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Hypertension Nutrition Assessment Mind Map


Step 1 Nutrition Assessment
The following table illustrates Nutrition Assessment data important to persons with hypertension. Explanatory additions to the NCP Mind Map are in blue italics. NCP terms and codes are in black font. Codes are provided for the domains and the primary and secondary headings beneath each domain.(3)


Select the Nutrition Assessment domain below to go directly to that section.

 

FOOD/NUTRITION-RELATED HISTORY (FH)

FOOD AND NUTRIENT INTAKE (FH-1)
Collect food-intake records, 24-hour recall, food diary or food-frequency questionnaire to estimate the following. 
Energy intake determination (FH-1.1)
·  Estimated energy intake, if overweight
   -  Total energy estimated intake in 24 hours, approximate intake

Food and beverage intake determination (FH-1.2)
·  Fluid intake
   -  Assess for high-sodium beverages such as packet or canned soup, flavored waters, electrolyte replacements and vitamin/mineral waters 
·  Food intake
   -  Estimated/measured grain, fruit, vegetables, milk, protein, fat and discretionary food in 24 hours
   -  Amount of food
   -  Assess for fruits and vegetables high in potassium, canned or frozen vegetables high in sodium
   -  Types of food, assess for high-sodium savory, takeout, processed and pre-prepared foods 
   -  Meal/snack pattern, DASH, Mediterranean or vegetarian diet pattern
   -  Diet quality index

Bioactive constituent intake determination (FH-1.4) 
·  Alcohol intake 
   -   Alcohol intake in one week
   -   Alcohol intake in 24 hours
   -   Days per week alcoholic drinks consumed
   -   Alcohol intake pattern on drinking days
    -  Drink size/volume
    -  Frequency
·  Bioactive substance intake
   -  Estimated bioactive substance intake
       -  Psyllium estimated intake in 24 hours
·  Caffeine intake

Macronutrient intake determination (FH-1.5)
·  Fat intake
   -  Estimated fat intake
        -  Total fat estimated intake in 24 hours, consider food preparation methods
·  Protein intake
   -  Estimated protein intake
        -  Total protein estimated intake in 24 hours
·  Carbohydrate intake
   -  Estimated carbohydrate intake
        -  Total carbohydrate estimated intake in 24 hours
·  Fiber intake
   -  Estimated fiber intake
       -  Total fiber estimated intake in 24 hours
       -  Soluble fiber estimated intake in 24 hours
       -  Insoluble fiber estimated  intake in 24 hours

Micronutrient intake determination (FH-1.6)
·  Mineral/element intake
   -  Estimated mineral intake
        -  Potassium estimated intake in 24 hours, (K)
        -  Sodium estimated intake in 24 hours, (Na)
   -  Measured mineral intake
        -  Potassium measured intake in 24 hours, (K) quantity of potassium in the diet 
        -  Sodium measured intake in 24 hours, (Na) quantity in the diet, use of salt for cooking and at table, restaurant and takeout meals, consider food-preparation methods


FOOD AND NUTRIENT ADMINISTRATION (FH-2)
Diet history (FH-2.1)
·  Diet experience 
   -  Previously prescribed diets for conditions that are risk factors for hypertension, e.g. weight reduction
   -  Previous diet/nutrition education/counseling
·  Eating environment
   -  Location
   -  Atmosphere
   -  Caregiver/companion


MEDICATION AND COMPLEMENTARY/ALTERNATIVE MEDICINE USE (FH-3) 
Medications (FH-3.1)
·  Prescription medication use, hypertension
   -  Anti-hypertensives
   -  Diuretics
   -  Angiotensin converting enzyme (ACE) inhibitors
   -  Angiotensin receptor blockers (ARBs or SARTANS)
   -  Beta-blockers
   -  Thiazide diuretics
·  Over the counter (OTC) medication use
   -  Herbal products affecting blood pressure
·  Misuse of medication

Complementary/Alternative Medicine (FH-3.2)
·  Nutrition-related complementary/alternative medicine use


KNOWLEDGE BELIEF ATTITUDE DETERMINATION (FH-4)
Food and nutrition knowledge (FH-4.1)
·  Nutrition knowledge of individual client (no knowledge, minimal knowledge, basic knowledge, intermediate knowledge, advanced knowledge)
   -  Formerly, area(s) and level of knowledge skill
   -  Principles of Nutrition Intervention for hypertension
   -  Selection/preparation of low-sodium meals and snacks
   -  Diet-disease relationship 
·  Diagnosis specific or global nutrition-related knowledge score

Food and nutrition skill (FH-4.2)
·  Nutrition skill of individual client (no skill, minimal skill, basic skill, intermediate skill, advanced skill)

Belief and attitude determination (FH-4.3)
·  Nutrition priority of individual client
     -  Present/absent, values supporting change
·  Nutrition priority of client's supportive individuals 
     -  Present/absent, values supporting change
·  Nutrition priority of client's supportive structures 
     -  Present/absent, values supporting change
·  Conflict with individual client's value system
     -  Present/absent
·  Conflict with client's supportive individuals' value system 
     -  Present/absent, consider the importance of food-related activities
·  Behavioral beliefs (motivation, control, norms, readiness)
   - Perceived susceptibility to nutrition related health problems score
     -  Self-rated, 1 = very low to 7 = very high perceived susceptibility
   - Perceived severity of risk to health score
     -  Self-rated, 1 = very low to 7 = very high perceived severity of risk
  - Perceived benefit of nutrition-related change score
     -  Self-rated, 1 = very low to 7 = very high perceived benefit
   - Likelihood of performing nutrition-related behavior score
     -  Self-rated, 1 = unlikely to perform behavior to 7 = very likely to perform behavior
   - Perceived control over nutrition related behavior score
     -  Self-rated, 1=very low to 7=very high perceived control
   - Nutrition self-efficacy score (self-belief regarding achieving success) 
     -  Self-rated, 1=very low confidence to 7 = very high confidence in ability
   - Perceived barrier to nutrition related behavior score (barriers to change)
     -  Self-rated, 1=very low to 7=very high perceived barriers
   - Readiness to change nutrition related behavior stage (readiness to change)
      -  Precontemplation stage 
          -  Present/absent
      -  Contemplation stage
          -  Present/absent
      -  Preparation stage
          -  Present/absent
      -  Action stage
          -  Present/absent
      -  Maintenance stage
          -  Present/absent
      -  Relapse stage
          -  Present/absent
   - Readiness to change nutrition related behavior score
      -  Self-rated on scale of 1 to 10; 1 = not ready to 10 = fully ready to change
  - Negative emotions about food and nutrition
     -  Present/absent, consider the impact of change 
  - Positive emotions about food and nutrition 
     -  Present/absent
  - Unrealistic nutrition related goals
     -  Present/absent, weight loss expectations
   - Unscientific nutrition beliefs/attitudes
     -  Present/absent
   - Body image disturbance
     -  Present/absent
   - Preoccupation with food
     -  Present/absent
   - Preoccupation with weight
     -  Present/absent
   - Preoccupation with body shape
     -  Present/absent
   - Negative nutrition self talk
     -  Present/absent, words used to describe lapses to self
   - Positive nutrition self talk
     -  Present/absent
   - Preferences for food
     -  Yes/No, problem energy-dense foods
   -  Consider the taste implications of low-sodium foods
   - Preferences for beverages
     -  Yes/No, problem energy-dense beverages


BEHAVIOR DETERMINATION (FH- 5)
Adherence behavior (FH-5.1)
·  Self reported nutrition adherence score
·  Nutrition encounter ratio 
·  Ability to recall nutrition goals
·  Nutrition self monitoring at agreed upon rate
   -  Blood pressure, dietary intake, physical activity
·  Nutrition self management as agreed upon

Eating behavior (FH-5.4)
·  Readiness to consume new foods
   -  Alternative seasonings to salt, cooking fresh foods


PHYSICAL ACTIVITY AND FUNCTION (FH-7)
Physical activity (FH-7.3)
·  Physical activity history
·  Consistency
·  Frequency
·  Duration
·  Intensity
·  Type of physical activity
·  Strength
·  TV/screen time
·  Other sedentary activity time

Factors affecting access to physical activity (FH-7.4)
·  Perceived neighborhood safety
·  Perceived walkability of neighborhood
·  Perceived proximity to parks/green space
·  Access to physical activity facilities/programs


NUTRITION RELATED PATIENT/CLIENT CENTERED MEASURES (FH-8)
Client's perception of their nutrition intervention and its impact on life.
Food and/or nutrition quality of life (FH-8.1)
 
