IMBALANCED NUTRITION: MORE THAN BODY REQUIREMENTS Nursing Care Plan

Imbalanced Nutrition: More Than Body Requirements
Intake of nutrients that exceeds metabolic needs
Defining Characteristics
Major (Must Be Present, One or More)
Overweight (weight 10% over ideal for height and frame), or
Obese (weight 20% or more over ideal for height and frame)*
Triceps skinfold greater than 15 mm in men and 25 mm in women*
Minor (May Be Present)
Reported undesirable eating patterns
Intake in excess of metabolic requirements
Sedentary activity patterns
Related Factors
Pathophysiologic
Related to excessive intake in relation to metabolic needs*
Related to altered satiety patterns secondary to (specify)
Related to decreased sense of taste and smell
Treatment Related
Related to altered satiety secondary to:
Medications (corticosteroids, antihistamines, estrogens)
Radiation (decreased sense of taste and smell)
Situational (Personal, Environmental)
Related to stress
Related to overeating
Related to dysfunctional eating pattern (e.g., pairing with other activities,
fast foods)
Related to risk to gain more than 25 to 30 lb when pregnant
Related to lack of basic nutrition knowledge

Author's Notes
Using this diagnosis to describe people who are overweight or obese places
the focus of interventions on nutrition. Obesity is a complex condition with
sociocultural, psychological, and metabolic implications. When the focus is
primarily on limiting food intake, as with many weight-loss programs, the
chance of permanent weight loss is slim. To be successful,
a weight-loss
program must focus on behavior modification and lifestyle changes.
The nursing diagnosis Imbalanced Nutrition: More Than Body
Requirements does not describe this focus. Rather, Risk-Prone Health
Behavior related to intake in excess of metabolic requirements better
reflects the need to increase metabolic requirements through exercise and
decreased intake. For some people who desire weight loss, Ineffective
Coping related to increased eating in response to stressors could be useful
in addition to Risk-Prone Health Behavior.
The nurse should be cautioned against applying a nursing diagnosis
for an overweight or obese person who does not want to participate
in a weight-loss program. Motivation for weight loss must come from
within. Nurses can gently and expertly teach the hazards of obesity but
must respect a client’s right to choose—the right of self-determination.
Imbalanced Nutrition: More Than Body Requirements does have clinical
usefulness for people at risk for or who have experienced weight gain
because of pregnancy, taste or smell changes, or medications
(e.g., corticosteroids).

Goal
The person will describe why he or she is at risk for weight gain as
evidenced by the following indicators:
• Describe reasons for increased intake with taste or olfactory
deficits.
• Discuss the nutritional needs during pregnancy.
• Discuss the effects of exercise on weight control.

Interventions
Refer to Related Factors
Explain the Effects of Decreased Sense of Taste and Smell on
Perception of Satiety After Eating. Encourage Client to:
• Evaluate intake by calorie counting, not feelings of satiety.
• If not contraindicated, season foods heavily to satisfy decreased
sense of taste. Experiment with seasonings (e.g., dill, basil).
• When taste is diminished, concentrate on food smells.
Explain the Rationale for Increased Appetite Owing to Use of
Certain Medications (e.g., Steroids, Androgens)
Discuss Nutritional Intake and Weight Gain During Pregnancy
Assist Client to Decrease Calorie Intake
• Request that client write down all the food he or she ate in the
past 24 hours.
• Instruct client to keep a diet diary for 1 week that specifies the
following:
• What, when, where, and why eaten
• Whether he or she was doing anything else (e.g., watching
television, cooking) while eating
• Emotions before eating
• Others present (e.g., snacking with spouse, children)
• Review the diet diary to point out patterns (e.g., time, place,
emotions, foods, persons) that affect food intake.
• Review high- and low-calorie food items.
Teach Behavior Modification Techniques to Decrease
Caloric Intake
• Eat only at a specific spot at home (e.g., the kitchen table).
• Do not eat while performing other activities.
• Drink an 8-oz glass of water immediately before a meal.
• Decrease second helpings, fatty foods, sweets, and alcohol.
• Prepare small portions, just enough for one meal, and discard
leftovers.
• Use small plates to make portions look bigger.
• Never eat from another person’s plate.
• Eat slowly and chew food thoroughly.
• Put down utensils and wait 15 seconds between bites.
• Eat low-calorie snacks that must be chewed to satisfy oral
needs (e.g., carrots, celery, apples).
Instruct Client to Increase Activity Level to Burn Calories
• Use the stairs instead of elevators.
• Park at the farthest point in parking lots and walk to buildings.
• Plan a daily walking program with a progressive increase in
distance and pace.
• Note: Urge client to consult with a primary provider before
beginning any exercise program.
Initiate Referral to a Community Weight Loss Program (e.g.,
Weight Watchers), If Indicated

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