Alteration in Nutrition: Less Than Body Requirements

(_)Actual (_) Potential

Related To:
[Check those that apply]

(_) Dysphagia caused by:_________________ (_) Absorptive disorders (_) Anorexia (_) Allergy (_) Burns (_) Cancer (_) Chemotherapy (_) Chemical dependence (_) Crash or fad diet (_) Depression

(_) Inability to obtain food (_) Infection (_) Lack of knowledge of adequate nutrition (_) Nausea and vomiting (_) Radiation Therapy (_) Social isolation (_) Stress (_) Trauma (_) Other:___________________________ __________________________________ __________________________________

As evidenced by:
[Check those that apply]

Major: (Must be present ) Minor: (May be present )

(_) Reported inadequate food intake less than recommended daily allowance with or without weight loss and/or actual or potential metabolic needs in excess of intake. (_) Weight 10% to 20% or more below ideal for height and frame. (_) Tachycardia on minimal exercise and bradycardia at rest. (_) Muscle weakness and tenderness. (_) Mental irritability or confusion. (_) Decreased serumm albumin.

Date & Sign.

Plan and Outcome

[Check those that apply]

Target Date:

Nursing Interventions
[Check those that apply]

Date Achieved:

The patient will: (_) Experience adeuqate nutrition through oral intake. (_) Experience an increase in the amount or type of nutrients ingested. (_) Gain weight. (_) Other:

(_) Assess and document patient's dietary history, patters of ingestion, intolerance to foods. (_) Assess patient likes and dislikes. Inform dietary. (_) Teach techniques to maintain adequate nutritional intake and stimulate appetite: y administer/instruct pt. on good oral hygiene before and after feedings maintain pleasant environment for

patient (_) Determine proper denture fit and profice adhesive as necessary. (_) Increase social contact with meals by:____________________ _______________________ (_) Plan care so that unpleasant/painful tests/tx's don't take place before meals. (_) Medicate pt. for pain 2 hrs before meals per physician's orders. (_) Consult with dietitian re: y y y y y y y y y calorie count change in food consistency spacing meals provision of high caloric supplements provision of high protein supplementation food intolerances/preferences extra fluids on tray dietetic teaching, food selelction therapeutic diet restrictions: __________________

(_)Consult with PT/PT re: y y y strengthening exercises prosthetic devices swallowing disorders

(_) Environmental support to improve intake: y y be sure pt. is alert and responsive before eating sit upright 60-90 degrees for 1520 min. before, during & after eating decrease distractions demonstrate patience by providing specific directions until finished assure good mouth care

y y

(_) Weigh patient q______

at _______ a.m./p.m. (_) Other:________________ ________________________ ________________________ ________________________

__________________________ Patient/Significant other signature

__________________________ RN signature

IMBALANCED NUTRITION, LESS THAN BODY REQUIREMENTS

Definition: Intake of nutrients insufficient to meet metabolic needs.
Copyright 2005 by F.A. Davis Company

Possible Etiologies ("related to")

Inability to ingest food because of: [Depressed mood] [Loss of appetite] [Energy level too low to meet own nutritional needs] [Regression to lower level of development] [Ideas of self-destruction]

Defining Characteristics ("evidenced by")

Loss of weight Lack of interest in food Pale conjunctiva and mucous membranes Poor muscle tone [Amenorrhea] [Poor skin turgor] [Edema of extremities] [Electrolyte imbalances] [Weakness]

[Constipation] [Anemias]

Goals/Objectives
Short-Term Goal
Client will gain 2 pounds per week for the next 3 weeks.

Long-Term Goal
Client will exhibit no signs or symptoms of malnutrition by time of discharge from treatment (e.g., electrolytes and blood counts will be within normal limits; a steady weight gain will be demonstrated; constipation will be corrected; client will exhibit increased energy in participation in activities).

