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IMBALANCED NUTRITION: LESS THAN BODY REQUIREMENTS Nursing Care Plan

Imbalanced Nutrition: Less Than Body Requirements
Intake of nutrients insufficient to meet metabolic needs

Major (Must Be Present, One or More)
The client who is not NPO reports or is found to have food intake
less than the recommended daily allowance (RDA) with or without
weight loss
and/or
Actual or potential metabolic needs in excess of intake with
weight loss
Minor (May Be Present)
Weight 10% to 20% or more below ideal for height and frame
Triceps skinfold, mid-arm circumference, and mid-arm muscle
circumference less than 60% standard measurement
Muscle weakness and tenderness
Mental irritability or confusion
Decreased serum albumin
Decreased serum transferrin or iron-binding capacity
Sunken fontanel in infant
Related Factors
Pathophysiologic
Related to increased caloric requirements and difficulty in ingesting
sufficient
calories secondary to:
Burns (postacute phase)
Cancer
Infection
Trauma
Chemical dependence
Preterm infants
Gastrointestinal (GI)
complications/deformities
AIDS
Related to dysphagia secondary to:
Cerebrovascular accident
(CVA)
Parkinson’s disease
Möbius syndrome
Muscular dystrophy
Cerebral palsy
Cleft lip/palate
Amyotrophic lateral sclerosis
Neuromuscular disorders
Related to decreased absorption of nutrients secondary to:
Crohn’s disease
Lactose intolerance
Necrotizing enterocolitis
Cystic fibrosis
Related to decreased desire to eat secondary to altered level of consciousness
Related to self-induced vomiting, physical exercise in excess of caloric
intake, or refusal to eat secondary to anorexia nervosa
Related to reluctance to eat for fear of poisoning secondary to paranoid
behavior
Related to anorexia, excessive physical agitation secondary to bipolar
disorder
Related to anorexia and diarrhea secondary to protozoal infection
Related to vomiting, anorexia, and impaired digestion secondary to
pancreatitis
Related to anorexia, impaired protein and fat metabolism, and impaired
storage of vitamins secondary to cirrhosis
Related to anorexia, vomiting, and impaired digestion secondary to
GI malformation or necrotizing enterocolitis
Related to anorexia secondary to gastroesophageal reflux
Treatment Related
Related to protein and vitamin requirements for wound healing and
decreased intake secondary to:
Surgery
Surgical reconstruction of
mouth
Radiation therapy
Medications (chemotherapy)
Wired jaw
Related to inadequate absorption as a medication side effect of (specify):
Colchicine
Neomycin
Pyrimethamine
Para-aminosalicylic acid
Antacid
Related to decreased oral intake, mouth discomfort, nausea, and vomiting
secondary to:
Radiation therapy
Tonsillectomy
Chemotherapy
Oral trauma
Situational (Personal, Environmental)
Related to decreased desire to eat secondary to:
Anorexia
Social isolation
Depression
Nausea and vomiting
Stress
Allergies
Related to inability to procure food (physical limitation or financial
or transportation problems)
Related to inability to chew (damaged or missing teeth, ill-fitting
dentures)
Related to diarrhea* secondary to (specify)
Maturational
Infant/Child
Related to inadequate intake secondary to:
Lack of emotional/sensory
stimulation
Lack of knowledge of caregiver
Inadequate production of
breast milk
Related to malabsorption, dietary restrictions, and anorexia secondary to:
Celiac disease
Lactose intolerance
Necrotizing enterocolitis
Cystic fibrosis
GI malformation
Gastroesophageal reflux
Related to sucking difficulties (infant) and dysphagia secondary to:
Cerebral palsy
Cleft lip and palate
Neurologic impairment
Related to inadequate sucking, fatigue, and dyspnea secondary to:
Congenital heart disease
Viral syndrome
Hyperbilirubinemia
Prematurity
Respiratory distress syndrome
Developmental delay

Author's Notes
Nurses are usually the primary diagnosticians and often the prescribers
for improving nutritional status. Although Imbalanced Nutrition is not a
difficult diagnosis to validate, interventions for it can challenge the nurse.
Many factors influence food habits and nutritional status: personal,
family, cultural, financial, functional ability, nutritional knowledge, disease
and injury, and treatment regimens. Imbalanced Nutrition: Less Than Body
Requirements describes people who can ingest food but eat an inadequate
or imbalanced quality or quantity. For instance, the diet may have
insufficient protein or excessive fat. Quantity may be insufficient because
of increased metabolic requirements (e.g., cancer, pregnancy, trauma,
or interference with nutrient use [e.g., impaired storage of vitamins in
cirrhosis]).
The nursing focus for Imbalanced Nutrition is assisting the client or
family to improve nutritional intake. Nurses should not use this diagnosis
to describe clients who are NPO or cannot ingest food. They should use
the collaborative problems RC of Electrolyte Imbalance or RC of Negative
Nitrogen Balance to describe those situations.

Goal
The client will ingest daily nutritional requirements in accordance
with activity level and metabolic needs, as evidenced by the
following
indicators:
• Relate importance of good nutrition.
• Identify deficiencies in daily intake.
• Relate methods to increase appetite.

