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Nursing Care Plans: Nursing Diagnosis and Intervention, 5/e
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Nutrition, Altered: Less than Body Requirements - Starvation; Weight Loss; Anorexia
Audrey Klopp, RN, PhD, ET, CS, NHA
Meg Gulanick, PhD, RN

NANDA: The state in which an individual experiences an 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 such as muscle weakness, poor dentation, activity intolerance, pain, substance abuse, social factors such as lack of financial resources to obtain nutritious foods, or psychological factors such as depression or boredom. During times of illness (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. The 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.

Related Factors

Defining Characteristics

Expected Outcomes

Ongoing Assessment

Actions/Interventions/Rationale
Key:
(i) independent
(c) collaborative
(i) Document actual weight; do not estimate.
Patients may be unaware of their actual weight or weight loss due to estimating weight.
(i) Obtain nutritional history; include family, significant others, or caregiver in assessment.
Patient's perception of actual intake may differ.
(i) Determine etiologic factors for reduced nutritional intake.
Proper assessment guides intervention. For example, patients with dentation problems require referral to a dentist whereas patients with memory losses may require services such as Meals-on-Wheels.
(i) Monitor or explore attitudes toward eating and food.
Many psychological, psychosocial, and cultural factors determine the type, amount, and appropriateness of food consumed.
(i) Monitor environment in which eating occurs.
Fewer families today have a general meal together. Many adults find themselves "eating on the run" (at their desk, in the car) or relying heavily on fast foods with reduced nutritional components.
(i) Encourage patient participation in recording food intake using a daily log.
Determination of type, amount, and pattern of food or fluid intake as facilitated by accurate documentation by patient or caregiver as the intake occurs; memory is insufficient.
(c) Monitor laboratory values that indicate nutritional well-being/deterioration:
(i) Weigh patient weekly.
During aggressive nutritional support, patient can gain up to 0.5 lbs per day.

Therapeutic Interventions

Actions/Interventions/Rationale
Key:
(i) independent
(c) collaborative
(c) 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).
(i) Establish appropriate short- and long-range goals.
Depending on the etiologic 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.
(i) Suggest ways to assist patient with meals as needed: ensure a pleasant environment, facilitate proper position, and provide good oral hygiene and dentition.
HOB elevated 30 degrees aids in swallowing and reduces risk of aspiration.
(i) Provide companionship during mealtime.
Attention to the social aspects of eating is important in both the hospital and home setting.
(i) For patients with changes in sense of taste, encourage use of seasoning.
(i) For patients with physical impairments, suggest referral to occupational therapist for adaptive devices.
(c) 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.
(i) Suggest liquid drinks for supplemental nutrition.
(i) Discourage beverages that are caffeinated or carbonated.
May decrease appetite and may lead to early satiety.
(i) 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 2 to 3 times per week. These feedings may be used in-hospital, long-term care, and subacute care settings, as well as in the home.
(i) Encourage exercise.
Metabolism and utilization of nutrients are enhanced by activity.

Education/Continuity of Care

Actions/Interventions/Rationale
Key:
(i) independent
(c) collaborative
(i) Review and reinforce the following to patient/caregivers:
(i) Provide referral to community nutritional resources such as Meals-on-Wheels or hot lunch programs for seniors as indicated.

NIC

Nutrition Monitoring; Nutrition Therapy; Nutrition Management

See also:
Anorexia Nervosa, Chapter 15, p. 1184
Bulimia, Chapter 15, p. 1189
Enteral Tube Feedings, Chapter 7, p. 688
Total Parenteral Nutrition, Chapter 7, p. 736

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