Weight 10% to 20% below ideal body weight and height

Goals and Outcomes

The following are the common goals and expected outcomes for Imbalanced
Nutrition: Less Than Body Requirements.

Patient presents understanding of significance of nutrition to healing

process and general health.

Patient or caregiver verbalizes and demonstrates selection of foods or

meals that will accomplish a termination of weight loss.

Patient demonstrates behaviors, lifestyle changes to recover and/or

keep appropriate weight.

Patient displays nutritional ingestion sufficient to meet metabolic needs

as manifested by stable weight or muscle-mass measurements,
positive nitrogen balance, tissue regeneration and exhibits improved
energy level.

Patient shows no signs of malnutrition.

Patient takes adequate amount of calories or nutrients.

Patient maintains weight or displays weight gain on the way to

preferred goal, with normalization of laboratory values.

Patient weighs within 10% of ideal body weight (IBW).

Nursing Assessment
Routine assessment is needed in order to identify potential problems that may
have lead toImbalanced Nutrition: Less Than Body Requirements as well as
name any circumstance that may transpire during nursing care.
Assessment

Rationales

Note real, exact weight; do

not estimate.

These anthropomorphic assessments are vital that

they need to be accurate. These will be used as
basis for caloric and nutrient requirements.

Take a nutritional history

with the participation of
significant others.

Family members may provide more accurate

details on the patients eating habits, especially if
patient has altered perception.

Ascertain etiological
factors for decreased
nutritional intake.

Several factors may affect the patients nutritional

intake, so it is vital to assess properly. Patients
with dentition problems need referral to a dentist,
whereas patients with memory losses may need
service like Meals on Wheels. Other medications
also have an effect on the appetite of the patient.

Review laboratory values

that indicate well-being or
deterioration.

Serum albumin

Transferrin

RBC and WBC

counts

Laboratory tests play a significant part in

determining the patients nutritional status. An
abnormal value in a single diagnostic study may
have many possible causes.
This determines degree of protein reduction (2.5
g/dl signifies severe diminution; 3.8 to 4.5 g/dl is
normal).
This is vital for iron transfer and typically
decreases as serum protein decreases.
These counts are frequently dropped in
malnutrition, revealing anemia, and reduced
resistance to infection.

Serum electrolyte
values

Look for physical signs of

poor nutritional intake.

Note the patients

perspective and feeling
toward eating and food.
Evaluate the environment
in which eating happens.
Link usual food intake to
USDA Food Pyramid, noting
slighted or omitted food
groups.
Assess patients ability to
obtain and use essential
nutrients.

If patient is a vegetarian,
evaluate if obtaining
sufficient amounts of
vitamin B12 and iron.

Potassium is typically elevated, and sodium is

typically lowered in malnutrition.
The patient encountering nutritional deficiencies
may resemble to be sluggish and fatigued. Other
manifestations include decreased attention span,
confused, pale and dry skin, subcutaneous tissue
loss, dull and brittle hair, and red, swollen tongue
and mucous membranes. Vital signs may show
tachycardia and elevated BP. Paresthesias may
also be present.
Various psychological, psychosocial, religious, and
cultural factors determine the type, amount, and
appropriateness of food utilized.
Most adults find themselves eating on the run or
relying massively on fast foods with lower
nutritional components. Older people living
independently may not have the drive to prepare a
meal for themselves.
The Food Guide Pyramid emphasizes the
importance of balanced eating. Omission of entire
food groups increases risk of deficiencies.
Several factors may affect the patients nutritional
intake, so it is necessary to assess
accurately. Cases of vitamin D deficiency rickets
have been reported among dark-skinned infants
and toddlers who were exclusively breast fed and
were not given supplemental vitamin D.
Strict vegetarians may be at particular risk for
vitamin B12 and iron deficiencies. Proper care
should be taken when implementing vegetarian
diets for pregnant women, infants, children, and
the elderly.

