Template Directions

1. Template Directions Welcome to the NCP Mini Case Study Presentation Template! This template will help as you prepare your presentation and will keep you on track! Each slide lists instructions/suggestions for completing the different NCP steps. These instructions are found in the �Notes� section of each slide. Feel free to change the formatting and background of the PowerPoint presentation as much as you would like. The template will just help you prepare your content!

2. Title of Mini Case Study Intern Name Add the title of your Mini Case Study. Add your name! The NCP consists of 4 steps. The goal of this presentation is to focus on those 4 steps. Add the title of your Mini Case Study. Add your name! The NCP consists of 4 steps. The goal of this presentation is to focus on those 4 steps.

3. Step #1: Nutrition Assessment Client History Step #1 is Nutrition Assessment. It consists of 6 areas. All 6 areas must be covered in your presentation. I have each listed on its own slide to designate each area; however, you can combine 2 or more areas on one slide if there is not a lot of information. Or you can add an additional slide if one category has a lot of information. I find that starting with Client History is best because it introduces the client so we have an idea of what is going on. Client history should include the following information as applicable: Personal history/data Patient/Client/Family Medical/Health History (this includes the patient�s current diagnosis) Treatments/therapy/alternative medicine Social History See your book pages 33 (2nd ed.) or 75 (3rd ed.) for more specifics on what is covered under Client HistoryStep #1 is Nutrition Assessment. It consists of 6 areas. All 6 areas must be covered in your presentation. I have each listed on its own slide to designate each area; however, you can combine 2 or more areas on one slide if there is not a lot of information. Or you can add an additional slide if one category has a lot of information. I find that starting with Client History is best because it introduces the client so we have an idea of what is going on. Client history should include the following information as applicable: Personal history/data Patient/Client/Family Medical/Health History (this includes the patient�s current diagnosis) Treatments/therapy/alternative medicine Social History See your book pages 33 (2nd ed.) or 75 (3rd ed.) for more specifics on what is covered under Client History

4. Step #1: Nutrition Assessment Food/Nutrition History Next under Step #1: Nutrition Assessment should focus on the Food/Nutrition History (we are interested in nutrition stuff- right?). Food/Nutrition History can cover many different things. I�d suggest you review pages 31-32 (2nd ed.) or 73-74 (3rd ed.) even if you think you know what goes under this section. To name just a few: Diet History Diet order Diet experience Intake (kcal, protein, nutrients, alcohol, etc) Medications and herbal supplements Knowledge/beliefs/attitudes Access to food Physical activity and function Next under Step #1: Nutrition Assessment should focus on the Food/Nutrition History (we are interested in nutrition stuff- right?). Food/Nutrition History can cover many different things. I�d suggest you review pages 31-32 (2nd ed.) or 73-74 (3rd ed.) even if you think you know what goes under this section. To name just a few: Diet History Diet order Diet experience Intake (kcal, protein, nutrients, alcohol, etc) Medications and herbal supplements Knowledge/beliefs/attitudes Access to food Physical activity and function

5. Step #1: Nutrition Assessment Anthropometrics Next is Anthropometrics found on pages 32 (2nd ed.) or 74 (3rd ed.) This includes: HT WT BMI Growth pattern Weight history*- this is the place to report if there has been any wt loss! Next is Anthropometrics found on pages 32 (2nd ed.) or 74 (3rd ed.) This includes: HT WT BMI Growth pattern Weight history*- this is the place to report if there has been any wt loss!

6. Step #1: Nutrition Assessment Biochemical Biochemical is next. This includes laboratory data and tests that a lab would do. There is a lot of things that could go under this section so take the time to review the options on page 32 (2nd ed.) or 74 (3rd ed) of your book. Biochemical is next. This includes laboratory data and tests that a lab would do. There is a lot of things that could go under this section so take the time to review the options on page 32 (2nd ed.) or 74 (3rd ed) of your book.

7. Step #1: Nutrition Assessment Physical Exam The 5th area is the Nutrition Focused Physical Exam. The general categories are listed below, but you�ll want to see page 163-164 (2nd ed.) or 188-190 (3rd ed.) for items that specifically fall under this category. Overall appearance Body Language Cardiovascular-pulmonary Extremities, muscles and bones Digestive system (anything from mouth to rectum) Head and eyes Nerves and cognition Skin Vital signs **Note- nausea, vomiting, and appetite are listed under this section (although it probably could be listed under Food/Nutrition History too).The 5th area is the Nutrition Focused Physical Exam. The general categories are listed below, but you�ll want to see page 163-164 (2nd ed.) or 188-190 (3rd ed.) for items that specifically fall under this category. Overall appearance Body Language Cardiovascular-pulmonary Extremities, muscles and bones Digestive system (anything from mouth to rectum) Head and eyes Nerves and cognition Skin Vital signs **Note- nausea, vomiting, and appetite are listed under this section (although it probably could be listed under Food/Nutrition History too).

8. Step #1: Nutrition Assessment Comparative Standards Finally, the last (6th category) in the Step #1 Nutrition Assessment is the Comparative Standards. Generally this is where you list the estimated needs of your patient/client. Those estimated needs may include (as appropriate): Kcal Protein Fat CHO Fiber Fluid Vitamin/Minerals It also includes the recommended weight and growth so that could include: IBW Recommended BMI Desired growth pattern (i.e. 1 # wt gain/wk)Finally, the last (6th category) in the Step #1 Nutrition Assessment is the Comparative Standards. Generally this is where you list the estimated needs of your patient/client. Those estimated needs may include (as appropriate): Kcal Protein Fat CHO Fiber Fluid Vitamin/Minerals It also includes the recommended weight and growth so that could include: IBW Recommended BMI Desired growth pattern (i.e. 1 # wt gain/wk)

9. Step #2: Nutrition Diagnosis Diagnosis 1 PES Statement Step #2: Once you have the Assessment you can use that information and decide what the nutrition problem(s) is/are and what is causing it (etiology). Then you must have information that supports or proves that your problem and etiology are indeed the problem and etiology (the signs/symptoms). Together this information is written in the PES Statement. List here your PES statement. You may have more than one, so just add it to this slide or add additional slides as needed Helpful tips in writing your PES Statement: You must use the terminology found on page 201 (2nd ed.) or 213 (3rd ed.) for the Problem (P). Don�t make up your own vocabulary. If you choose a problem that asks you to specify�make sure you do. An example would be NI-5.1 Double check to make sure you have selected the correct etiology. Ask yourself, �does this ____ really cause my problem ____? If not you may need to adjust it so it makes sense. Try not to use the medical diagnosis (or any diagnosis) as the etiology. That is not always possible but usually you can reword it differently so it focuses on the nutrition related cause. For example, if your patient has swallowing difficulty and just had a stroke�DON�T say swallowing difficulty related to stroke! Yes, the stroke may have brought on the swallowing difficulty, but really it is the paralysis of the throat muscles (which occurred because of the stroke) that we want to focus on. Always ask yourself �WHY� even once you have an etiology. This will help make sure you have the root cause. So if you have listed malnutrition related to inadequate intake�ask yourself, WHY? You might answer yourself�because the patient doesn�t have access to food. All of a sudden your etiology is different and that will greatly affect your intervention. If you are including something in your PES statement that does not appear in your nutrition assessment- there is a problem. Go back and add that information to step #1 or you shouldn�t be using it. Step #2: Once you have the Assessment you can use that information and decide what the nutrition problem(s) is/are and what is causing it (etiology). Then you must have information that supports or proves that your problem and etiology are indeed the problem and etiology (the signs/symptoms). Together this information is written in the PES Statement. List here your PES statement. You may have more than one, so just add it to this slide or add additional slides as needed Helpful tips in writing your PES Statement: You must use the terminology found on page 201 (2nd ed.) or 213 (3rd ed.) for the Problem (P). Don�t make up your own vocabulary. If you choose a problem that asks you to specify�make sure you do. An example would be NI-5.1 Double check to make sure you have selected the correct etiology. Ask yourself, �does this ____ really cause my problem ____? If not you may need to adjust it so it makes sense. Try not to use the medical diagnosis (or any diagnosis) as the etiology. That is not always possible but usually you can reword it differently so it focuses on the nutrition related cause. For example, if your patient has swallowing difficulty and just had a stroke�DON�T say swallowing difficulty related to stroke! Yes, the stroke may have brought on the swallowing difficulty, but really it is the paralysis of the throat muscles (which occurred because of the stroke) that we want to focus on. Always ask yourself �WHY� even once you have an etiology. This will help make sure you have the root cause. So if you have listed malnutrition related to inadequate intake�ask yourself, WHY? You might answer yourself�because the patient doesn�t have access to food. All of a sudden your etiology is different and that will greatly affect your intervention. If you are including something in your PES statement that does not appear in your nutrition assessment- there is a problem. Go back and add that information to step #1 or you shouldn�t be using it.

