Nursing Diagnosis: Imbalanced Nutrition: Less than Body Requirements

Starvation; Weight Loss; Anorexia

NOC Outcomes (Nursing Outcomes Classification)
Suggested NOC Labels
* Nutritional Status: Food and Fluid Intake
* Nutritional Status: Nutrient Intake
NIC Interventions (Nursing Interventions Classification)
Suggested NIC Labels
* Nutrition Monitoring
* Nutrition Therapy
* Nutrition Management
NANDA Definition: Intake of nutrients insufficient to meet metabolic needs
Adequate nutrition is necessary to meet the body s demands. Nutritional status can
be affected by disease or injury states (e.g., gastrointestinal [GI] malabsorpt
ion, cancer, burns); physical factors (e.g., muscle weakness, poor dentition, ac
tivity intolerance, pain, substance abuse); social factors (e.g., lack of financ
ial resources to obtain nutritious foods); or psychological factors (e.g., depre
ssion, boredom). During times of illness (e.g., trauma, surgery, sepsis, burns),
adequate nutrition plays an important role in healing and recovery. Cultural an
d religious factors strongly affect the food habits of patients. Women exhibit a
higher incidence of voluntary restriction of food intake secondary to anorexia,
bulimia, and self-constructed fad dieting. Patients who are elderly likewise ex
perience problems in nutrition related to lack of financial resources, cognitive
impairments causing them to forget to eat, physical limitations that interfere
with preparing food, deterioration of their sense of taste and smell, reduction
of gastric secretion that accompanies aging and interferes with digestion, and s
ocial isolation and boredom that cause a lack of interest in eating. This care p
lan addresses general concerns related to nutritional deficits for the hospital
or home setting.
* Defining Characteristics: Loss of weight with or without adequate caloric inta
ke
* 10% to 20% below ideal body weight
* Documented inadequate caloric intake
* Related Factors: Inability to ingest foods
* Inability to digest foods
* Inability to absorb or metabolize foods
* Inability to procure adequate amounts of food
* Knowledge deficit
* Unwillingness to eat
* Increased metabolic needs caused by disease process or therapy
* Expected Outcomes Patient or caregiver verbalizes and demonstrates selection o
f foods or meals that will achieve a cessation of weight loss.
* Patient weighs within 10% of ideal body weight.
Ongoing Assessment
* Document actual weight; do not estimate. Patients may be unaware of their actu
al weight or weight loss due to estimating weight.
* intervObtain nutritional history; include family, significant others, or careg
iver in assessment. Patient s perception of actual intake may differ.
* Determine etiological factors for reduced nutritional intake. Proper assessmen
t guides intervention. For example, patients with dentition problems require ref
erral to a dentist, whereas patients with memory losses may require services suc
h as Meals-on-Wheels.
* Monitor or explore attitudes toward eating and food. Many psychological, psych
osocial, and cultural factors determine the type, amount, and appropriateness of
food consumed.
* Monitor environment in which eating occurs. Fewer families today have a genera
l meal together. Many adults find themselves "eating on the run" (e.g., at their
desk, in the car) or relying heavily on fast foods with reduced nutritional com
ponents.
* Encourage patient participation in recording food intake using a daily log. De
termination of type, amount, and pattern of food or fluid intake is facilitated
by accurate documentation by patient or caregiver as the intake occurs; memory i
s insufficient.
* Monitor laboratory values that indicate nutritional well-being/deterioration:
o Serum albumin This indicates degree of protein depletion (2.5 g/dl indicates s
evere depletion; 3.8 to 4.5 g/dl is normal).
o Transferrin This is important for iron transfer and typically decreases as ser
um protein decreases.
o RBC and WBC counts These are usually decreased in malnutrition, indicating ane
mia and decreased resistance to infection.
o Serum electrolyte values Potassium is typically increased and sodium is typica
lly decreased in malnutrition.
* Weigh patient weekly. During aggressive nutritional support, patient can gain
up to 0.5 pound/day.
Therapeutic Interventions
* Consult dietitian for further assessment and recommendations regarding food pr
eferences and nutritional support. Dietitians have a greater understanding of th
e nutritional value of foods and may be helpful in assessing specific ethnic or
cultural foods (e.g., "soul foods," Hispanic dishes, kosher foods).
* Establish appropriate short- and long-range goals. Depending on the etiologica
l factors of the problem, improvement in nutritional status may take a long time
. Without realistic short-term goals to provide tangible rewards, patients may l
ose interest in addressing this problem.
* Suggest ways to assist patient with meals as needed. Ensure a pleasant environ
ment, facilitate proper position, and provide good oral hygiene and dentition. E
levating the head of bed 30 degrees aids in swallowing and reduces risk of aspir
ation.
* Provide companionship during mealtime. Attention to the social aspects of eati
ng is important in both the hospital and home settings.
* For patients with changes in sense of taste, encourage use of seasoning.
* For patients with physical impairments, refer to occupational therapist for ad
aptive devices.
* For hospitalized patients, encourage family to bring food from home as appropr
iate. Patients with specific ethnic, religious preferences, or restrictions may
not be able to eat hospital foods.
* Suggest liquid drinks for supplemental nutrition.
* Discourage beverages that are caffeinated or carbonated. These may decrease ap
petite and lead to early satiety.
* Discuss possible need for enteral or parenteral nutritional support with patie
nt, family, and caregiver as appropriate. Enteral tube feedings are preferred fo
r patients with a functioning GI tract. Feedings may be continuous or intermitte
nt (bolus). Parenteral nutrition may be indicated for patients who cannot tolera
te enteral feedings. Either solution can be modified to provide required glucose
, protein, electrolytes, vitamins, minerals, and trace elements. Fat and fat-sol
uble vitamins can also be administered two or three times per week. These feedin
gs may be used with in-hospital, long-term care, and subacute care settings, as
well as in the home.
* Encourage exercise. Metabolism and utilization of nutrients are enhanced by ac
tivity.
Education/Continuity of Care
* Review and reinforce the following to patient or caregivers:
o The basic four food groups, as well as the need for specific minerals or vitam
ins Patients may not understand what is involved in a balanced diet.
o Importance of maintaining adequate caloric intake; an average adult (70 kg) ne
eds 1800 to 2200 kcal/ day; patients with burns, severe infections, or draining
wounds may require 3000 to 4000 kcal/day
o Foods high in calories and protein that will promote weight gain and nitrogen
balance (e.g., small frequent meals of foods high in calories and protein)
* Provide referral to community nutritional resources such as Meals-on-Wheels or
hot lunch programs for seniors as indicated