Nutrition Care Process (ADIME) Process

• ADIME Nutritional Care Process

  • Nutritional Assessment
  • Adequate Diet
  • Assessment of Nutritional Status
  • Nutritional Status Assessment
• Adequate Diet

  Composed of various nutrients which body needs for maintenance, repair, and for growth and development
• Essential components of an Adequate Diet

  • Milk Group
  • Meat Group
  • Bread and Cereal Group
  • Vegetable-Fruit Group
• Nutritional Status or Nutriture

  The degree to which the individual's psychological need for nutrients is being met by food she or he eats<|>The state of balance in the individual between the nutrient intake and the nutrient expenditure or needs
• Nutritional Status Assessment Methods

  • Dietary History and Intake Data
  • 24 Hour Recall
  • Food Frequency Questionnaire
  • Dietary History
  • Food Diary or Record
  • Observation of Food Intake
• Dietary History Information

  • Income
  • Physical activity
  • Ethnic and cultural background
  • Influences on eating habits and religion
  • Home life and meal patterns
  • Factors that affect appetite
  • Allergies, intolerances, food avoidance
  • Dental and oral problems in eating
  • Gastrointestinal problems
  • Chronic diseases
  • Dietary modifications
  • Medication
• Religious/Ethnic Dietary Restrictions

  • Christianity - No meat on Good Friday
  • Seventh Day Adventist - No pork, shellfish, alcohol, encourages vegetarian diet
  • Judaism - No pork, shellfish, blood products, no mixing of milk and meat, Kosher diet, no cooking on Sabbath
  • Mormon - No alcohol, tobacco, caffeine
  • Islam - No pork, alcohol, caffeine, Ramadan fasting
  • Hinduism - All meats prohibited
• Food Avoidance

  • Phenylalanine (low protein diet for Phenylketonuria)
  • Purine (reduce uric acid producing foods for gouty arthritis and hyperuricemia)
  • Tyramine (high protein foods that underwent breakdown)
  • Gluten (for Celiac Disease)
• Medication Interactions

  • Monoamine Oxidase Inhibitors (avoid tyramine containing foods)
  • Warfarin Sodium (avoid or reduce green leafy vegetables)
  • Methimazole (avoid seafood and iodine products)
  • Estrogen Replacement Therapy (avoid or reduce alcohol, caffeine, smoking)
• General Rules for Menu Planning


  • Use the whole day as a unit rather than the individual meal
  • Use some food from each food group daily
  • Use some raw fruits or vegetables at least once a day
  • Plan to have at least one food with staying power or high satiety value per meal
  • Combine or alternate bland and pronounced flavors
  • Combine and alternate soft and crisp foods
  • Have a variety of color, food and food arrangement
  • Decrease portion sizes and use fewer rich foods when more foods are served at one meal
  • Consider family habits and needs when planning meal patterns
• It is best to have a weekly menu plan
• Methods of Nutritional Assessment

  • Clinical Examination
  • Biochemical Examination
  • Anthropometric Measurement
• Clinical Examination

  Advantages: more coverage in a short time, inexpensive, no sophisticated equipment

  Disadvantages: non-specificity of signs, overlapping of deficiency states, bias of the observer
• Biochemical Examination

  Advantages: objectivity, can detect nutritional deficiency states easily

  Disadvantages: costly, time consuming, factors affecting accuracy like standards, collection, transport and storage
• Anthropometric Measurement

  Measurement of the variations of the physical dimensions and gross composition of the human body at different age levels and degrees of nutrition
• Anthropometric Measurements

  • Weight for age
  • Height for age
  • Weight for height/length
  • Skin fold thickness
  • Body circumferences
  • Birth weight
• Healthy Waistline

  Women - <31 inches

  Men - <35 inches
• Methods that provide Indirect Nutritional Information

  • Food Consumption Studies
  • Studies on Health Condition and Vital Statistics
  • Studies on food supply situation
  • Studies on socio-economic conditions
  • Studies on cultural and anthropological influences
• Malnutrition

  A global problem, a condition caused by sustained, deficient, excessive, or imbalanced supply of calories, and nutrients
• Forms of Malnutrition

  • Under nutrition
  • Specific deficiency
  • Over nutrition
• Types of Malnutrition

  • Acute malnutrition
  • Chronic malnutrition
• Effects of Malnutrition

  • Increases susceptibility of infections
  • Inhibits mental development
  • Imposes heavy social and economic burdens
• Causes of Malnutrition in the Philippines

  • Poverty
  • Poor distribution of food supply
  • Large family size
  • Low level of education among household members
• Body Mass Index (BMI)

  The most acceptable parameter and the simplest way to determine the nutritional status of school children

  Formula: Weight in kg / (Height in m)^2
• BMI Interpretation

  • <18.5 - Underweight

  18.5 - 24.9 - Healthy

  25 - 29.9 - Overweight

  30 - 34.9 - Obese I

  35 - 39.9 - Obese II

  >40 - Extremely Obese
• Waist Circumference

  An accurate measure of the amount of visceral fat (central obesity)

  Normal: Men <90 cm, Women <80 cm
• Waist Hip Ratio

  Normal: Men <1, Women <0.85

  Equal to or greater than 1 (men), 0.85 (women) means android or central obesity
• Weight for Age

  Sensitive indicator of current nutritional status
• Height for Age

  Indicator of past nutritional status (chronic malnutrition)
• Weight for Height


  Most accurate indicator of present or current state of nutrition
• Skinfold Thickness

  Assesses body composition and fat distribution
• Mid-upper Arm Circumference

  Can be used for rapid diagnosis of PEM in children 1-4 years old

  <12.5 cm - Undernutrition

  12.5 to 13.5 cm - Risk of undernutrition

  >13.5 to 16 cm - Adequate nutrition
• Nurse

  • Usually the first person who sees the patient's eating problems
  • Has direct communication with the patient
  • Observes how well the patient eats his food
  • Observes what kinds and amounts of food are refused
  • Observes the patient's attitude towards his food
  • Must have a knowledge in diet therapy (food allowed / restriction)
  • Should immediately forward the diet prescription to the dietary department
  • Makes sure that the patient is ready to consume the food served on the tray
• Nurse

  • Shows his/her general interest and understanding of the patient
  • Helps the patient express his/her feelings
  • Learned from the patient some of his/her favorite foods and dislikes
  • Explains concerns on foods that cannot be eaten due to ethnic, cultural background and religious beliefs
  • Becomes aware of what concerns the patient may have about the diet he will have at home
• Reporting

  Documents and charts all the problems related to food intake
• Nutritional History

  • Dietary Intake Data
  • Dietary Computations: Desirable Body Weight, Basal Metabolic Rate, Total Energy Requirement, Food Exchange List
  • Nutrient Intake Analysis (NIA)
  • Food Diary
  • Food Frequency
  • 24 hour Recall
• Physical Assessment

  • Anthropometric Measurements: Height and Weight, Body Mass Index, Body Composition, Mid-arm Circumference (MAC), Fat-fold or Skin-fold Thickness
• Other Sources of Data

  • Malnutrition Universal Screening Tool (MUST)
  • Subjective Global Assessment (SGA)
  • Mini Nutritional Assessment (MNA)
  • Geriatric Nutritional Risk Index (GNRI)
• BLEP

  Unknown
• Nutrition Diagnosis

  Identify and label the nutrition problem