NUTRITION moments intended to improve patient’s

comfort and health

• North American Nursing Diagnosis
Association (NANDA) includes the following 7 MAINS OF NIC:
diagnostic labels for nutritional problems:
1. FAMILY NURSING INTERVENTIONS
- Imbalanced Nutrition: More Than Body
2. BEHAVIORAL NURSING INTERVENTIONS
Requirements
3. BASIC PHYSIOLOGICAL NURSING
- Imbalanced Nutrition: Less Than Body
INTERVENTIONS
Requirements
4. COMPLEX PHYSIOLOGICAL NURSING
- Readiness for Enhanced Nutrition
INTERVENTIONS
- Risk for Imbalanced Nutrition: More
5. COMMUNITY NURSING INTERVENTIONS
Than Body Requirements
6. SAFETY NURSING INTERVENTION
• Nutritional diagnostic label may be used as
7. HEALTH SYSTEMS INTERVENTIONS
the etiology
- Activity Intolerance related to NOC outcomes / NIC interventions
inadequate intake of iron-rich foods
- Continuity of care = consider client’s
resulting in iron-deficiency anemia.
needs for assistance with nutrition
- Constipation related to inadequate
- E.g., eating purchasing food, preparing
fluid intake and fiber intake.
meals, instructions about enteral/
- Low Self-Esteem related to obesity.
parental nutrition therapy
- Risk for Infection related to
- Client and family’s abilities for self-care,
immunosuppression secondary to
financial resources referrals, home
insufficient protein intake
health services
PLANNING
IMPLEMENTING
- Maintain or restore optimal nutritional
Nursing Interventions = collaboration with
status
primary care provided & dietitian
- Promote healthy nutritional practices
- Prevent complications associated with NURSE:
malnutrition
- Decrease weight 1. Reinforce instruction
- Regain specified weight 2. Creates an atmosphere that encourages
eating
NIC/NOC 3. Provides assistance with eating
4. Monitors the client’s appetite and food
• NOC
intake
- a system to evaluate effects of nursing
5. Administers enteral feedings
care
6. Consults with the primary health
- Describes patients’ outcomes sensitive
provided & dietitian about nutritional
to nursing interventions
problems that arise
• NIC – care classification system which
- Community setting-nurse’s role is
describes activities a nurse takes to
EDUCATIONAL
implement patient care plan e.g.,
▪ Health fairs, prenatal diseases,
treatments, procedures, or teaching
nutritional screens, referrals
 enteral and parental feedings,
nutritional counselling
EXAMPLES OF NURSING INTERVENTIONS
Intervention / Examples
1. Food and/or nutrient delivery
- Providing appropriate meals
- Determining the need for feeding
assistance
2. Nutritional education
- Providing basic nutrition-related
instruction
- Providing in-department training to
increase dietary knowledge/skills
3. Nutrition counselling
- Motivating the individual to change
behaviors
- Solving problems that interfere with the
nutrition care plan
4. Coordination of nutrition care
- Providing referrals or consulting other
health professionals or agencies that can
assist with treatment
- Arranging transfer of nutrition care to
another professional or location
INCORPORATING NUTRITION CARE INTO THE
NURSING CARE PLAN
- 74-year-old man with emphysema &
dysphagia; lives with wife
- Uses oxygen therapy at home but mostly
while sleeping; frequently feels “out of
breath” during the day
- Reports coughing while eating; senses
that food gets “stuck” in his throat
- Believes he has lost weight recently
because his clothes seem looser than
usual. Says usual weight is 160 pounds,
which is documented in the medical
record
- Physically inactive, most watches TV
during the day.
NURSING PROCESS / NUTRITION-RELATED
FEATURES:
1. NURSING DIAGNOSIS – Impaired
swallowing: related to neuromuscular
impairment
- OUTCOME IDENTIFICATION –
Appropriate outcomes include the
patient’s ability to: identify foods &
beverages that can be consumed with
difficulty
- PLANNING – To achieve the expected
outcomes, the nurse plans to: Educate
the patient about body positioning &
feeding techniques that can improve his
ability to eat w/o coughing or discomfort
2. NURSING DIAGNOSIS – Risk for
aspiration; related to ineffective
swallowing reflex
- OUTCOME IDENTIFICATION –
Appropriate outcomes include the
patient’s ability to: Consume meals w/o
coughing or aspiration
- PLANNING – Ex. of intervention that
would require the involvement of other
health professionals include: the
standing physician may need to
prescribe dysphagia testing to help
determine the most appropriate food
plan for the patient
EXPECTED OUTCOMES:
- Verbalize plan for modifying factors to
prevent or minimize shifts in glucose
level
- Maintain glucose in satisfactory level
- Verbalize knowledge & understanding of
