NURSING DIAGNOSIS: Altered nutrition: less than body requirements

related to:
  1. decreased oral intake associated with:
    1. anorexia resulting from decreased activity, depression and social isolation, the effect of negative nitrogen balance, and early satiety that occurs with decreased gastrointestinal motility
    2. difficulty feeding self as a result of impaired or limited physical mobility;
  2. increased nutritional needs associated with an imbalance in the rate of catabolism and anabolism (in the immobilized person, catabolic processes occur at a faster rate than anabolic processes).
Desired Outcome
The client will maintain an adequate nutritional status as evidenced by:
  1. weight within normal range for client
  2. normal BUN and serum albumin, Hct, Hb, and lymphocyte levels
  3. no further decline in strength and activity tolerance
  4. healthy oral mucous membrane.
Nursing Actions and Selected Purposes/Rationales
  1. Assess for and report signs and symptoms of malnutrition:
    1. weight below client's usual weight or below normal for client's age, height, and body frame
    2. abnormal BUN and low serum albumin, Hct, Hb, and lymphocyte levels
    3. weakness and fatigue
    4. sore, inflamed oral mucous membrane
    5. pale conjunctiva.
  2. Monitor percentage of meals and snacks client consumes. Report a pattern of inadequate intake.
  3. Implement measures to maintain an adequate nutritional status:
    1. perform actions to improve oral intake:
      1. obtain a dietary consult if necessary to assist client in selecting foods/fluids that meet nutritional needs, are appealing, and adhere to personal and cultural preferences
      2. encourage a rest period before meals to minimize fatigue
      3. maintain a clean environment and relaxed, pleasant atmosphere
      4. provide oral hygiene before meals (removes unpleasant tastes, which often improves the taste of foods/fluids)
      5. serve frequent, small meals rather than large ones if client is weak, fatigues easily, and/or has a poor appetite
      6. implement measures to prevent gastrointestinal distention (e.g. perform actions to prevent constipation, administer prescribed gastrointestinal stimulants) in order to prevent feeling of fullness and early satiety
      7. encourage significant others to bring in client's favorite foods unless contraindicated and eat with him/her to make eating more of a familiar social experience
      8. encourage significant others to be present to assist client with meals if needed
      9. allow adequate time for meals; reheat foods/fluids if necessary
      10. limit fluid intake with meals (unless the fluid has high nutritional value) to reduce early satiety and subsequent decreased food intake
      11. enable client to feed self if possible; if client needs to be fed, offer foods/fluids in the order he/she prefers
      12. increase activity as allowed (activity usually promotes a sense of well-being, which can improve appetite)
    2. ensure that meals are well balanced and high in essential nutrients; offer high-protein, high-calorie dietary supplements if indicated
    3. administer vitamins and minerals if ordered.
  4. Perform a calorie count if ordered. Report information to dietitian and physician.
  5. Consult physician about an alternative method of providing nutrition (e.g. parenteral nutrition, tube feedings) if client does not consume enough food or fluids to meet nutritional needs.