Nursing Interventions
This care plan addresses general concern related to nutritional deficits for the
hospital or home setting.
Interventions

Rationales

Ascertain healthy body

weight for age and height.
Refer to a dietitian for
complete nutrition
assessment and methods
for nutritional support.

Experts like a dietician can determine nitrogen

balance as a measure of the nutritional status of
the patient. A negative nitrogen balance may
mean protein malnutrition. The dietician can also
determine the patients daily requirements of
specific nutrients to promote sufficient nutritional
intake.

Set appropriate short-term

and long-term goals.

Patients may lose concern in addressing this

dilemma without realistic short-term goals.

Provide a pleasant
environment.

A pleasing atmosphere helps in

decreasingstress and is more favorable to eating.

Promote proper positioning.

Elevating the head of bed 30 degrees aids in

swallowing and reduces risk for aspiration with
eating.

Provide good oral hygiene

and dentition.

Oral hygiene has a positive effect on appetite and

on the taste of food. Dentures need to be clean,
fit comfortably, and be in the patients mouth to
encourage eating.

If patient lacks strength,

schedule rest periods before
meals and open packages
and cut up food for patient.

Nursing assistance with activities of daily living

(ADLs) will conserve the patients energy for
activities the patient values. Patients who take
longer than one hour to complete a meal may
require assistance.

Provide companionship
during mealtime.

Attention to the social perspectives of eating is

important in both hospital and home settings.

Consider the use of

seasoning for patients with
changes in their sense of
taste; if not contraindicated.

Seasoning may improve the flavor of the foods

and attract eating.

Consider six small nutrientdense meals instead of

three larger meals daily to
lessen the feeling of
fullness.

Eating small, frequent meals lessens the feeling

of fullness and decreases the stimulus to vomit.

For patients with physical

impairments, refer to an
occupational therapist for
adaptive devices.

Special devices may be provided by an expert

that can help patients feed themselves.

For patients with impaired

swallowing, coordinate with
a speech therapist for
evaluation and instruction.

Adjustments of the thickness and consistency of

foods to improve nutritional intake may be
provided by a speech therapist.

Determine time of day

when the patients appetite
is at peak. Offer highest
calorie meal at that time.

Patients with liver disease often have their largest

appetite at breakfast time.

Encourage family members

to bring food from home to
the hospital.

Patients with specific ethnic or religious

preferences or restrictions may not consider foods
from the hospital.

Offer high protein

supplements based on
individual needs and
capabilities.

Such supplements can be used to increase

calories and protein without conflict with
voluntary food intake.

Offer liquid energy

supplements.

Energy supplementation has been shown to

produce weight gain and reduce falls in frail
elderly living in the community.

Discourage caffeinated or
carbonated beverages.

These beverages will decrease hunger and lead to

early satiety.

Keep a high index of

suspicion of malnutrition as
a causative factor in
infections.

Impaired immunity is a critical adjunct factor in

malnutrition-associated infections in all age
groups.

Encourage exercise.

Metabolism and utilization of nutrients are

improved by activity.

Consider the possible need

for enteral or parenteral
nutritional support with the
patient, family, and
caregiver, as appropriate.

Nutritional support may be recommended for

patients who are unable to maintain nutritional
intake by the oral route. If gastrointestinal tract is
functioning well, enteral tube feedings are
indicated. For those who cannot tolerate enteral
feedings, parenteral nutrition is recommended.

Validate the patients

feelings regarding the
impact of current lifestyle,
finances, and transportation
on ability to obtain
nutritious food.

Validation lets the patient know that the nurse

has heard and understands what was said, and it
promotes the nurse-patient relationship.

Once discharged, help the

patient and family identify
area to change that will
make the greatest

Change is difficult. Multiple changes may be

overwhelming.

contribution to improved
nutrition.
Adapt modification to their
current practices.

Accepting the patients or familys preferences

shows respect for their culture.