Tuesday, November 9, 2010

Imbalanced Nutrition: Less than Body Requirements

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] malabsorption, cancer, burns); physical factors (e.g., muscle weakness, poor dentition, activity intolerance, pain, substance abuse); social factors (e.g., lack of financial resources to obtain nutritious foods); or psychological factors (e.g., depression, boredom). During times of illness (e.g., trauma, surgery, sepsis, burns), adequate nutrition plays an important role in healing and recovery. Cultural and 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 experience 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 social isolation and boredom that cause a lack of interest in eating. This care plan addresses general concerns related to nutritional deficits for the hospital or home setting.

* Defining Characteristics: Loss of weight with or without adequate caloric intake
* 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 of 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 actual weight or weight loss due to estimating weight.
* intervObtain nutritional history; include family, significant others, or caregiver in assessment. Patient’s perception of actual intake may differ.
* Determine etiological factors for reduced nutritional intake. Proper assessment guides intervention. For example, patients with dentition problems require referral to a dentist, whereas patients with memory losses may require services such as Meals-on-Wheels.
* Monitor or explore attitudes toward eating and food. Many psychological, psychosocial, and cultural factors determine the type, amount, and appropriateness of food consumed.
* Monitor environment in which eating occurs. Fewer families today have a general 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 components.
* Encourage patient participation in recording food intake using a daily log. Determination of type, amount, and pattern of food or fluid intake is facilitated by accurate documentation by patient or caregiver as the intake occurs; memory is insufficient.
* Monitor laboratory values that indicate nutritional well-being/deterioration:
o Serum albumin This indicates degree of protein depletion (2.5 g/dl indicates severe depletion; 3.8 to 4.5 g/dl is normal).
o Transferrin This is important for iron transfer and typically decreases as serum protein decreases.
o RBC and WBC counts These are usually decreased in malnutrition, indicating anemia and decreased resistance to infection.
o Serum electrolyte values Potassium is typically increased and sodium is typically 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 preferences and nutritional support. Dietitians have a greater understanding of the 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 etiological factors of the problem, improvement in nutritional status may take a long time. Without realistic short-term goals to provide tangible rewards, patients may lose interest in addressing this problem.
* Suggest ways to assist patient with meals as needed. Ensure a pleasant environment, facilitate proper position, and provide good oral hygiene and dentition. Elevating the head of bed 30 degrees aids in swallowing and reduces risk of aspiration.
* Provide companionship during mealtime. Attention to the social aspects of eating 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 adaptive devices.
* For hospitalized patients, encourage family to bring food from home as appropriate. 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 appetite and lead to early satiety.
* Discuss possible need for enteral or parenteral nutritional support with patient, family, and caregiver as appropriate. Enteral tube feedings are preferred for patients with a functioning GI tract. Feedings may be continuous or intermittent (bolus). Parenteral nutrition may be indicated for patients who cannot tolerate enteral feedings. Either solution can be modified to provide required glucose, protein, electrolytes, vitamins, minerals, and trace elements. Fat and fat-soluble vitamins can also be administered two or three times per week. These feedings 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 activity.

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 vitamins Patients may not understand what is involved in a balanced diet.
o Importance of maintaining adequate caloric intake; an average adult (70 kg) needs 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.


  1. Good day I am so happy I found your weblog, I really found you by mistake, while
    I was looking on Google for something else, Anyhow I am here now and would just like to say thank you for a incredible post and a all round enjoyable
    blog (I also love the theme/design), I don't have time to read through it all at the moment but I have book-marked it and also added your RSS feeds, so when I have time I will be back to read a lot more, Please do keep up the excellent work.
    Check out my website :: what does african mango do

  2. you're in point of fact a just right webmaster. The website loading speed is incredible. It sort of feels that you're doing any distinctive trick.
    Moreover, The contents are masterpiece. you've performed a excellent activity on this topic!
    My page :: than

  3. Hi there! I just want to find out you have got difficulties with cyber-terrorist?
    My very last blog (wordpress blogs) ended up being broken in
    to i wound up sacrificing nearly a year regarding effort resulting from no back.
    Have any kind of strategies to end online hackers?
    Also visit my website Criminal Record

  4. At times feedback such as these is going to
    be hard to trust however there’s lots of related and also valuable tips right here.

    Folks that posting this info should be thanked.
    Here is my web-site ... Genital Warts Remedy

  5. Thank you so much all of for ones interesting in addition
    to insightful opinions until now. Significantly meals with regard to considered.
    Several inciteful strategies in addition to points of views all-around.
    I cannot say that I agree with everything else that you
    express but when i didn't recognize the actual legitamecy within your article I might always be not aware for a understanding.
    Here is my web site - http://www.zuneauto.com/

  6. Excellent items from you, man. I've remember your stuff prior to and you are simply extremely great. I really like what you've obtained
    here, certainly like what you're stating and the best way through which you are saying it. You're
    making it entertaining and you continue to care for to stay it wise.
    I can't wait to read far more from you. That is really a terrific website.

    my blog :: best diet

  7. Usually the brewer provides hot chocolate or maybe beverages inside
    three tracfone minutes also as an frosty refreshment.
    Attraction is definitely the company name of a fixture in establishing back together, no matter how horny it may
    sound, it's still a fantastic fall # 2. Need to taste some sort of drink linked with frigid weather sea water to maintain your location refreshing take a look at take gourmet coffee. I have heard, you have been wondering to how could i understand or know when my own, personal Seattle's Best and / or
    Newman's Very own coffe beans were ultimately cooking? Actually, spot #1 stated above for your own reply to. Saturated fats content in nourishment need to be 15-25% along with whole calorie intake and higher of polyunsaturated extra fat. A nice ten-year-long study created found at The philipines Institution Medical facility functions associated a positive frame-of-mind from amazing benefits.

    Also visit my webpage :: drip coffee makers best

  8. As the foodstuff is destroyed and site with them shoves against the filter
    meaning that veggie juice has been squashed from the. The suppressor is
    to be able to clear mainly is derived above the rest at the
    center, together with the rear 50 % off might submersed over normal water then purged of along
    with the all the cleanup. Something that units that
    you can buy because the kitchen area gear is the right flower
    juicer. Some other ability will be effortless care.
    It all runs possibly at ten rates of speed: wake, cube, add
    in, blend, in addition liquefy As as well, quality of the screen rhythm quality and so love blizards

    Also visit my site; omega 9000 juicer instruction book

  9. Even so in this situation, you are discover might know about spend money on.
    Expanded polystyrene is not good, primarily sucks by vital so
    healthy nutritional requirements and so mineral deposits.
    Itrrrs also acknowledged to help in hub nicely.

    my webpage: good mini blender []

  10. If or when one akin to pieces component drink or eat this system particularly
    efficient mixer undoubtedly just need to limit the working
    any time. Utilizing a hand citrus fruit juicer calls for little or no task hours seeing that
    the truth that bit fruit is lacking in to be peeled before it's juiced. A further accounts to look at may well objective of that wheatgrass machine.

    Feel free to surf to my blog commercial food processor used

  11. Your blog has given me that thing which I never expect to get from all over the websites. Nice post guys!


Related Posts Plugin for WordPress, Blogger...


My Blog List