Step 4: Evaluate

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 an inpatient setting, you will need to gather updated information from the same key areas of nutrition concern that you identified in your initial assessment.

In populations with chronic kidney disease, the three main areas to commonly re-assess include:

  1. Malnutrition
  2. Abnormal electrolytes
  3. Fluid overload
Common Nutrition Issues Evaluate effectiveness of NCP
  • Has weight increased?
  • Improvements in appetite?
  • Increased protein or caloric intake from diet history?
  • Improvements in pre-dialysis urea? (for dialysis pts)
Abnormal Electrolytes
  • If hyper/hypo-kalemic, can ask for a repeat of serum potassium
  • If hyper/hypo-phosphatemic, can ask for a repeat of serum phosphorus
  • If taking phosphate binders, can ask for repeat calcium and phosphorus
  • Appropriate changes in diet and/or nutrition knowledge?
Fluid Overload
  • Improvements in fluid/sodium intake from diet history?
  • Improvements in edema, weights, , (if on dialysis)?

Evaluating Raymond’s Nutrition Care Plan

When assessing Raymond’s status after the implementation of your nutrition care plan, you want to see if his phosphorus levels are WNL since he was previously hyperphosphatemic, so you request a repeat for serum phosphorus. You also decided to start a calcium based phosphate binder after liaising with the team, so you’ll want to request a calcium level as well. Finally you’ll want to check his fluid status by seeing if there have been any improvements in his edema.

The results of the lab work you requested show that his serum phosphorus is 1.42 and is now WNL, but his calcium went up slightly to 2.55 as a result of starting the calcium-based phosphate binders. This means you’ll have to keep an eye on his calcium and switch to a non-calcium based binder if it continues to rise. There has also been slight improvements in his ankle edema. As part of the plan you will continue the fluid restriction and low sodium diet and continue to monitor his fluid status and edema.

Keep in mind that another part of evaluation that occurs in outpatient settings is following up with the patient regarding the SMART goals they set.

Common Nutrition Issues Evaluate effectiveness of NCP Outcome
Malnutrition No concerns at this time
Abnormal Electrolytes
  • Previously hyperphosphatemic, so ask for a repeat of serum phosphorus
  • Taking calcium-based phosphate binder, so ask for repeat calcium
  • Serum PO4 = 1.42 mmol/L (WNL)
  • Ca = 2.55 mmol/L (up slightly from 2.4 mmol/L on admission)
Fluid Overload
  • Improvements in fluid/sodium intake from diet history?
  • Improvements in edema?
  • Slight improvements

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 Renal nutrition module. Please consider providing feedback through the embedded form in the next section.


Arti Sharma Parpia, RD, MSc
Jess Wiles, RD, MHSc(c)



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Preparation for Dietetic Practice Copyright © by Megan Omstead, RD, MPH is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.