Pediatric Nursing Care Plan

Priority Nursing Diagnosis: Imbalanced nutrition: less than body requirements related to decreased oral intake AEB loss of subcutaneous
tissue.
Goal: Patient will have balanced nutrition that meets body requirements by time of discharge.
Outcome Criteria

Interventions

Scientific Rationale

Evaluation

1. Patients weight will be within 10

lbs of the average weight for their
age group by time of discharge.
(32 lbs)

1. Perform daily weight measurement q day.

1. Continuously monitoring
patient weight will help
determine whether progress is
being made. Awareness of daily
weights can help establish
accurate calculation of caloric
needs. It is also important to
establish whether the patient is
within normal parameters for
weight for their age.

1. This outcome was not met. The patients

weight was measured every day, but the
weight was still significantly lower than the
average for their age group at time of
discharge.

2. Assessing the intake and

output ratio frequently helps to
determine hydration status. A
ratio that is not within 30cc
indicates a hydration deficit. This
should be monitored for upon
assessment.

3. This outcome was met. The patients

environment was assessed before each
attempt at eating. A non-distracting
environment was maintained for the duration
of hospitalization.

2. Patients intake and output ratio

will be within 30 cc of each other
every four hours for the duration of
hospitalization.
3. Patients environment at meal
times will remain free of
distractions for the duration of
hospitalization to promote
increased oral intake.
4. Patient will not have a decreased
appetite due to consumption of
caffeinated and carbonated
beverages for the duration of
hospitalization.
5. Patient and family will establish
a list of preferred foods to promote
increased oral intake during the
remainder of hospital stay.

2. Assess intake and output ratio q 4 hours.

3. Assess eating environment before each
meal.
4. Discourage caffeinated/carbonated
beverages q day.
5. Assess patient food preferences q shift.
6. Provide patients oral hygiene TID and
PRN.
7. Monitor total protein and albumin levels
q 3 days.
8. Assess serum electrolyte values q 3 days.
9. Assess RBC and WBC values q 3 days.
10. Assess skin turgor q shift.
11. Assess oral cavity q shift.
12. Assess vital signs q 4 hours.

6. Patient will maintain clean

adequate oral hygiene before and
after meals to promote increased
caloric intake for the duration of
hospitalization.

2. This outcome was met. The patients

intake and output ratio were within 30cc
upon measurement every four hours for the
duration of hospitalization.

13. Administer Pediasure 64 cc/hour ND

tube continuously as prescribed.
14. Encourage physical activity q shift.

3. There may be environmental

factors in which contribute to a
patients decreased oral intake. A
distracting environment may
require intervention. Other
factors within the environment
that may be contributing factors
may be discovered upon
assessment.
4. These beverages may lead to a
decrease in appetite. They may
also lead to early satiety.
Educating patients about the

4. This outcome was met. The patient

avoided consumption of caffeinated as well
as carbonated beverages for the duration of
hospitalization.
5. This outcome was met. The patients
family and various hospital staff including
dieticians, nursing staff, and speech therapy
all collaborated to establish and offer desired
food selections to the patient.
6. This outcome was met. The patient,
patients family, and nursing staff
collaborated to ensure patient oral hygiene
was adequately performed before attempts
to eat for the duration of hospitalization.

7. Patients total protein and

albumin levels will remain within
the hospitals parameters of
normal values for the duration of
hospitalization; Total protein within
the ranges of 6.4-8.3, and albumin
within the ranges of 3.8-5.4.
8. Patients serum electrolyte
values will remain within hospitals
parameters of normal values for
the duration of hospitalization;
Chloride within the ranges of 96108, Sodium within the ranges of
133-145, and potassium within the
ranges of 3.3-5.1.
9. Patients white blood cells will
remain in the range of 6-17 and
red blood cells will remain within
the limits of 4.0-5.2 for the
duration of hospitalization.
10. The patients skin turgor will
indicate adequate hydration by
non-tenting during skin
assessment each shift for the
duration of hospitalization.
11. The patients oral mucous
membranes and tongue will be free
of redness and swelling for the
duration of hospitalization.
12. The patients vital signs will
remain within the normal
parameters for the appropriate age
group for the duration of
hospitalization; temperature- 99.099.7 degrees farenheit, pulse- 90140 BPM, respiration rate-24-40 ,
and blood pressure- 80-112
systolically, and 50-80 diastolically.