10. Step #3: Nutrition Intervention Nutrition Prescription Step #3: The Nutrition Assessment consists of a two different parts: planning and implementation. Planning consists of 1. prioritizing your diagnosis (so decide what problem is most critical and focus on that first), 2. consulting evidence-based and practice guidelines (to make sure you chose an appropriate intervention), 3. defining the nutrition prescription, 4. setting patient-focused goals that targets each diagnosis, 5. conferring with the patient and caregivers, 6. defining the intervention plan and strategies, 7. define the time and frequency of care, 8. identify resources needed. Implementation includes 1. communication of the plan, 2. carrying out the plan. So you should do steps 1 and 2 of the planning phase and then determine what your nutrition prescription will be. The nutrition prescription concisely defines the patient�s individualized recommended dietary intake of energy and/or selected foods or nutrients based on 1. current reference standards, 2. dietary guidelines, 3. the patient�s health or condition, and 4. the nutrition diagnosis. The purpose of the prescription is to communicate the nutrition professional�s (YOUR) diet/nutrition recommendations based on a thorough nutrition assessment. It may include: Specific energy, protein, fluid needs Specific needs of other vitamins/minerals Specific needs of food groups Specific diet or modification needed Physical activity needs What it doesn�t include: Avoid methods for meeting the needs (i.e. if the patient needs increase protein list the protein amount needed and NOT �send supplement 3 x day) Just don�t be too specific! The prescription tells us what our overall goal is and not how we are getting there. Examples: Tell me 30 min exercise 3 x week� NOT running 2 mile M, W, F! (The prescription gives guidelines but allows us to adjust the actual intervention or way we meet our recommendations) 60 gm of CHO- NOT � cup peaches, 1 slice of bread, 1 cup of milk, � cup of pasta Tell me the kcal, protein, and fluid needed�NOT the specific formula and rate (this is your intervention). Realize we can change to a different formula and rate and still meet the needs and that would be just fine!Step #3: The Nutrition Assessment consists of a two different parts: planning and implementation. Planning consists of 1. prioritizing your diagnosis (so decide what problem is most critical and focus on that first), 2. consulting evidence-based and practice guidelines (to make sure you chose an appropriate intervention), 3. defining the nutrition prescription, 4. setting patient-focused goals that targets each diagnosis, 5. conferring with the patient and caregivers, 6. defining the intervention plan and strategies, 7. define the time and frequency of care, 8. identify resources needed. Implementation includes 1. communication of the plan, 2. carrying out the plan. So you should do steps 1 and 2 of the planning phase and then determine what your nutrition prescription will be. The nutrition prescription concisely defines the patient�s individualized recommended dietary intake of energy and/or selected foods or nutrients based on 1. current reference standards, 2. dietary guidelines, 3. the patient�s health or condition, and 4. the nutrition diagnosis. The purpose of the prescription is to communicate the nutrition professional�s (YOUR) diet/nutrition recommendations based on a thorough nutrition assessment. It may include: Specific energy, protein, fluid needs Specific needs of other vitamins/minerals Specific needs of food groups Specific diet or modification needed Physical activity needs What it doesn�t include: Avoid methods for meeting the needs (i.e. if the patient needs increase protein list the protein amount needed and NOT �send supplement 3 x day) Just don�t be too specific! The prescription tells us what our overall goal is and not how we are getting there. Examples: Tell me 30 min exercise 3 x week� NOT running 2 mile M, W, F! (The prescription gives guidelines but allows us to adjust the actual intervention or way we meet our recommendations) 60 gm of CHO- NOT � cup peaches, 1 slice of bread, 1 cup of milk, � cup of pasta Tell me the kcal, protein, and fluid needed�NOT the specific formula and rate (this is your intervention). Realize we can change to a different formula and rate and still meet the needs and that would be just fine!

