Definition
A situation where individuals who are at risk of weight loss associated with inadequate input, or metabolism of nutrients is not adequate for metabolic needs.
Related Factors:
Pathophysiology
Related to an increased calorie needs and difficulty in digesting sufficient calories
Burn
Infection
Dependence of chemicals
Cancer
Trauma
Related to dysphagia
Cerebrovascular injury
Amiotrofik lateral sclerosis
Cerebral palsy
Parkinson's
Abnormalities neurovaskuler
Muscular dystrophy
Related to decreased absorption of nutrients
Crohn's Disease
Cystic Fibrosis
Lactose Intolerance
Related to decreased desire to eat
Decreased level of consciousness
Related to vomiting is stimulated alone, refusing to eat
Anorexia nervosa
Related to a reluctance to eat for fear of poisoning
Paranoid behavior
Related to anorexia, excessive physical agitation
Bipolar disorder
Related to anorexia and diarrhea
Protozoan infection
Related to vomiting, anorexia, gastrointestinal damage
Pancreatitis
Related to anorexia, fat and protein metabolism damage, and damage to storage of vitamin
Cirrhosis
Action
Related to an increased need for protein and vitamins for healing wounds
Surgery
Medications
Reconstruction of oral surgery
Wire jaw
Radiation Therapy
Related to inadequate absorption as the effect of
Colchicine
Piremetamin
Antacids
Neomycin
Para-Aminosalicylic Acid
Related to decreased oral input, mouth discomfort, nausea, vomiting
Radiation Therapy
Chemotherapy
Tonsillectomy
Situational (Personal, environmental)
Related to decreased desire to eat
Anorexia
Depression
Stress
Social isolation
Nausea and vomiting
allergy
Related to less knowledge of adequate nutrition
Related to the inability to chew
Damage to teeth or no teeth
Installation of false teeth are not strong
Maturisional
Related to inadequat input
Lack of emotional stimulation / sensory
Lack of knowledge about caregivers
Related to malabsorption, diet restriction, and anorexia
Celiac disease
Lactose Intolerance
Cystic Fibrosis
Related to difficulties to suck (infant) and dysphagia
Cerebral palsy
Cleft lip or palate
Related to inadequate swallowing, fatigue, and dyspnea
Congenital heart disease
Prematurity
Nursing Care Plan for Imbalanced Nutrition Less than Body Requirements
Major Data
- Reported inadequate food input is less than the recommended food inputs with or without weight loss
- Metabolic needs of actual or risk of excessive nutrient inputs.
Minor Data
- Weight loss of 10% -20% or more below ideal body weight for height
- Triceps skin folds, arm circumference was less than 60% of the standard measurement
- Muscle weakness and tenderness
- Sensitive mental stimulation and mental disorder
- Decrease in serum albumun
Expected Outcomes Nursing Care Plan for Imbalanced Nutrition Less than Body Requirements
Individuals will:
- Improving the oral input
- Explain the factors that cause if known
- Explain the rationale and treatment procedures
Nursing Intervention Nursing Care Plan for Imbalanced Nutrition Less than Body Requirements
- Determine daily calorie needs are realistic and adequate. Consultation on nutrition expert.
- Weigh the body weight every day, monitor the results of laboratory examination.
- Explain the importance of adequate nutrition.
- Teach individuals to use flavorings to help improve the taste and smell of food (lemon, mint, clove, cinnamon, rosemary)
- Give encouragement of individuals to eat with others (food served in the family room or group)
- Plan maintenance procedures have an unpleasant or painful not done before eating.
- Give a fun, relaxed atmosphere (not visible potty, do not busy)
- Adjust the treatment plan to reduce or eliminate odors that cause wanted to vomit or procedure performed near the time of eating.
- Teach or assist individuals to rest before eating.
- Teach individuals to avoid the smell of fried food-eating, coffee-cooked if possible.
- Maintain oral hygiene before and after chewing.
- Offer to eat small portions but frequently to reduce feelings of tension in the stomach (six times per day with little food)
- Set to get the nutrients protein / high calorie, which is presented to individuals when they want to eat. (Eg, if the chemotherapy is done early morning and serve meals in the evening before eating).
- Instruct individuals who experience decreased appetite for:
- Eating dry foods waking.
- Eating salty foods if there are no restrictions.
- Avoid foods that are too sweet, fattening, greasy.
- Try to drink clear, warm.
- Sip through a straw.
- Eat whenever tolerated.
- Eat small meals low in fat and eat more often.
- Try commercial supplements are available in many forms (powder, pudding, liquid)
- If individuals experiencing eating disorders (Townsend, 1994)
- Set goals with the client's input, doctors and nutritionists.
- Talk about the benefits of compliance and the consequences of disobedience.
- If the input of food that must be rejected, remind the doctor.
- Sitting accompany individuals during the meal, limit the time to eat up to 30 minutes.
- Observe at least 1 hour before. Accompany client when to the bathroom.
- Weigh the client body when he woke up and after the first micturition.
- Give encouragement to repair, but do not focus the conversation on food or way of eating.
- Along the improvement of individual, explore issues of self-image, weigh again, and watched over.
- For individuals who are hyperactive
- Provide food and beverages that are high in protein, high calorie.
- Offer more frequent smaller meals. Avoid foods that contain no calories (eg, soda)
- Take a stroll along individual when given little food.
Source : Nanda Nursing Interventions