Interventions with Selected Rationales

1. In collaboration with dietitian, determine number of calories required to provide adequate nutrition and realistic (according to body structure and height) weight gain. 2. To prevent constipation, ensure that diet includes foods high in fiber content. Encourage client to increase fluid consumption and physical exercise to promote normal bowel functioning. Depressed clients are particularly vulnerable to constipation because of psychomotor retardation. Constipation is also a common side effect of many antidepressant medications. 3. Keep strict documentation of intake, output, and calorie count. This information is necessary to make an accurate nutritional assessment and maintain client safety. 4. Weigh client daily. Weight loss or gain is important assessment information. 5. Determine clients likes and dislikes, and collaborate with dietitian to provide favorite foods. Client is more likely to eat foods that he or she particularly enjoys. 6. Ensure that client receives small, frequent feedings, including a bedtime snack, rather than three larger meals. Large amounts of food may be objectionable, or even intolerable, to the client. 7. Administer vitamin and mineral supplements and stool softeners or bulk extenders, as ordered by physician. 8. If appropriate, ask family members or significant others to bring in special foods that client particularly enjoys. 9. Stay with client during meals to assist as needed and to offer support and encouragement. 10. Monitor laboratory values, and report significant changes to physician. Laboratory values provide objective data regarding nutritional status. 11. Explain the importance of adequate nutrition and fluid intake. Client may have inadequate or inaccurate knowledge regarding the contribution of good nutrition to overall wellness.

Outcome Criteria
1. Client has shown a slow, progressive weight gain during hospitalization. 2. Vital signs, blood pressure, and laboratory serum studies are within normal limits. 3. Client is able to verbalize importance of adequate nutrition and fluid intake. 4.

Pregnancy and Nutrition

5. Is the first of a three part exclusive web series by T. J. Clark & Company dealing with the aspects of pregnancy, birth and the developmental years most affected by nutrition. 6. Of Special concern for Mothers-to-be 7. Although everyone needs the same nutrients, the amounts we need change as our lives change. This message is for all women of childbearing age, mothers-to-be, and growing families everywhere. We will discuss perhaps the three most important phases of nutrient requirements that determine an individuals lifelong health and nutrition status; Pregnancy, lactation, and infancy. 8. We normally think of our nutrition as personal, affecting only our own lives. This isn't always the case though. The woman who is pregnant, or who may be, must understand that her nutrition today will be critical to the health of her child throughout life. The nutrition demands of pregnancy are extraordinary because the growth of a whole new person requires all the minerals and other nutrients, and most in larger amounts. 9. Before Pregnancy 10. Before becoming pregnant, a woman must establish nutrition habits that will optimally nourish both the growing fetus, and herself. She must be well nourished at the outset because in early pregnancy the embryo undergoes rapid and significant developmental changes that depend on her prior balance of minerals, vitamins, and other nutrition concerns. Fathers-to-be are also encouraged to consider their nutrition status. Some evidence suggests that men who consume too few vitamins and minerals, or who drink too much alcohol before conception may damage their sperm's genetic material. This damage can cause birth defects in future children. 11. Prepregnancy weight 12. The weight gain for a woman of healthy body weight is recommended to be between 2535 lbs. during the course of pregnancy. Prior to pregnancy, all women should strive for appropriate body weights. This is especially important for underweight women. An underweight woman who fails to gain adequately during pregnancy is most likely to give birth to a baby with dangerously low birthweight. Infant birthweight is the single most potent indicator of a child's future nutrition and health status. A low-birthweight baby is defined as one who weighs less than 5 1/2 pounds at full-term. These victims of improper nutrition, and sometimes unavoidable health concerns, are almost 40 times more likely to die in the first year of life than is a normal-weight baby. Underweight women are therefore advised to not only see to their nutrition needs of minerals, vitamins and all the other necessary nutrients, but to consume extra amounts of them so as to gain weight in a healthy manner. Nutritional deficiency, coupled with low birthweight, is the underlying cause of more than half of all deaths worldwide of children under five years of age. It is