11. Step #3: Nutrition Intervention Individual Intervention Goal(s) for each intervention Continuing Step #3- After we have talked with the patient and caregivers to make sure we know what their goals our and their abilities, we will actually define the intervention or what we are going to do to �fix� or �minimize� the problem and set a goal which will help us measure if we are making any progress. Interventions: (see the next slide for information on Goals) List each intervention planned or recommended. Each intervention should fall under one of the intervention categories. See page 351 (2nd ed.) or 337 (3rd ed.). You DO NOT have to use the exact language, but the terms will help you determine what types of interventions are appropriate. Hint! Some interventions are only used in certain settings. The food and/or nutrient delivery (ND) terms are usually only used in IPC, LTC, or homecare settings. If you use the ND terms you are basically saying that you (the RD) are providing that patient with the specific intervention (food, TF, TPN, medication, feeding environment, etc.) or you are specifically recommending it to the MD who can order it. It DOES NOT mean you are recommending it to the patient! Recommending things to the patient falls under EDUCATION. Nutrition education (E) terms can be used really in any setting. Education includes formally teaching an individual, family, or group a specific topic. It also includes when you just casually tell a patient or client about something and maybe suggest they try something. This is education! For example, if you are working with a WIC mother and you want her to offer more snacks you would list that as education (E-2.2, 2nd ed. or E-1.5, 3rd ed.) and not as ND 1.2. Nutrition Counseling (C) terms are generally only going to be used in the OPC or community setting. We don�t have the time to do �counseling� in IPC and is not usually needed in the LTC areas. Coordination of Nutrition Care (RC) is used in all the areas!Continuing Step #3- After we have talked with the patient and caregivers to make sure we know what their goals our and their abilities, we will actually define the intervention or what we are going to do to �fix� or �minimize� the problem and set a goal which will help us measure if we are making any progress. Interventions: (see the next slide for information on Goals) List each intervention planned or recommended. Each intervention should fall under one of the intervention categories. See page 351 (2nd ed.) or 337 (3rd ed.). You DO NOT have to use the exact language, but the terms will help you determine what types of interventions are appropriate. Hint! Some interventions are only used in certain settings. The food and/or nutrient delivery (ND) terms are usually only used in IPC, LTC, or homecare settings. If you use the ND terms you are basically saying that you (the RD) are providing that patient with the specific intervention (food, TF, TPN, medication, feeding environment, etc.) or you are specifically recommending it to the MD who can order it. It DOES NOT mean you are recommending it to the patient! Recommending things to the patient falls under EDUCATION. Nutrition education (E) terms can be used really in any setting. Education includes formally teaching an individual, family, or group a specific topic. It also includes when you just casually tell a patient or client about something and maybe suggest they try something. This is education! For example, if you are working with a WIC mother and you want her to offer more snacks you would list that as education (E-2.2, 2nd ed. or E-1.5, 3rd ed.) and not as ND 1.2. Nutrition Counseling (C) terms are generally only going to be used in the OPC or community setting. We don�t have the time to do �counseling� in IPC and is not usually needed in the LTC areas. Coordination of Nutrition Care (RC) is used in all the areas!

