How do you contribute to the plan of care for a client who has malnutrition?

October 31, 2025 •

4 min read

Malnutrition affects a significant portion of hospitalized patients, with some studies reporting rates as high as 40%. Healthcare professionals, including nurses and dietitians, play a critical role in developing and implementing the plan of care for a client who has malnutrition to combat these statistics and promote recovery.

Quick Summary

Healthcare professionals contribute to a malnutrition care plan through comprehensive screening, targeted nutritional interventions, collaboration with multidisciplinary teams, and continuous monitoring to improve patient health.

Key Points

Comprehensive Assessment: Use validated screening tools like MUST or MNA and assess weight history, dietary intake, and physical signs of malnutrition to create a robust care plan.
Multidisciplinary Collaboration: Work closely with dietitians, physicians, and other therapists to address all aspects of malnutrition, from underlying medical causes to swallowing difficulties.
Prioritize Oral Intake: Encourage and support oral food intake first, using food fortification and mealtime assistance to maximize nutritional consumption.
Consider Supplementation: Administer prescribed oral nutritional supplements or advanced nutrition support like enteral or parenteral nutrition when oral intake is insufficient or impossible.
Consistent Monitoring: Regularly monitor weight, fluid intake, and relevant lab values to track progress, prevent complications like refeeding syndrome, and adjust the care plan as needed.
Educate and Empower: Involve the patient and family in the care plan by providing education on managing dietary needs and recognizing warning signs, fostering independence upon discharge.
Optimize the Eating Environment: Ensure a pleasant, distraction-free environment and provide companionship during meals to encourage and improve food intake.

Initial Nutritional Assessment

Contributing effectively to a malnutrition care plan begins with a thorough and accurate nutritional assessment. This is a multi-step process that uses both objective and subjective data to determine the client's current nutritional status and identify risk factors.

Performing Nutritional Screening

Initial screening is a vital first step, often performed using a validated tool like the Malnutrition Universal Screening Tool (MUST) or the Mini Nutritional Assessment (MNA). A screening involves assessing:

Body Mass Index (BMI) or other anthropometric measurements.
Unintentional weight loss within a specified timeframe.
Acute illness effect on nutritional intake.

Gathering Dietary and Physical Data

Beyond formal screening, a comprehensive assessment includes gathering a detailed dietary history and performing a physical examination. Nurses are crucial in observing and documenting these details.

Dietary History: Ask about recent intake, usual eating habits, food preferences, allergies, and factors affecting food intake such as difficulty chewing or swallowing.
Physical Examination: Look for clinical signs of nutrient deficiencies, such as skin changes, hair abnormalities, muscle wasting, and edema.

The Multidisciplinary Team Approach

Malnutrition care is not a solitary task but a collaborative effort involving various healthcare professionals. Effective communication and coordination are essential for a successful outcome.

Dietitian: The registered dietitian is the nutrition expert who conducts a detailed assessment, develops the specific nutritional plan, and provides counseling.
Physician: The doctor addresses the underlying medical conditions contributing to the malnutrition, such as chronic disease, infections, or GI issues.
Speech and Language Pathologist: If a client has dysphagia (swallowing difficulty), a speech therapist can recommend safe swallowing techniques and texture-modified diets.
Occupational Therapist: For clients with physical impairments, an occupational therapist can recommend adaptive devices to help with eating.

Implementing Nutritional Interventions

Based on the assessment and collaborative planning, specific nutritional interventions are implemented. These can range from simple dietary adjustments to more advanced feeding methods.

Food-First Strategies

For clients who can eat orally, the first approach is to maximize their intake of nutrient-dense food. This can include:

Food Fortification: Adding ingredients like milk powder, cheese, or butter to meals to increase caloric and protein density without increasing volume.
Small, Frequent Meals: Offering smaller, more frequent meals (e.g., 6 small meals instead of 3 large ones) can be less overwhelming for clients with a reduced appetite.
Enhancing the Environment: Creating a pleasant, quiet, and sociable environment during meal times can encourage intake. Providing companionship can be particularly beneficial for socially isolated clients.
Mealtime Assistance: Providing physical help with feeding for clients with physical limitations.