ANTHROPOMETRIC MEASUREMENTS (AD)
Body composition/growth/weight history (AD-1.1)
·  Body height
·  Body weight
   -  Measured body weight (lb, oz, kg, g)
   -  Stated body weight (lb, oz, kg, g)
   -  Stated peak body weight (lb, kg)
   -  Usual stated body weight (UBW) (lb, oz, kg, g) 
   -  Usual body weight (UBW) percentage (%)
   -  You may consider age of onset at this point
·  Body frame
   -   Body frame size (small/medium/large)
·  Body weight change
   -  Body weight gain (lb, oz, kg, g)
   -  Body weight loss (lb, oz, kg, g)
   -  Body weight change percentage (%) 
   -  Specify time frame
   -  Lowest weight/time
   -  Highest weight/time
   -  Patterns of weight loss and gain
·  Body mass
   -  Body mass index (BMI) (kg/m2)
   -  Body mass index prime ratio (BMI prime) (actual BMI to the upper limit BMI of 25) 
·  Body compartment estimates 
   -  Body fat percentage (%)
   -  Waist circumference (in or cm)
   -  Waist to hip ratio (ratio)
BIOCHEMICAL DATA, MEDICAL TESTS AND PROCEDURES (BD)
Acid base balance (BD-1.1)
Electrolyte and renal profile (BD-1.2)
·  BUN
·  Creatinine 
·  BUN:creatinine ratio
·  Glomerular filtration rate
·  Sodium (Na)
·  Potassium (K)
·  Phosphorus (P)

Gastrointestinal profile (BD-1.4)
·  Alkaline phosphatase
·  Alanine aminotransferase (ALT)
·  Aspartate aminotransferase (AST)
·  Gamma glutamyl transferase (GGT)

Glucose/endocrine profile (BD-1.5)
·  For those at increased risk for diabetes
·  Glucose, fasting 
·  Glucose, casual 
·  Pre-diabetes
·  Hemoglobin A1c (HgbA1c), if confirmed with diabetes
·  Thyroid stimulating hormone

Lipid profile (BD-1.7)
·  For those needing cardiovascular risk assessment
·  Cholesterol, serum 
·  Cholesterol, HDL
·  Cholesterol, LDL
·  Triglycerides, serum 

Metabolic rate profile (BD-1.8)
·  Resting metabolic rate, measured 
·  Respiratory quotient, measured

Vitamin profile (BD-1.13)
·  Vitamin D, 25-hydroxy(3)
 PHYSICAL EXAM FINDINGS (PD)
Nutrition-focused physical findings (PD-1.1)
·  Overall findings
   -  Overweight/change in how clothes fit
   -  Obese
·  Adipose finding
   -  Excess subcuataneous fat
   -  Central adiposity
·  Cardiovascular-pulmonary system finding
   -  Dyspnea
·  Digestive system finding
   -  Ascites 
   -  Bowel function, including flatus (specify stool type, frequency, volume) if diet is high in fiber due to increased plant food intake
   -  Dyspepsia
   -  Excessive appetite
   -  Increased appetite
·  Mouth finding
   -  Dental health
·  Nerves, cognition, and feeling finding
   -  Depressed mood
·  Skin finding
   -  Facial flushing
   -  Flushing
·  Vital signs
   -  Blood pressure, systolic (mmHg)
   -  Blood pressure, diastolic (mmHg)
CLIENT HISTORY (CH)
PERSONAL HISTORY (CH-1)
Personal data (CH-1.1)
·  Age
·  Gender, personal identification
·  Sex, biological
·  Race, if relevant to care 
·  Ethnicity
·  Language
·  Literacy factors
·  Education
·  Role in family
·  Tobacco (and drug) use
·  Physical disability
·  Mobility


CLIENT AND/OR FAMILY HEALTH HISTORY (CH-2)
Client and/or family health history that may have a nutritional impact
Individual client and/or family nutrition-related health history (CH-2.1)
·  Individual client nutrition related health history, obesity
Patients or families with overweight/obesity are at increased risk of:
    -  Cardiovascular disease history, heart disease, hyperlipidemia, overweight/obesity, micro- and macrovascular
        complications, stroke, erectile dysfunction
    -  Excretory disease history, acute renal failure, chronic renal failure, nephropathy
    -  Metabolic disease history
    -  Neurological disease history, cognitive impairment, dementia
·  Family nutrition related health history
    -  Family history of above

Treatments/therapy (CH-2.2)
·  Surgical treatment (specify)
   -  Surgical history
·  Palliative/end-of-life care (specify)


SOCIAL CONTEXT (CH-3)
Social History (CH-3.1)
·  Socioeconomic factors (specify) 
   -  Ability to purchase items recommended by dietitian
·  Living/housing situation (specify) 
   -  Other household members eating same food
   -  The person responsible for shopping and cooking
·  Domestic issues (specify)
·  Social and medical support (specify) 
   -  Family members and the support of friends
   -  Medical insurance
   -  Involvement of health professionals
·  Geographic location of home (specify)
   -  Travel time to consultations
·  Occupation (specify), impact on physical activity
·  Religion (specify)
·  History of recent crisis (specify) 
·  Daily stress level (specify) (high, moderate, low bodily or mental tension)
   -  Stress levels high enough to affect blood pressure
ASSESSMENT, MONITORING AND EVALUATION TOOLS (AT)
NUTRITION ASSESSMENT, MONITORING AND EVALUATION TOOL RATINGS (AT-1)
Subjective global assessment (SGA) rating (AT-1.1)

The scored patient generated subjective global assessment (PG-SGA) rating (AT-1.3)
·  pt-global.org

The scored patient generated subjective global assessment (PG-SGA) score (AT-1.4)

Mini nutritional assessment long form (MNA-LF) rating (AT-1.5)
ETIOLOGY CATEGORY (EY)

NUTRITION DIAGNOSIS ETIOLOGY CATEGORY IDENTIFICATION (EY-1)
The Etiology Categories are located in the Nutrition Assessment. However, these terms are used in the Nutrition Diagnoses section. The Nutrition Diagnoses Etiology Matrix from the Academy of Nutrition and Dietetics is available here.

Beliefs attitudes etiology (EY-1.1)

Cultural etiology (EY-1.2)

Knowledge etiology (EY-1.3)

Physical function etiology (EY-1.4)

Physiologic metabolic etiology (EY-1.5)

Psychological etiology (EY-1.6)

Social personal etiology (EY-1.7)

Treatment etiology (EY-1.8)

Access etiology (EY-1.9)

Behavior etiology (EY-1.10)
COMPARATIVE STANDARD (CS)
Sample related to hypertension
ENERGY NEEDS (CS-1)
Estimated energy needs (CS-1.1)
·  Total energy estimated needs in 24 hours
·  Method for estimating total energy needs 
·  Total energy estimated needs per kg of body weight


MACRONUTRIENT NEEDS (CS-2)
Estimated fat needs (CS-2.1)
·  Total fat estimated needs in 24 hours
·  Type of fat needed
·  Method for estimating total fat needs

Estimated protein needs (CS-2.2)
·  Total protein estimated needs in 24 hours
·  Total protein estimated needs per kg of body weight
·  Type of protein needed
·  Method for estimating total protein needs

Estimated carbohydrate needs (CS-2.3)
·  Total carbohydrate estimated needs in 24 hours
·  Type of carbohydrate needed 
·  Method for estimating total carbohydrate needs


FLUID NEEDS (CS-3)
Estimated fluid needs (CS-3.1)
·  Total fluid estimated needs
·  Method for estimating needs


MICRONUTRIENT NEEDS (CS-4)
Estimated mineral needs (CS-4.2)
·  Potassium (adequacy)
·  Sodium (maximum recommendation)


WEIGHT AND GROWTH RECOMMENDATION (CS-5)
Recommended body weight/body mass index/growth (CS-5.1)
·  Ideal/reference body weight (IBW)
·  Recommended body mass index (BMI)
PROGRESS EVALUATION (EV)

INTERVENTION GOAL STATUS (EV-1)
The Nutrition Diagnosis Status are located under Nutrition Assessment.
These terms are used to evaluate the progress towards meeting goals set in the course of Nutrition Intervention. 

New goal identified (EV-1.1)

Goal achieved (EV-1.2)

Goal discontinued (EV-1.3)

Goal not achieved (EV-1.4)

Some progress toward goal (EV-1.5)

Some digression away from goal (EV-1.6)



NUTRITION DIAGNOSIS STATUS (EV-2)
The Nutrition Diagnosis Status are located under Nutrition Assessment.
These terms are used in the Nutrition Diagnoses section to clearly evaluate the status/progress of a nutrition diagnosis. 

New nutrition diagnosis (EV-2.1)

Active nutrition diagnosis (EV-2.2)

Resolved nutrition diagnosis (EV-2.3)

Discontinued nutrition diagnosis (EV-2.4)


References
1.  Academy of Nutrition and Dietetics. Nutrition Terminology Reference Manual (eNCPT): Dietetics Language for Nutrition Care. 2023. Accessed 15 March 2024. Available from: https://www.ncpro.org/. 
2.  Academy of Nutrition and Dietetics. Nutrition Terminology Reference Manual (eNCPT): Dietetics Language for Nutrition Care. NCP Step 1: Nutrition Assessment. 2023; Accessed 15 March 2024. Available from: https://www.ncpro.org/pubs/2023-encpt-en/page-006
3.  Franz MJ, Boucher JL, Pereira RF. ADA Pocket Guide to Lipid Disorders, Hypertension, Diabetes, and Weight Management. Chicago: Academy of Nutrition and Dietetics; 2012.

Updated November 11, 2024

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