Nutrition Intervention, Monitoring, and Evaluation
Nutrition Intervention, Monitoring, and Evaluation covers selecting and delivering the intervention, then judging whether it worked. Interventions include food and nutrient delivery, nutrition education, counseling, and coordination of care; the nutrition prescription specifies energy, protein, route, and frequency.
Core rules
- Choose the least invasive effective route: oral diet and supplements before enteral nutrition, enteral before parenteral when the gut works.
- Enteral access: nasogastric for short-term gastric feeding; post-pyloric (NJ) when aspiration risk or delayed gastric emptying; PEG for long-term use.
- Refeeding syndrome risk: low BMI, unintentional weight loss, little intake for more than 5 days, low potassium, magnesium, or phosphate. Give thiamine before feeding, correct electrolytes, start at 10-15 kcal/kg/day, and advance slowly.
- Monitoring compares status with intended goals using specific indicators (intake, weight, labs, functional status) and a defined reassessment interval.
- Evaluation documents whether goals were met and whether the plan continues, changes, or ends.
Worked example
A patient with a BMI of 15 kg/m² and 10 days of minimal intake is starting enteral nutrition. Phosphate is 1.8 mg/dL. The plan: thiamine 200-300 mg before feeding, start at 10-15 kcal/kg/day, check phosphate, potassium, and magnesium daily for the first week, and increase formula only after electrolytes are stable. Monitoring indicators are intake volume, electrolyte trends, weight, and edema.
Traps
Starting goal-rate feeding in a high-risk patient; forgetting thiamine; documenting "patient ate well" without quantities; confusing monitoring (tracking) with assessment (baseline data); and continuing a plan that is not meeting goals.