Nutrition, Altered: Less than Body Requirements - Starvation;
Weight Loss; Anorexia
Audrey Klopp, RN, PhD, ET, CS,
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.
- 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
- Loss of weight with or without adequate caloric intake
- 10% to 20% below ideal body weight
- Documented inadequate caloric intake
- 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.
- (i) independent
- (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
- 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
- Many psychological, psychosocial, and cultural factors
determine the type, amount, and appropriateness of food consumed.
- (i) Monitor environment in which eating
- 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
- Serum albumin.
- Indicates degree of protein depletion (2.5 g/dl
indicates severe depletion; 3.8 to 4.5 g/dl is normal).
- Important for iron transfer and typically decreases as
serum protein decreases.
- RBC and WBC counts.
- Usually decreased in malnutrition, indicating anemia
and decreased resistance to infection.
- Serum electrolyte values.
- Potassium is typically increased and sodium is
typically decreased in malnutrition.
- (i) Weigh patient weekly.
- During aggressive nutritional support, patient can gain up
to 0.5 lbs per day.
- (i) independent
- (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
- 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
- (i) Provide companionship during
- 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
- (i) Discourage beverages that are caffeinated
- May decrease appetite and may lead to early
- (i) Discuss possible need for enteral or
parenteral nutritional support with patient, family, and caregiver as
- 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
- (i) Encourage exercise.
- Metabolism and utilization of nutrients are enhanced by
Education/Continuity of Care
- (i) independent
- (i) Review and reinforce the following to
- The basic four food groups, as well as the need for specific
minerals or vitamins.
- Patients may not understand what is involved in a
- Importance of maintaining adequate caloric intake: an average
adult (70 kg) needs 1800 to 2200 Kcal per day; patients with burns, severe
infections, or draining wounds may require 3000 to 4000 Kcal per day.
- Foods high in calories/protein that will promote weight gain
and nitrogen balance (e.g., small frequent meals of foods high in calories and
- (i) Provide referral to community nutritional
resources such as Meals-on-Wheels or hot lunch programs for seniors as
Nutrition Monitoring; Nutrition Therapy; Nutrition
- See also:
Anorexia Nervosa, Chapter 15, p.
Bulimia, Chapter 15, p. 1189
Enteral Tube Feedings, Chapter 7, p.
Total Parenteral Nutrition, Chapter 7, p. 736
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