Basic Interventions

to Maintain:
NUTRITION
STEPS TO OPTIMAL
NUTRITION CARE
 STEP 1
Nutrition Screening

-Required for patients within 24 hours of admission

-Determine need for a detailed nutrition assessment
-Part of the general admission assessment
 STEP 2

At-risk Determination
At risk for malnutrition:

· involuntary loss of 10% or more of usual body weight within 6 months, or involuntary loss of 5% or
more of usual body weight in 1 month
· involuntary loss or gain of 10 lb within 6 months
· body mass index below 18.5 kg/m2 or above 25 kg/m2
· chronic disease
· increased metabolic require­ments
· altered diet or diet schedule
· inadequate nutritional in-take, including not receiving food or nutrition products for more than 7
days.
 STEP 3
weight loss
inadequate energy intake
Nutrition Assessment muscle mass loss
Relies on a combination of medical, nutrition, and subcutaneous fat loss
medication histories; physical examination fluid accumulation
findings; anthropometric measurements; and reduced hand-grip strength.
laboratory data.
Delineates the malnutrition diagnosis Malnutrition Manifestations
Basis for the nutrition plan of care.
trouble chewing
swallowing disorders
weight history
height and weight measurement
skin integrity
edema
electrolyte abnormalities
hand-grip strength (have the patient
squeeze your hand)
STEP 4
 STEP 5

Patient’s nutritional status, nutrition goals, and

Nutrition Care Plan safety and efficacy of interventions must be
monitored on a continual basis, particularly with
Formal statement of nutritional goals and transition-of-care planning.
interventions

Includes statements of nutritional goals and Monitoring and transition-

monitoring and evaluation parameters, the of-care planning
most appropriate administration route for nutrition
therapy, nutrition access method, anticipated
duration of therapy, and training and counseling
goals and methods.

STEP 6
Imbalanced Nutrition:
MORE THAN BODY
REQUIREMENTS
Common Goals and
Outcomes
· Patient claims ownership for current eating patterns.
·

Patient designs dietary modifications to meet individual long-term

goal of weight control, using principles of variety, balance, and
moderation.
· Patient verbalizes accurate information about benefits of weight
loss.
· Patient verbalizes measures necessary to attain beginning weight
reduction.
· Patient states related factors contributing to weight gain.
· Patient identifies behaviors that remain under his or her control.
· Patient fulfills desired weight loss in a reasonable period (1 to 2
pounds per week).
· Patient organizes relevant activities requiring energy expenditure
into daily life.
· Patient uses sound scientific sources to evaluate naeed for
nutritional supplements.
· Patient demonstrates appropriate selection of meals or menu
planning toward the goal of weight reduction.
 Nursing assessment
Note weight, waist Assess the effects or
circumference, and calculate complications of being
body mass index (BMI). overweight.

Know patient’s knowledge of

Obtain a thorough history a nutritious diet and need for
supplements.

Evaluate patient’s Assess dietary intake through 24-

physiological status in hour recall or questions regarding
relation to weight control. usual intake of food groups.

 Nursing assessment
Determine patient’s motivation
Determine the patient’s readiness
to lose weight, whether for
to initiate a weight loss regimen
appearance or health benefits.
by asking questions.

Observe for situations that Assess the patient’s ability to

indicate a nutritional intake of read food labels.
more than body requirements.

Discover the behavioral factors Assess for use of nonprescription

that contribute to overeating. diet aids.

Evaluate the patient’s ability to Determine the patient’s ability to

accurately identify appropriate plan a menu and make
food portions. appropriate food selections.
 Nursing interventions
1. Initiate a patient contract that includes rewarding and reinforcing progressive goal
attainment.
2. Set appropriate short-term and long-term goals.
3. Negotiate with the patient regarding the aspects of his or her diet that will need to be
modified.
4. Suggest patient to keep a diary of food intake and circumstances surrounding its
consumption (methods of preparation, duration of meal, social situation, overall
mood, activities accompanying consumption).
5. Advise patient to measure food regularly.
6. Encourage water intake.
7. Review patient’s current exercise level. With patient and primary healthcare
provider, design a long-term exercise program.
8. Weigh patient twice a week under the same conditions.
9. Educate patient about adequate nutritional intake. A total plan permits occasional
treats.
10. Familiarize patient with the following behavior modification techniques:
Nursing interventions
 Nursing interventions
11. Allow and encourage patient to adopt an exercise routine that involves 45
minutes of exercise five times per week.
12. Observe for overuse of particular nutrients.
13. Provide the patient and family with information regarding the treatment plan
options.
14. Guide the patient regarding changes that will make a major impact on health.
15. Acquaint the patient and family of the disadvantages of trying to lose weight
by dieting alone.
16. Explain the importance of exercise in a weight control program.
17. Teach stress reduction methods as alternatives to eating.
Imbalanced Nutrition:
LESS THAN BODY
REQUIREMENTS
Several diseases can greatly affect the nutritional status of
an individual, this includes gastrointestinal malabsorption,
burns, cancer; physical factors (e.g., activity intolerance,
pain, substance abuse); social factors (e.g., economic
status, financial constraint); psychological factors (e.g.,
dementia, depression, grieving).
 Nursing assessment
Ascertain etiological factors for Evaluate the environment in
decreased nutritional intake. which eating happens.

Link usual food intake to

Review laboratory values that
USDA Food Pyramid, noting
indicate well-being or
slighted or omitted food
deterioration.
groups.

Look for physical signs of poor Assess patient’s ability to obtain

nutritional intake. and use essential nutrients.

Note the patient’s perspective If patient is a vegetarian, evaluate

and feeling toward eating and if obtaining sufficient amounts of
food. vitamin B12 and iron.
 This determines degree of protein reduction
· Serum albumin (2.5 g/dl signifies severe diminution; 3.8 to
4.5 g/dl is normal).

This is vital for iron transfer and typically

· Transferrin
decreases as serum protein decreases.

These counts are frequently dropped in

malnutrition, revealing anemia, and reduced
· RBC and WBC counts
resistance to infection.

Potassium is typically elevated, and sodium is

· Serum electrolyte values typically lowered in malnutrition.
 Nursing interventions
Ascertain healthy body weight for age and height. Refer to a
dietitian for complete nutrition assessment and methods for
nutritional support.
Set appropriate short-term and long-term goals.
Provide a pleasant environment.
Promote proper positioning.
Provide good oral hygiene and dentition.
If patient lacks strength, schedule rest periods
before meals and open packages and cut up food
for patient.
Provide companionship during mealtime.
Encourage exercise.
Consider the use of seasoning for patients with
changes in their sense of taste; if not contraindicated.
Consider six small nutrient-dense meals instead of
three larger meals daily to lessen the feeling of
fullness.
For patients with physical impairments, refer to an
occupational therapist for adaptive devices.
For patients with impaired swallowing, coordinate with a
speech therapist for evaluation and instruction.
Adapt modification to their current practices.
Determine time of day when the patient’s appetite is at
peak. Offer highest calorie meal at that time.
Encourage family members to bring food from home to
the hospital.
Offer high protein supplements based on
individual needs and capabilities.
Offer liquid energy supplements.
Discourage caffeinated or carbonated beverages.
Keep a high index of suspicion of malnutrition
as a causative factor in infections.
Consider the possible need for enteral or parenteral
nutritional support with the patient, family, and
caregiver, as appropriate.
Validate the patient’s feelings regarding the impact of
current lifestyle, finances, and transportation on ability
to obtain nutritious food.
Once discharged, help the patient and family identify
area to change that will make the greatest contribution
to improved nutrition.
END OF PRESENTATION