12. Step #3: Nutrition Intervention Individual Intervention Goal(s) for each intervention Continuing Step #3- Setting measurable goals is very important. The goals help us determine if we are making any progress. You need at least one goal (you can have more) that relates back to each of the interventions. One goal can relate back to several interventions, but you CAN�T have interventions listed with no goal(s). Ask yourself�what do I want to have happen or do I want the patient to be able to do or say after my intervention? Remember the goals are what you want the patient to do and not what you are going to do! For example: Maybe your diagnosis was �involuntary weight loss related to inability to prepare meals . . .� and your intervention was to refer the client to meals on wheels so he would still get food even when he isn�t able to prepare them. My goal for this might be something like, �Prevention of further weight loss� or �Client will state he has reliable access to prepared meals�. You can see that each goal relates back to that particular intervention and support our diagnosis. Remember all steps should support and relate back to each other!Continuing Step #3- Setting measurable goals is very important. The goals help us determine if we are making any progress. You need at least one goal (you can have more) that relates back to each of the interventions. One goal can relate back to several interventions, but you CAN�T have interventions listed with no goal(s). Ask yourself�what do I want to have happen or do I want the patient to be able to do or say after my intervention? Remember the goals are what you want the patient to do and not what you are going to do! For example: Maybe your diagnosis was �involuntary weight loss related to inability to prepare meals . . .� and your intervention was to refer the client to meals on wheels so he would still get food even when he isn�t able to prepare them. My goal for this might be something like, �Prevention of further weight loss� or �Client will state he has reliable access to prepared meals�. You can see that each goal relates back to that particular intervention and support our diagnosis. Remember all steps should support and relate back to each other!

13. Step #4: Monitoring/Evaluation Indicators: List specific indicator Criteria Step #4- Finally we will specify how we will or would monitor the patient�s progress. Ask yourself, �how will I know if my interventions are working?� This step consists of 2 parts: 1. the indicator and 2. the criteria. The indicator is basically just that item that you will check or measure to help you determine if your making progress. The criteria defines what you are going to compare your indicator to, so you can determine if you have actually made progress. Your indicator(s) will come from the same list that we used for the nutrition assessment on pages 31-33 (2nd ed.) or 73-75 (3rd ed.). You DO NOT need to use the standard language, but the terms will help you determine what types of things you might measure. Often your goals that you set for your interventions will drive your indicators! The criteria may be your prescription, goals, reference standards, or baseline data from the initial nutrition assessment. For example- continuing from our example under the intervention: One of my goals was the �prevention of further weight loss�. How am I going to measure that�let�s just monitor weight changes�right? So my indicator would be weight changes (AD-1.1.4). Now how am going to determine if I�m heading in the right direction or improving? Well I could compare the new weight to the initial admit weight� correct? I could also just base it on my goal of not losing any weight�correct? So my criteria would be either of those�initial admit weight or my goal of no further weight loss. Both help give me guidelines on how I will determine if my indicator is getting better or worse and if my intervention is really working! So, you need to have at least 1 indicator and criteria that relates back to each intervention/goal. Again- an easy way to do it is to take your goals and make sure you have an indicator that links back to each goal!Step #4- Finally we will specify how we will or would monitor the patient�s progress. Ask yourself, �how will I know if my interventions are working?� This step consists of 2 parts: 1. the indicator and 2. the criteria. The indicator is basically just that item that you will check or measure to help you determine if your making progress. The criteria defines what you are going to compare your indicator to, so you can determine if you have actually made progress. Your indicator(s) will come from the same list that we used for the nutrition assessment on pages 31-33 (2nd ed.) or 73-75 (3rd ed.). You DO NOT need to use the standard language, but the terms will help you determine what types of things you might measure. Often your goals that you set for your interventions will drive your indicators! The criteria may be your prescription, goals, reference standards, or baseline data from the initial nutrition assessment. For example- continuing from our example under the intervention: One of my goals was the �prevention of further weight loss�. How am I going to measure that�let�s just monitor weight changes�right? So my indicator would be weight changes (AD-1.1.4). Now how am going to determine if I�m heading in the right direction or improving? Well I could compare the new weight to the initial admit weight� correct? I could also just base it on my goal of not losing any weight�correct? So my criteria would be either of those�initial admit weight or my goal of no further weight loss. Both help give me guidelines on how I will determine if my indicator is getting better or worse and if my intervention is really working! So, you need to have at least 1 indicator and criteria that relates back to each intervention/goal. Again- an easy way to do it is to take your goals and make sure you have an indicator that links back to each goal!