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MBALANCED NUTRITION, LESS THAN BODY REQUIREMENTS

Definition: Intake of nutrients insufficient to meet metabolic needs. Copyright 2005 by F.A. Davis Company

Possible Etiologies ("related to")

Inability to ingest food because of: [Depressed mood] [Loss of appetite] [Energy level too low to meet own nutritional needs] [Regression to lower level of development] [Ideas of self-destruction]
Defining Characteristics ("evidenced by")

Loss of weight Lack of interest in food Pale conjunctiva and mucous membranes Poor muscle tone [Amenorrhea] [Poor skin turgor] [Edema of extremities] [Electrolyte imbalances] [Weakness] [Constipation] [Anemias]
Goals/Objectives
Short-Term Goal

Client will gain 2 pounds per week for the next 3 weeks.
Long-Term Goal

Client will exhibit no signs or symptoms of malnutrition by time of discharge from treatment (e.g., electrolytes and blood counts will be within normal limits; a steady weight gain will be demonstrated; constipation will be corrected; client will exhibit increased energy in participation in activities).
Interventions with Selected Rationales
1. In collaboration with dietitian, determine number of calories required to provide adequate nutrition and realistic (according to body structure and height) weight gain.

2. 3. 4. 5. 6.

To prevent constipation, ensure that diet includes foods high in fiber content. Encourage client to increase fluid consumption and physical exercise to promote normal bowel functioning. Depressed clients are particularly vulnerable to constipation because of psychomotor retardation. Constipation is also a common side effect of many antidepressant medications. Keep strict documentation of intake, output, and calorie count. This information is necessary to make an accurate nutritional assessment and maintain client safety. Weigh client daily. Weight loss or gain is important assessment information. Determine clients likes and dislikes, and collaborate with dietitian to provide favorite foods. Client is more likely to eat foods that he or she particularly enjoys. Ensure that client receives small, frequent feedings, including a bedtime snack, rather than three larger meals. Large amounts of food may be objectionable, or even intolerable, to the client.

7. Administer vitamin and mineral supplements and stool softeners or bulk extenders, as ordered by physician. 8. If appropriate, ask family members or significant others to bring in special foods that client particularly enjoys.

9.

Stay with client during meals to assist as needed and to offer support and encouragement. Monitor laboratory values, and report significant changes to physician. Laboratory values provide objective data regarding nutritional status. Explain the importance of adequate nutrition and fluid intake. Client may have inadequate or inaccurate knowledge regarding the contribution of good nutrition to overall wellness.

10. 11.

12. 13.

Discourage beverages that are caffeinated or carbonated. These may decrease appetite and lead to early satiety. Encourage exercise. Metabolism and utilization of nutrients are enhanced by activity.

Outcome Criteria
1. Client has shown a slow, progressive weight gain during hospitalization. 2. Vital signs, blood pressure, and laboratory serum studies are within normal limits. 3. Client is able to verbalize importance of adequate nutrition and fluid intake.