advisable for an underweight woman to gain about 40 pounds during the course of her pregnancy. Teenage mothers seem to be at greater risk for this condition than adult women, therefore any teen pregnancy should be closely monitored. More information about this in a later section. 13. Obese women too, are urged to attain healthy weights before pregnancy. Under no conditions should a woman go on a diet after she has learned she is pregnant. Doing so may dangerously reduce the amount of nutrients fed to the growing embryo. The infant of an obese mother may be larger than normal, and born late, or it may be large in size even if born prematurely. In the latter case, the baby may not be recognized as premature and may not receive the special care it requires from medical staff. Maternal obesity also may double the risk for neural tube defects in the infant. Also, obese pregnant women more often suffer gestational diabetes, hypertension, and infections after the birth, than do women of healthy weight. The birth itself may be more likely to require drugs, or surgical intervention to induce labor. A good idea for obese women who may become pregnant is to consume adequate amounts of essential nutrients from nutrient-dense foods and goodquality supplements, without consuming excess fat. The goal is to attain a body weight just low enough to lower the medical risks associated with obesity, before becoming pregnant. Even for obese women, the minimum weight gain should be around thirteen pounds during the pregnancy. 14. Nutrition in the first days and weeks 15. A major reason the mother's nutrition before pregnancy is so important is that it determines whether her uterus will be able to support the growth of a healthy placenta during the first month of gestation. If the placenta works perfectly, the fetus wants for nothing, if it doesn't, no alternative source of sustenance is available and the fetus will not thrive. The Placenta is a sort of cushion of tissue in which the mother's and baby's blood vessels intertwine and exchange materials. The two bloods never mix, but nutrients and oxygen cross from the mother's blood into the baby's blood while wastes move out of the baby's blood, ultimately to be excreted by the mother. The amniotic sac forms to cradle the baby, cushioning it with fluids. 16. Far from being passive in its transport of molecules, the placenta is a highly metabolic organ with about 60 sets of enzymes of its own. It actively gathers up hormones, nutrients, and protein molecules such as antibodies and transfers them into the fetal bloodstream. It also produces hormones that maintain pregnancy and prepare the mother's breasts for lactation. If the mother's nutrient stores are inadequate during the period when the body is preparing to develop the placenta, then the placenta will never develop properly. As a consequence, no matter how well she eats later, the fetus will not receive optimal nourishment. The infant is likely to be a low-birthweight baby with all of the associated risks. After getting such a poor start on life, the child may be ill equipped, even as adults, to store sufficient nutrients, and a girl may later be unable to grow her own placenta. In turn, she may bear an infant who is unable to reach full potential. The importance of this statement cannot be overstated; The single most critical nutrition period in a pregnancy occurs before the woman ever knows she is pregnant in most cases. And as we have seen, improper balance of the proper nutrients can not only affect the mother and child, but the child's child, and so forth. 17. The growth of a proper placenta for fetal development isn't even the only nutrient factor to consider. Throughout pregnancy, there are thousands more, and like the placenta,

many of them are taking place before the woman knows she is pregnant. A good example is neural tube defects. Neural Tube Defects include any condition in which the tissue encasing the spinal column and brain stem fail to close properly, leaving the spinal cord exposed. The most common form is Spina Bifida. An even more severe form is Anencepholy, in which the upper neural tube fails to close, and the child is born without a brain, or an underdeveloped brain. A condition that is always fatal within a few days or weeks after birth. As tragic as these conditions are, they are often preventable if the mother would ensure that she is properly nourished even if she may become pregnant. Not every case of neural tube defect is caused by malnutrition. Some are caused by heredity (perhaps caused by mother's malnutrition), disease, an injury during pregnancy or unknown causes. Still, many are known to result from malnutrition, enough so that the U.S. Congress saw it necessary to pass legislation making it the law for certain foods to be fortified with critical nutrients. The time of fetal development at which the neural tube should close is about 28 days. Again, most women don't even know they are pregnant at that time, so good nutrition is always important. Enough folate is required to fuel the explosion of new cells which occur with gestation, but folate isn't the only nutrient required in larger amounts. Also Vitamin's B6 and B12, the minerals Iron and Magnesium, and all the other major and trace minerals and other nutrients which are involved in normal cell division and replication. Including the amino acids, which are the structural building blocks for new tissue. If a woman's nutrition status isn't what it should be during the time these developments are taking place there is no second chance. Further damage can be prevented by supplying the proper diet and supplement changes, but you cannot undo the damage that has already been done. This is because certain developments can take place only at one certain time during gestation, and not later. If the chance is missed, it's gone for good. Make no mistake, it definitely pays for the woman in her child-bearing years to ensure that at all times she has the proper balance of minerals, vitamins, and other nutrients necessary to support life. 18. Yet with the immense need for extra nutrients a woman needs before and during pregnancy, she is only recommended to consume 300 more calories than a non-pregnant woman, and then only during the second and third trimesters. Obviously, the 300 calorie allotment isn't always attainable, but it does make it very important for the woman to consume nutrient-dense foods, and take quality nutritional supplements so that she can get these extra items without gaining more weight than is healthy.