Core Nursing Diagnosis: Imbalanced Nutrition: Less Than Body Requirements
According to NANDA-I, the core nursing diagnosis for undernutrition, or malnutrition resulting from insufficient intake, is Imbalanced Nutrition: Less Than Body Requirements. This diagnosis is defined as an "intake of nutrients insufficient to meet metabolic needs". It provides a standardized framework for nurses to identify the patient's problem, its underlying causes, and the defining characteristics seen during assessment.
Related Factors
Multiple factors can contribute to a patient receiving this diagnosis, often linked to the patient's inability to ingest, digest, or absorb enough nutrients. Common related factors include:
- Psychological Issues: Depression, dementia, or eating disorders (anorexia, bulimia) that decrease the desire to eat.
- Physical Limitations: Conditions like dysphagia (difficulty swallowing), poor dentition, or limited mobility that interfere with feeding.
- Medical Treatments and Conditions: Altered taste perception from medications, persistent nausea and vomiting, malabsorption syndromes (e.g., Crohn's disease), or increased metabolic needs due to cancer, trauma, or burns.
- Socioeconomic Factors: Financial constraints or limited access to nutritious food.
Defining Characteristics (Assessment Findings)
During assessment, nurses look for specific signs and symptoms, or defining characteristics, that support the diagnosis. These include:
- Objective Data:
- Body weight below the ideal range for age and gender.
- Documented inadequate caloric intake.
- Loss of subcutaneous fat and muscle mass.
- Pale mucous membranes and dry skin.
- Brittle hair and hair loss.
- Changes in lab values, such as decreased serum albumin and prealbumin.
- Delayed wound healing.
- Signs of specific nutrient deficiencies, like anemia from low iron or vitamin B12.
- Subjective Data:
- Patient reports of decreased appetite or lack of interest in food.
- Complaints of fatigue and weakness.
- Expressing a dislike for food.
- Mental changes, such as irritability or confusion.
Additional Related Nursing Diagnoses
Beyond the primary diagnosis, nurses may identify other related problems depending on the patient's condition. These can include:
- Deficient Fluid Volume: Related to inadequate fluid intake, persistent vomiting, or diarrhea associated with malabsorption.
- Fatigue: Caused by the reduced metabolic energy production and physical deconditioning that result from malnutrition.
- Risk for Infection: A weakened immune system due to malnutrition increases the risk of infection.
- Impaired Skin Integrity: Reduced subcutaneous tissue and poor healing can lead to skin breakdown and delayed wound recovery.
- Deficient Knowledge: The patient or caregiver may lack information about healthy eating patterns or the management of nutritional needs.
Nursing Interventions and Care Planning
The nursing care plan for malnutrition focuses on correcting the nutritional imbalance, addressing the underlying causes, and monitoring the patient's progress. Key interventions include:
- Assess and Monitor:
- Regularly weigh the patient and monitor their weight trends.
- Track dietary intake and caloric counts.
- Monitor laboratory values for changes in albumin, prealbumin, and electrolytes.
- Promote Oral Intake:
- Create a quiet, pleasant eating environment free of odors.
- Serve small, frequent, nutrient-dense meals rather than large, overwhelming ones.
- Offer high-protein and high-calorie nutritional supplements, such as shakes, between meals.
- Provide good oral hygiene before meals to improve appetite.
- Manage Underlying Issues:
- Collaborate with a dietitian to develop a personalized meal plan tailored to the patient's preferences and condition.
- Administer antiemetics before meals if nausea is an issue.
- Refer to occupational or speech therapists for patients with physical impairments or swallowing difficulties.
- Advanced Nutritional Support:
- In severe cases or when oral intake is impossible, consult the physician about the need for enteral tube feedings or parenteral nutrition.
- Patient and Family Education:
- Educate the patient and family on nutritional needs, healthy eating habits, and how to identify and acquire nutritious food.
- Connect the family with community resources, such as food assistance programs, if financial constraints are a factor.
Undernutrition vs. Overnutrition: A Comparison
Malnutrition is a broad term that encompasses both undernutrition and overnutrition. Nurses must recognize the differences in defining characteristics, risk factors, and interventions.
| Feature | Undernutrition | Overnutrition |
|---|---|---|
| Description | Insufficient intake of nutrients to meet metabolic demands. | Excessive consumption of calories and nutrients. |
| Common Causes | Poor intake, illness, malabsorption, poverty, eating disorders. | Overeating, sedentary lifestyle, high-calorie diet, emotional eating. |
| Signs & Symptoms | Unintentional weight loss, fatigue, brittle hair/nails, poor wound healing. | Weight gain, obesity, high blood pressure, high cholesterol, edema. |
| At-Risk Patients | Older adults, cancer patients, post-op patients, those with eating disorders. | Patients with obesity, diabetes, hypertension, metabolic syndrome. |
| Nursing Focus | Encourage intake, provide supplements, monitor lab values, manage symptoms. | Nutrition education, portion control, exercise promotion, monitoring labs. |
Conclusion
For malnutrition, the primary nursing diagnosis of Imbalanced Nutrition: Less than Body Requirements serves as a critical foundation for nursing care. This diagnosis guides a comprehensive nursing process, beginning with a thorough assessment of objective and subjective data to identify related factors and specific symptoms. Based on this assessment, nurses can implement a range of tailored interventions, from promoting oral intake and managing symptoms to collaborating with interdisciplinary teams for specialized nutritional support. By addressing the physical, psychological, and socioeconomic elements contributing to malnutrition, nurses can play a vital role in helping patients achieve and maintain adequate nutritional status, thereby supporting healing and improving overall health.
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