prescribed diet, signs of hypoglycemia,
preparation & administration of insulin
OTHER PROBLEM:
Consider:
- Max’s age-level of understanding &
pyscho-emotional status
 - Chronic nature of Max’s Illness
• Monitoring of blood glucose level, signs of
hypoglycemia
- Compliance to treatment plan
• Proper preparation & administration of
insulin
APPROACHES TO NUTRITION CARE
1. Long-term Nutrition Intervention
- Determine the individual’s readiness for
change
- Emphasize what to eat, rather than what
not to eat
- Suggest only 1 or 2 changes at a time
2. Nutrition Education
- Level of literacy, age, cultural
background
- Sample menus, type & amount of food,
diet analysis, food label
3. Follow-up Care
- Monitor progress
- Evaluate effectiveness of the nutrition
care plan
CULTURALLY COMPETENT CARE: SELECTED
VARIATIONS IN NUTRITIONAL PRACTICES AND
PREFERENCES AMONG DIFFERENT CULTURES
AFRICAN AMERICAN HERITAGE
- Gifts of food are common ans should
never be rejected
- Diets are often high in fat, cholesterol
and sodium
- Being overweight as viewed as positive
- Most persons are lactose intolerant
ARAB HERITAGE
- Many spices and herbs are used such as:
cinnamon, allspice, cloves, mint, ginger
and garlic
- Meats are often skewer roasted or slow
simmered; most common are lamb and
chicken
- Bread is served at every meal
- Muslims do not eat pork, and all meats
must be cooked well done
- Food is eaten (and clients fed) with the
right hand  Beverages are drank after
the meal not during
- Muslims fast during daylight hours
during the month of Ramadan (may fall
at a slightly different time each year on
non-Muslim calendars)
CHINESE HERITAGE
- Foods are served at meals in a specific
order
- Each region in China has its own
traditional diet
- Traditional Chinese may not want ice in
their drinks
- Foods are chosen to balance yin and
yang in order to avoid indigestion
JEWISH HERITAGE
- Dietary loss governs killing, preparation,
and eating of foods
- Meat and milk are not eaten at the same
time; daily substitutes (e.g. Margarine)
are permitted
- Pork is one meat that is forbidden to eat
- All blood must be drained from meats.
- Always wash hands before eating
MEXICAN HERITAGE
- Rice, beans and tortillas are core
essential foods
- Many persons are lactose intolerant.
Leafy green vegetables and stews with
bones provide calcium
- Being overweight is viewed as positive 
Sweet fruit drinks, including adding
sugar to juice are popular  The main
meal of the day is at noontime  Foods
are chosen according to hot and cold
theory
NAVAJO HERITAGE
 - Rites of passage and ceremonies are
celebrated with food
- Herbs are used to treat many illnesses
- Sheep are the major source of meat
- Squash and corn are major vegetables
- Most persons are lactose intolerant
HOME CARE ASSESSMENT
CLIENT/ENVIRONMENT:
- Self-care abilities: Assess ability to feed
self, to purchase food, and to prepare
meals
- Adaptive feeding aids required:
Determine need for special drinking
cups, plates, or feeding utensils 
Instructional needs: Consider nutritional
requirements (e.g. Food Guide Pyramid,
Dietary Guidelines, Special Diet),
adaptive aids available, recommended
lifestyle variations, and management of
enteral/parenteral nutrition
- Physical environment: Assess adequacy
of water, electricity, refrigeration, and
telephone facilities; and presence of
clean, secure area to store and set-up
enteral/parenteral equipment as
needed
(adult day care, senior centers) and so
on.
COMMUNITY
- Current knowledge, use, and experience
with community resources: Nutritional
counseling services; home health
agencies for enteral/parenteral nutrition
support; dietitian or nutritionist for
planning appropriate meals for
prescribed diet, ways to include ethnic
food preferences into the diet, and
providing written meal plans; medical
equipment and supply companies;
financial assistance services; and
support and educational services such as
▪ Weight management programs
(e.g., Weight Watchers)
▪ National Center for Nutrition and
Dietetics for Information on all
nutrition topics
▪ National Eating Disorder
Information Center
▪ Meals on Wheels

FAMILY

- Caregiver availability, skills, and

willingness: primary and secondary
persons able to assist with food
purchase, meal preparation, and feeding
and able to comprehend and administer
special diets or enteral/parenteral
nutrition required
- Family role changes and coping: effect
on parenting and spousal roles, financial
resources, and social roles
- Alternate potential primary or respite
caregivers: For example, other family
members, volunteers, church members,
paid caregivers or housekeeping
services; available community respite