Oral Nutritional Supplements

If dietary intake remains insufficient, prescribed oral nutritional supplements (ONS) can be added between meals. ONS are available in various forms (liquid drinks, powders, puddings) and can provide extra protein, calories, vitamins, and minerals.

Advanced Nutritional Support

In severe cases, or when oral intake is impossible, more advanced methods are necessary. The decision for these routes is made by the multidisciplinary team, with careful consideration given to the client's condition and risk of refeeding syndrome.

Nutritional Support Comparison


Feature	Oral Nutritional Supplements (ONS)	Enteral Nutrition (EN)	Parenteral Nutrition (PN)
Method	Oral ingestion	Tube feeding directly into the stomach or intestines	Intravenous (IV) administration
Typical Use	Insufficient oral intake to meet needs; mild to moderate malnutrition	Functional gastrointestinal tract but unable to ingest enough orally	Non-functional or inaccessible gastrointestinal tract
Advantages	Non-invasive, palatable, can be used at home	Physiologically preferred over PN, preserves gut integrity	Bypasses the GI tract completely, provides complete nutrition
Risks	Poor adherence, taste fatigue	Aspiration, tube blockage, infection, GI intolerance	Infection, electrolyte imbalances, refeeding syndrome, metabolic complications

Monitoring and Evaluation

Consistent monitoring is critical for assessing the effectiveness of the care plan and making necessary adjustments.

Weight: Regular weighing is a key indicator of progress, though it should be interpreted cautiously in the presence of edema.
Intake Records: Maintain accurate food and fluid charts to document actual consumption and hydration status.
Biochemical Markers: Monitor laboratory values like albumin, prealbumin, and electrolytes to check for deficiencies and potential refeeding syndrome.
Clinical Observations: Regularly re-evaluate physical signs and symptoms of malnutrition, such as wound healing, energy levels, and overall mood.

Patient and Family Education

Empowering the client and their family is a cornerstone of long-term success. Education should cover the disease process, the nutritional plan, and practical strategies for implementation.

Understanding Malnutrition: Help them understand the causes and consequences of malnutrition and the importance of their role in recovery.
Managing Dietary Needs: Teach them how to read food labels, prepare fortified meals, and identify nutritious food choices.
Recognizing Complications: Educate on signs of worsening malnutrition or potential refeeding syndrome.
Discharge Planning: Ensure a smooth transition home by addressing access to food, home care assistance, and follow-up appointments with a dietitian or social services.

Conclusion

Effectively contributing to the plan of care for a client who has malnutrition requires a systematic and collaborative approach. By performing a thorough assessment, implementing targeted interventions, and consistently monitoring progress, healthcare professionals can significantly impact a client's health and recovery. The cornerstone of success lies in the integrated efforts of the multidisciplinary team and the active involvement of the client and their family. Proper nutritional care is fundamental to improving clinical outcomes, reducing complications, and enhancing the overall quality of life for clients with malnutrition.

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Frequently Asked Questions

The first steps include performing a nutritional screening using a validated tool like MUST, gathering a detailed dietary history, conducting a physical exam for signs of nutrient deficiencies, and documenting findings in the client's record.

A nurse can assist by collaborating with a speech and language pathologist to implement safe swallowing techniques and provide texture-modified diets. The nurse can also ensure the client is properly positioned and takes small, slow bites to prevent aspiration.

Food fortification is the practice of adding extra calories, protein, and nutrients to a client’s regular food without significantly increasing the volume. This can be done by adding ingredients like milk powder, cheese, or butter to meals to boost nutritional content.

Nutritional supplementation becomes necessary when a client cannot meet their nutritional needs through regular oral food intake alone. Supplements are typically added between meals and come in various forms like drinks or puddings.

Signs of a successful care plan include stabilization or gain in body weight, improved intake recorded on food charts, and positive changes in biochemical markers, energy levels, and wound healing.

The family plays a crucial role by being involved in care plan development, assisting with meal preparation, offering companionship during meals, and helping to identify practical solutions for obtaining nutritious food, especially during discharge.

Refeeding syndrome is a potentially life-threatening condition caused by shifts in fluids and electrolytes when a severely malnourished client is re-fed too quickly. Prevention involves initiating nutrition slowly and monitoring electrolytes closely under medical supervision.