Evaluating the Nutrition Care Plan
After you have implemented the plan, you want to follow-up and evaluate it to see if it has been effective in addressing your nutrition concerns. This can help you to decide on appropriate changes to make to the nutrition care plan moving forward.
When evaluating your plan in a inpatient setting, you will need to gather updated information from the same key areas of nutrition concern that you identified in your initial assessment. This will include, but is not limited to, the diet order, daily inputs and outputs, malnutrition, laboratory values, education, and the medical care plan.
Questions to evaluate nutrition care plan effectiveness, by issue type
| Common Nutrition Issues |
Questions to Evaluate Effectiveness of NCP |
| Diet |
- Are they tolerating current dietary order?
- Are they eating and drinking? If calorie counts available – how much? Macronutrient distribution?
- Does the patient have any complaints or concerns?
|
| Daily Input and Output |
- Fluid balance? Ostomy output? Urine output?
- GI tolerance? Does the patient have any complaints?
- Changes in IV fluids?
|
| Malnutrition |
- Has weight changed (depending on length of stay or readmission)?
- Has energy/ lethargy improved?
- Changes in appetite?
|
| Abnormal Electrolytes |
- Electrolytes normal?
- Are laboratory values being checked on an appropriate schedule & replaced in a timely manner?
|
| Education |
- Did the patient understand your education? Do they have any questions?
- Do they require outpatient follow up?
|
| Medical Care Plan |
- Are there any changes to the medical care plan?
- Changes in medications that impact the nutrition care plan?
- Any updated laboratory work, procedures, or assessments (MD, PT)?
- Disposition planning? Does this impact your nutrition care plan?
|
Review the evaluation chart for Sam’s nutrition care plan. This chart is a representation of our evaluation on day 3 based on what we implemented on day 2.
Outcomes of Sam’s nutrition care plan, by issue type
| Common Issues |
Evaluate effectiveness of NCP |
Sam’s outcomes |
| Diet |
- Tolerating full fluid diet.
- Calorie counts reveal intake of ~ 1300 kcal/day (drinking 3 vanilla Ensure +, Gatorade and apple juice)
- Oral fluid intake estimated at 1500 mL.
- Patient reports appetite is improving each day.
|
- Progress to low residue diet on day 3 (as planned). Emphasize importance of soluble fiber.
- You may consider liaising with MD to reduce IV fluids (50 – 75 cc/ hour). Sam continues to improve his oral intake of fluids (but consider other factors – laboratory values, absorption of fluid, etc)
|
| Daily Input and Output |
- Ostomy output 1.5 L on day 3.
- Receiving ⅔ + ⅓ @ 100 mL/hr.
|
- 1 day of higher than normal ostomy output. Monitor on day 4 (i.e. may not require immediate attention as it is a new ileostomy – wait to see if outputs decrease).
- High ostomy output education (soluble fibre).
- Consider adding Metamucil to diet while in hospital, if high outputs continue.
|
| Malnutrition |
- Only three days since initiation – no need for evaluation at this time.
- Fatigue and appetite seems to be improving (patient report).
|
- Emphasize ‘making the most’ out of moments when Sam feels hungry and energized. These moments should be used to improve nutrition.
|
| Abnormal Electrolytes |
- Electrolytes have been normal over the past three days.
|
- Continue to monitor (while in hospital).
- Liaise with team regarding replacements, if necessary (in light of recent high output – risk of greater losses).
|
| Education |
- You provided Sam education (and handouts to take home) on day 2.
- Sam does not have any questions today about the education and feels confident about the plan.
|
- Check in once more with Sam on his nutrition education prior to being discharged (if possible).
|
| Medical Care Plan |
- No changes to medical care plan- appears to be tolerating well and ostomy is actively functioning.
- Monitor and prepare for discharge home on day 5.
|
- Continue to monitor patient until he is discharged.
|
The Nutrition Care Process Model
As you use the Nutrition Care Process Model and the learning from this case study as a guide throughout your patient care in practicum, please keep in mind that the process is dynamic, and not step-by-step as all cases are different. You are encouraged to complete the recommended readings for this module and continue to expand your learning in this clinical area of practice.
PART 4: EVALUATE COMPLETE. Pause to reflect on the evaluation strategies discussed, and review the readings and resources in the following section for your information.
You’ve now completed the nutrition for Inpatient GI module. Please consider providing feedback through the embedded form in the next section.
Acknowledgements
Cristina Gandolfi, MSc, RD
Michaela Kucab, MHSc, RD