Interventions
Explain the Need for Adequate Consumption of Carbohydrates,
Fats, Protein, Vitamins, Minerals, and Fluids
Consult With a Nutritionist to Establish Appropriate Daily Caloric
and Food Type Requirements for the Client
Discuss With the Client Possible Causes of Decreased Appetite
Encourage the Client to Rest Before Meals
Offer Frequent, Small Meals Instead of a Few Large Ones; Offer
Foods Served Cold
With Decreased Appetite, Restrict Liquids With Meals and Avoid
Fluids 1 Hour Before and After Meals
Encourage and Help the Client to Maintain Good Oral Hygiene
Arrange to Have High-Calorie and High-Protein Foods Served at
the Times That the Client Usually Feels Most Like Eating
Take Steps to Promote Appetite
• Determine the client’s food preferences and arrange to have
them provided, as appropriate.
• Eliminate any offensive odors and sights from the eating area.
• Control any pain and nausea before meals.
• Encourage the client’s family to bring permitted foods from
home, if possible.
• Provide a relaxed atmosphere and some socialization during
meals.
Provide for Supplemental Dietary Needs Amplified by Acute Illness
Give the Client Printed Materials Outlining a Nutritious Diet That
Includes the Following:
• High intake of complex carbohydrates and fiber
• Decreased intake of sugar, salt, cholesterol, total fat, and
saturated
fats
• Alcohol use only in moderation
• Proper caloric intake to maintain ideal weight
Pediatric Interventions
• Teach parents the following regarding infant nutrition:
• Adequate infant feeding schedule and weight gain requirements
for growth: 100 to 120 kcal/kg/day for growth
• Proper preparation of infant formula
• Proper storage of breast milk and infant formula
• Proper elevation of infant’s head during and immediately after
feedings
• Proper chin/cheek support techniques for orally compromised
infants
• The age-related nutritional needs of their children (consult
an appropriate textbook on pediatrics or nutrition for specific
recommendations).
• Discuss the importance of limiting snacks high in salt, sugar, or
fat (e.g., soda, candy, chips) to limit risks for cardiac disorders,
obesity, and diabetes mellitus. Advise families to substitute
healthy snacks (e.g., fresh fruits, plain popcorn, frozen fruit
juice bars, fresh vegetables).
• Assist families in evaluating their nutritional patterns.
• Discuss strategies to make meals a social event and to avoid
struggles (Dudek, 2009; Hockenberry & Wilson, 2009).
• Allow the child to select one type of food he or she does not
have to eat.
• Provide small servings (e.g., one tablespoon of each food for
every year of age).
• Make snacks as nutritiously important as meals (e.g., hardboiled
eggs, raw vegetable sticks, peanut butter/crackers, fruit
juices, cheese, and fresh fruit).
• Offer a variety of foods.
• Encourage all members to share their day.
• Involve the child in monitoring healthy eating (e.g., create a
chart where the child checks off intake of healthy foods daily).
• Replace passive television watching with a group activity (e.g.,
Frisbee tossing, biking, walking).
• Address strategies to improve nutrition when eating fast foods:
• Drink skim milk.
• Avoid french fries.
• Choose grilled foods.
• Eat salads and vegetables.
• Substitute quick, nutritious fast meals (e.g., frozen dinners).
Maternal Interventions
• Teach the importance of adequate calorie and fluid intake
while breastfeeding in relation to breast milk production.
• Explain physiologic changes and nutritional needs during
pregnancy.
Discuss the effects of alcohol, caffeine, and artificial sweeteners
on the developing fetus.
• Explain the different nutritional requirements for pregnant
girls 11 to 18 years of age, pregnant young women 19 to
24 years of age, and women older than 25 years.
• Determine if a woman needs more calories because of daily
activity.
• 28.5 kcal/kg for 11 to 14 years
• 24.9 kcal/kg for 15 to 18 years
• 23.3 kcal/kg for 19 to 24 years
• 21.9 kcal/kg for 25 to 50 years
• Multiply resting caloric needs by:
• 1.5 for light activity
• 1.6 for moderate activity
• 1.9 for heavy activity
Geriatric Interventions
Determine the Client’s Understanding of Nutritional Needs With:
• Aging
• Medication use
• Illness
• Activity
Assess Whether Any Factors Interfere With Procuring or Ingesting
Foods (Miller, 2009)
• Anorexia from medications, grief, depression, or illness
• Impaired mental status leading to inattention to hunger or
selecting insufficient kinds/amounts of food
• Impaired mobility or manual dexterity (paresis, tremors,
weakness, joint pain, or deformity)
• Voluntary fluid restriction for fear of urinary incontinence
• Small frame or history of undernutrition
• Inadequate income to purchase food
• Lack of transportation to buy food or facility to cook
• New dentures or poor dentition
• Dislike of cooking and eating alone
• Client regularly eats alone
• Client has more than two alcoholic drinks daily
Explain Decline in Sensitivity to Sweet and Salty Tastes; If
Indicated, Consult With Home Health Nurse to Evaluate Home
Environment (e.g., Cooking Facilities, Food Supply, Cleanliness)
Access Community Agencies as Indicated (e.g., Nutritional
Programs, Community Centers, Home-Delivered Grocery Services)

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