Ah, no work today. I have been needing this since it was a bit busier than planned this week due to a sick dietitian.
My usual Friday evening routine is to plop down and relax after work. Yesterday I decided I can “plop down” only after I did a little cleaning around my apartment for guilt-free relaxing. I relaxed for a bit then got to work on my spaghetti squash. I’ve never used this squash before and only had it in my kitchen because another dietitian gave it to me.
Another dietitian told me how to cook it. She told me to cut it open lengthwise.
Next, to put it in the oven at 375 for 30-40 minutes. She said you’ll know its done when the seeds begin turning black.
I did a few fork pricks to check the done-ness. I scooped out the seeds and fibrous strings and then shredded the remaining flesh with a fork to create “spaghetti.” I defrosted marinara sauce that I made months ago that’s been waiting patiently in the freezer to be used and topped the squash.
I also made caramelized Brussels sprouts while the squash was finishing up in the oven. I couldn’t stop thinking about this recipe since I saw it last week. The vegetable ended up tasting a bit more dessert-like so I think next time I make this I’ll use less brown sugar.
The verdict on the spaghetti squash? It’s just as tasteless as I had read about. Your sauce needs to be amazing and plentiful when eating spaghetti squash. It was a good experience, I’d probably make it again next fall.
Dietitians don’t use soap-soap notes that is. SOAP notes are a charting style that had been used by dietitians and are used by most other clinicians still. SOAP is an acronym for: Subjective, Objective, Assessment, and Plan.
Most dietitians now use the NCP style of charting (I’ve visited a few hospitals that do something just a little different). The Nutrition Care Process is still somewhat new in the dietetics world. The major difference from SOAP notes to NCP notes is the PES statement.
The Nutrition Care Process involves 5 “categories” to document. They include Assessment, Diagnosis, Intervention, and Monitor/Evaluation. With paper charting I’d write out “ADIME” vertically and fill in each section.
The “Diagnosis” or PES statement is what drives a note! (To confuse you more, not all notes need a diagnosis. Patients who are not at nutritional risk do no require a diagnosis.)
When assessing a patient, we determine what the main nutrition problem is with a patient. I was super
cool nerdy and slapped a PES statement in Kath’s comment section last night, so let’s use that as an example. Patient has pancreatitis. The main nutrition issue with pancreatitis is abdominal pain and other GI symptoms and feeding. Most patients are NPO (nothing by mouth) for pancreatitis in order to let the pancreas rest.
I used the nutrition diagnosis of “Altered GI Function” due to pancreatitis for Problem. The Etiology is pancreatitis. Signs and symptoms is “diet order of NPO” and if patient had any pain (likely) I’d tack that on as well. This PES statement could be written as:
Altered GI function related to pancreatitis as evidenced by NPO status, abdominal pain.
Now our Intervention has to reflect how we are going to improve/resolve our diagnosis which in this case is altered GI function. I would recommend to advance diet as medically appropriate within 72 hours. If anticipated pt will be NPO > 72 hours or pt does go >72 hours NPO, recommend to consider nutrition support. Nutrition support in this case would be TPN to allow the pancreas to rest. Tube feeding would not be appropriate because it does not rest the gut/pancreas.
Now Monitoring/Evaluation needs to be driven by the diagnosis/PES. I would want to primarily monitor diet order/energy intake and GI symptoms. Evaluation is based on a system that we have based on their nutritional risk level. I’ll save that for another day.
Simple as that. Not really of course. PES statements were the biggest thing that I had to work on during my internship. Sometimes there are numerous diagnoses you could use and sometimes you are struggling to find an appropriate one. For example, there’s a diagnosis of “Inadequate oral intake” that may seem like it could have been used with my example, but with experience and the feeling in my bones “Altered GI funciton” is the appropriate diagnosis.
Hope you learned something rather than stopped reading or are now more confused than before reading.