15. Encourage participation in speech

therapy q day.

correlation between
caffeine/carbonated beverages
and appetite is appropriate.
5. Determining preferred food
selections may contribute to
increased oral intake. Patients
may be more likely to consume
more calories if given choices of
preferred foods. It is also helpful
to determine desired nutrient
filled foods to ensure nutritional
requirements are being met.
6. Oral hygiene before meals has
a positive effect has a positive
effect on appetite. It also
positively affects the taste of
food. This intervention can
positively affect the attitude
related to eating and nutrition.
7. Total protein and albumin may
indicate a degree of protein
depletion. Therefore, they should
be monitored to evaluate protein
intake. Both lab tests are a good
indicator of nutritional status.
8. Electrolyte values are
indicators of nutrition status.
Potassium is typically increased
in malnutrition. Sodium on the
other hand is generally
decreased in malnutrition.
9. It is common to see low red
blood cell and white blood cell
counts in malnutrition. This
decrease is called anemia or
leukopenia. Continuous
assessment of these lab values
can provide information related
to nutrition status.

7. This outcome was partially met. The

patients albumin remained within the listed
parameters. The last drawn total protein
level before discharge was 5.6, which is
below the stated parameters.
8. This outcome was partially met. The
patients sodium and potassium remained
within the listed parameters, but the chloride
level was elevated at time of discharge.
9. This outcome was not met. Both the WBC
and RBC were elevated.
10. This outcome was met. Upon each
assessment of the skin, non-tenting was
observed.
11. This outcome was met. The patients oral
cavity was free of redness and swelling and
the membranes appeared to be moist upon
each assessment up until discharge.
12. This outcome was met. The patients vital
signs remained within the listed parameters
for the duration of hospitalization.
13. This outcome was met. The patient
continued to receive 64 cc/hour of pediasure
via ND tube for the duration of hospitalization
and through discharge to ensure adequate
caloric intake.
14. This outcome was met. Exercise was
encouraged every shift and the patient
participated in strengthening exercises when
encouraged each shift.
15. This outcome was met. The patient and
patients family participated in speech
therapy and successfully began working with
new consistencies of food and new selections
for the duration of hospital stay.

13. Patient will ingest caloric intake

that meets bodys nutritional
requirements (calculated out to be
64cc/hour) for the duration of
hospitalization.
14. Patient will participate in a
form of physical activity each shift
for the duration of hospital stay.
15. Patient will actively participate
in speech therapy every day for
the duration of hospital stay.

10. The patients skin turgor

reflects hydration status. When
gently pulling the skin upward,
the skin may not demonstrate
elasticity, known as an
observation called tenting. The
presence of tenting is indicative
of dehydration.
11. The oral mucous membranes
are affected negatively by
malnutrition. When
malnourished, the tongue and
oral mucous membranes can
become swollen and red.
Assessment of the membranes
will help determine whether or
not progress is being made
related to nutrition status.
12. Vital signs can support the
diagnosis of malnutrition. The
heart rate and blood pressure
may be effected. A malnourished
patient may experience
tachycardia as well as an
elevated blood pressure.
Assessment of vital signs every
four hours can help determine
whether further interventions are
appropriate.
13. For patients who are unable
to maintain nutritional intake by
the oral route, other means of
nutritional support such as the
ND tube may be indicated.
Continuous use of the ND tube
ensures ingestion of calories. This
intervention also assists with
meeting vitamin and mineral
requirements in the malnourished
patient.

14. Physical activity plays a key

role in nutritional status.
Metabolism and utilization of
nutrients are enhanced by
activity. Therefore, exercise
should be encouraged for the
patient with a nutritional
imbalance.
15. Speech therapists can
evaluate the degree of
swallowing impairment and make
recommendations for nutrition.
Recommendations may include
adjustments in the thickness and
consistency of foods to increase
caloric intake. Encouragement to
participate in this therapy will
promote correction of the
nutritional imbalance.

Work Cited:
Gulanick, M., and Myers, J.L. (2014). Nursing Care Plans, Diagnoses, Interventions, and Outcomes (8 th Edition):

Philadelphia, PA: Elsevier/Mosby: