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High Risk Nutrition Care Plan Guidelines 5
Macronutrient deficiencies include deficiencies in protein, fat, and/or calories and can lead to stunting, pronounced wasting (marasmus) or a disproportionately large abdomen (a sign of kwashiorkor). Micronutrient deficiencies would include deficiencies in vitamins and minerals in the body. Refer to the Nutrient Deficiency Table included in the Nutritional Risk Criteria Manual.
Populations who may be at greater risk of nutrient deficiencies or disease include: • Individuals who have intakes below the established RDA (Recommended Dietary Allowance). • Individuals who experience food insecurity or are experiencing homelessness. • Women who have a short interpregnancy interval. • People with gastrointestinal disease that can limit absorption of nutrients (such as celiac or Crohn’s disease) or individuals with a history of gastrointestinal surgery (such as gastric bypass). • People with other medical conditions that influence nutrient status such as cystic fibrosis, renal disease, and genetic disorders. • Individuals on medications that are known to interact with the absorption or excretion of certain vitamins and minerals. • People who smoke or use other harmful substances.
Assessment, counseling, and referral guidelines: • Complete nutritional assessment according to WIC protocol. • Assess diet, noting any criteria making the participant at risk for nutrient deficiencies. • Investigate the availability of food or food security. • Counsel based on assessment findings. • Make referrals according to Section 3.5 of the WIC Procedure Manual, specifically for smoking cessation, substance abuse, and supplemental feeding programs, as appropriate.
Documentation: • Check “High Risk Education” on the Nutrition Education screen under Nutrition Education Topics and enter “Nutrient Deficiencies or Disease” under Topic Status. • Document the specific details regarding the nutritional assessment and nutrition care plan in the Nutrition Assessment field on the Care Plan Summary. This includes documentation of any prescribed medications and current medical care plan.
Recommendations for the WIC CPA: • Learn about and reinforce the health care team’s plan of care and encourage participants/caregivers to keep all appointments and take any prescribed supplements or medications as directed. • Encourage improved intake of whole grains, legumes, dairy, lean protein, fruits, and vegetables.