Nutrition Care Process Worksheet

Patient ID Diabetes

Step 1 - Nutrition Assessment

Food/Nutrition-Related History
1. Food and nutrient intake
2. Food and nutrient administration
3. Medication and
complementary/alternative medicine
use
4. Knowledge/beliefs/attitudes
5. Behavior
6. Factors affecting food access and
food/nutrition-related supplies
7. Physical activity and function
8. Nutrition-related patient/client-centered
measures

Anthropometric Measurements
1. Height/length
2. Weight
3. Frame size
4. Weight change
5. Body mass index
6. Growth pattern indices/percentile ranks
7. Body composition estimates
Biochemical Data, Medical Tests and
Procedures

Nutrition-Focused Physical Findings

1. Overall appearance
2. Body Language
3. Cardiovascular-pulmonary
4. Extremities, muscles and bones
5. Digestive system
6. Head and eyes
7. Nerves and cognition
8. Skin
9. Vital signs
Client History

Possible Nutrition Diagnosis

Knowledge and beliefs of diabetes.
1. Pt reports she sometimes follows a
diabetic diet at home but often eats
processed sugar if her blood glucose is
under 60 in the AM.
2. Pt consumes all of her intakes orally.
3. Pt is on Humalog, Lantus, and Victoza
for diabetes control.
4. Pt did not want any diabetic diet
information and said she has her
diabetes under control.
5. Pt takes all of her medicine and feels
she has control of her diabetes
compared to the past.
6. No factors affecting access to food or
food/nutrition related supplies.
7. Pt did not report.
8. N/A
1. 65
2. 203#
3. Medium
4. Pt gained 8 pounds in 5 days.
5. BMI 33.8
6. N/A
7. IBW: 125#, %IBW: 162.4%
GLU 151, 142, 212, 288, 163, 154
HgbA1C 8.0
BUN 20

1. Overall healthy.
2. Positive body language and interested
in my conversation.
3. N/A
4. Normal
5. Normal
6. Normal
7. Normal
8. Warm and dry
9. Temp: 96.1, BP 118/77
1. 59y old female, here for spinal fusion.

1. Personal history
2. Patient/client/family medical/health
history
3. Social history

Comparative Standards
1.
2.
3.
4.
5.

Energy needs
Macronutrient needs
Fluid needs
Micronutrient needs
Weight and growth recommendations

Hx of sinus infections, high cholesterol,

HTN, diabetes, GERD, pneumonia.
2. Mother hx of diabetes, father hx of
heart disease.
3. Pt lives at home with husband, socially
drinks and does not smoke.
1. Mifflin-St Joer
161 + 10 (92.3 kg) + 6.25 (165.1cm) -5
(59) = 1,820.9 kcal/day
2. 0.8-1g pro/kg = 73.8- 92.3 g pro/day
3. 30ml/kg= 30 x 92.3= 2769 ml
4. Multivitamin/ mineral supplement that
meets RDA.
5. N/A

Critical thinking:
1. Determine appropriate data to collect
2. Select valid and reliable tools for data collection
3. Select appropriate norms and standards for comparing data
4. Organizing the data in a meaningful way that relates to the nutrition problem
5. Categorizing the data in a meaningful way that relates to the nutrition
problem

Class of
Diagnosi
s

Step 2 Nutrition Diagnosis

Intake (NI)
Class 1 Energy Balance (NI-1.1 to NI 1.5)
Class 2 Oral or Nutrition Support Intake (NI2.1 to
NI-2.11)
Class 3 Fluid Intake (NI-3.1 to NI-3.2)
Class 4 Bioactive Substances Intake (NI-4.1 to
NI 4.3)
Class 5 Nutrient Intake (NI-5.1 to NI-5.4)
Subclass 5.5 Fat and Cholesterol (NI-5.5.1 to
NI-5.5.3)
Subclass 5.6 Protein (NI-5.6.1 to NI-5.6.3)
Subclass 5.7 Amino Acid (NI 5.7.1)
Subclass 5.8 Carbohydrate and Fiber (NI5.8.1 to 5.8.6)
Subclass 5.9 Vitamin (NI-5.9.1 to NI-5.9.2)
Subclass 5.10 Minerals (NI-5.10.1 to NI5.10.2)
Subclass 5.11 Multi-nutrient (NI-5.11.1 to NI5.11.12)
Clinical (NC)
Class 1 Functional (NC-1.1 to NC-1.5)
Class 2 Biochemical (NC-2.1 to NC-2.4)
Class 3 Weight (NC-3.1 to NC-3.6)
Class 4 Malnutrition Disorders (NC-4.1)
Behavioral-environmental (NB)
Class 1 Knowledge and beliefs (NB-1.1 to NB1.7)
Class 2 Physical Activity and Function (NB-2.1 to
NB-2.6)
Class 3 Food Safety and Access (NB-3.1 to NB3.3)
Other
No nutrition diagnosis at this time (NO-1.1)

