Unlike the daily food guide, where foods are
divided into categories based on content of protein vitamin and mineral.


The CHO group includes these exchanges

-starch-cereals, grain pasta, bred, crackers, snack, starchy vegetables and 
        dried bens ,peas and lentils
-fruit
- milk
-other CHO ( deserts , snack with added sugar and fats)
-Vegetables

The fat group includes this exchange list:
-fats

The meat and meats substitute group includes
- meet and meets substitute

Exceptions in exchange system
-cheese is not listed in milk group as in FGP, but is grouped with meat items 
 as a protein food since, it contains only negligible amount of CHO
-starchy vegetables- corn , green peace, potatoes, are on starchy list in 
 exchange system rather than within the vegetables
-olives are not listed in fruits but on fat list because of the large content
 of fat

Portion sizes
- by strictly defining the potion sizes all the food in exchange list provide 
  approximately the same amounts of energy nutrients ( CHO fat , protein) and
  the same number of kcal.

     Exchange system is excellent tool to estimate energy intake, but does not
guarantee adequate intake of vitamins and minerals . Food guide pyramid works in
this regard better because it lists food based on similarities in vitamin and
mineral content.
    For that reason it is advised to check the exchange system with food guide
pyramid that contains enough servings from each food group.

 Click here for Diabetic Exchange table 
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 Click here to review Food Guide Pyramid serving sizes 



Translating exchange into meals
   Based on given amount of servings diet planner will select appropriate
number of servings of each food item. Eg. If diet order calls for 3 starchy
exchanges, client may receive 1 slice of bread for breakfast ,1/3 of a cup for 
unch and ½ a cup of mashed potatoes for dinner.

  
                   Nutrition education

     Whether nutrition education is effective depends on the extend
to which client change their eating habits in response to it.

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