Expanded Nutrition Diagnostic

Terminology found in the eNCPT
located at:
https://ncpt.webauthor.com/

(P) Diagnosis or Problem

Altered nutrition related laboratory values (NC 2.1)
Related to
(E) Etiology
Diabetes
As Evidenced by
(S) Signs/Symptoms
Blood glucose range 128-288mg/dL and A1C 8.0%

Step 3 Nutrition Intervention

Food and/or Nutrient Delivery (ND)
Meal and Snacks (ND-1.1 to ND-1.5)
Enteral and Parenteral Nutrition (ND-2)
Enteral Nutrition (ND-2.1.1 to ND-2.1.9)
Parenteral Nutrition/IV Fluids (ND-2.2.1 to ND-2.2.8)
Nutrition Supplement Therapy (ND-3)
Medical Food Supplement Therapy (ND-3.1.1 to ND-3.1.5)
Vitamin and Mineral Supplement Therapy (ND-3.2.1 to
ND-3.2.4)
Bioactive Substance Management (ND-3.3.1 to ND-3.3.9)
Feeding Assistance (ND-4.1 to D-4.6)
Manage Feeding Environment (ND-5.1 to ND-5.9)
Nutrition-Related Medication Management (ND-6.1 to ND6.3)

Expanded Nutrition
Diagnostic Terminology
found in the eNCPT located
at:
https://ncpt.webauthor.com/

Nutrition Education (E)

Nutrition Education-Content (E-1.1 to E-1.7)
Nutrition Education-Application (E-2.1 to E-2.3)

Nutrition Counseling (C)

Theoretical basis/approach (C-1.1 to C-1.5)
Strategies (C-2.1 to C-2.11)

Coordinated of Nutrition Care by a Nutrition

Professional (RC)
Collaboration and Referral of Nutrition Care (RC-1.1 to RC1.6)
Discharge and Transfer of Nutrition Care to New Setting or
Provider (RC-2.1 to RC-2.3)

Nutrition Prescription
Initial/Brief Nutrition Education on 1800 calorie ADA diet (E-1 and E-2) including eating 3 meals a
day spaced 4-6 hours apart containing 45-60g CHO at each meal. Snacks between meals are to
be 15g CHO. Handouts: My Food Plan and Carbohydrate Counting for People with Diabetes.
Intervention

Provide a brief overview of a diabetes diet and carbohydrate counting to help

#1
Goal

stabilize blood glucose (NI 5-8).

Pt will be able to state how many grams of CHO she needs at each meal.

#1
Goal

Pt will eat 3 meals a day spaced 4-6 hours apart.

#2
Goal

Pt will be able to read a food label and count carbohydrates correctly.

#3

Step 4 Nutrition Monitoring and Evaluation

Food/Nutrition-Related History
1. Food and nutrient intake
2. Food and nutrient administration
3. Medication and complementary/alternative medicine
use
4. Knowledge/beliefs/attitudes
5. Behavior
6. Factors affecting food access and food/nutritionrelated supplies
7. Physical activity and function
8. Nutrition-related patient/client-centered measures
Anthropometric Measurements
1. Height/length
2. Weight
3. Frame size
4. Weight change
5. Body mass index
6. Growth pattern indices/percentile ranks
7. Body composition estimates
Biochemical Data, Medical Tests and Procedures
Nutrition-Focused Physical Findings

Diagnostic Terminology
found in the eNCPT located
at:
https://ncpt.webauthor.com
/

Comparative Standards
1.
2.
3.
4.
5.

Energy needs
Macronutrient needs
Fluid needs
Micronutrient needs
Weight and growth recommendations

Targets on nutrition intervention

Carbohydrate Intake (FH 1.5-3) will be consistent at each meal.
Food and Nutrition Knowledge/Skill (FH 4.1) will increase regarding an 1800 ADA diet.
Intervention and goal/expected

Increase food and nutrition related knowledge on a dietetic

outcome
Indicat Conversation with pt.

diet.

or
Conversation with pt.
Indicat
or

Criteri

Pt will be able to verbalize how many

a
Criteri

grams CHO she needs at each meal.

Pt will be able to verbalize how many

meals a day she needs and spacing

between each meal.