What is a Nanda Diagnosis for Nutrition?
A NANDA diagnosis is a clinical judgment about an individual, family, or community's actual or potential health problems or life processes. It provides the standardized terminology used by nurses to communicate the patient's response to their health condition, which guides the development of a nursing care plan. Unlike a medical diagnosis, which focuses on identifying the disease (e.g., celiac disease or cancer), a nursing diagnosis addresses the patient's holistic response to that disease, such as their inability to absorb nutrients or reduced appetite.
For nutrition, a NANDA diagnosis helps nurses pinpoint and address specific dietary issues, whether it's an intake problem, a clinical condition affecting digestion, or behavioral factors impacting food choices. This process is part of the broader nursing care process, which includes assessment, diagnosis, planning, implementation, and evaluation.
Types of Nutritional Diagnoses from NANDA-I
NANDA International (NANDA-I) organizes nursing diagnoses into domains and classes to create a standardized language for nurses. The 'Nutrition' domain includes several specific diagnoses. While the terminology is updated periodically, with "Imbalanced Nutrition" recently relabeled to "Inadequate Nutritional Intake," many healthcare professionals still use the former widely. Below are some of the key nutritional diagnoses:
Imbalanced Nutrition: Less than Body Requirements
This diagnosis describes a state where an individual's intake of nutrients is insufficient to meet their metabolic needs. It is often related to factors like decreased appetite, difficulty swallowing (dysphagia), malabsorption, or psychological issues.
Imbalanced Nutrition: More than Body Requirements
This diagnosis is for patients consuming excessive nutrients that exceed their metabolic needs, leading to weight gain and potential health risks. Contributing factors often include excessive caloric intake, a sedentary lifestyle, or emotional eating.
Risk for Overweight
Used for patients at risk of exceeding the ideal body weight for their height and frame due to factors like excessive intake, physical inactivity, or metabolic problems.
Obesity
This diagnosis applies when an individual's body mass index (BMI) is at or above 30 kg/m², signaling a significant weight issue.
Readiness for Enhanced Nutrition
This is a health promotion diagnosis for patients who demonstrate a desire to improve their dietary habits and have a basic understanding of nutritional principles. It highlights a motivational state where the patient is prepared to make positive dietary changes.
Impaired Swallowing
This diagnosis refers to an individual's difficulty in moving food or fluids from the mouth to the stomach. It is a functional problem within the nutrition domain that can directly lead to nutritional deficiencies.
The PES Statement for Nutrition Diagnoses
To write a problem-focused NANDA diagnosis, nurses use the Problem-Etiology-Symptoms (PES) format, which creates a precise and actionable statement for the patient's care plan.
- Problem (P): The specific NANDA diagnostic label (e.g., Imbalanced Nutrition: Less than Body Requirements).
- Etiology (E): The contributing factors or root cause of the problem, linked by the phrase “related to” (e.g., related to inadequate food intake due to dysphagia).
- Signs & Symptoms (S): The measurable or observable evidence supporting the diagnosis, linked by the phrase “as evidenced by” (e.g., as evidenced by significant weight loss of 10% over the last month and reported difficulty swallowing).
Assessment: Gathering Data for a Nutrition Diagnosis
Formulating an accurate NANDA diagnosis begins with a thorough nursing assessment. This includes objective and subjective data collection.
Subjective Data
This includes information reported by the patient, such as:
- Reports of decreased appetite or food aversion
- Difficulty chewing or swallowing
- Feelings of fatigue or weakness
- Verbalized concerns about weight or body image
- Changes in taste sensation
Objective Data
This involves observable and measurable findings from the nurse's examination, such as:
- Anthropometric Measurements: Height, weight, BMI, and monitoring for unintentional weight changes
- Physical Signs: Pale mucous membranes, poor skin turgor, hair loss, muscle wasting, or edema
- Laboratory Values: Abnormal serum albumin, prealbumin, hemoglobin, or electrolyte levels
- Clinical Findings: Diarrhea, constipation, abdominal cramping, or abnormal vital signs like bradycardia in severe malnutrition
Nutritional Screening Tools
Nurses also utilize validated screening tools to identify patients at nutritional risk, which provides crucial data for diagnosis. Examples include the Malnutrition Universal Screening Tool (MUST) and the Mini Nutritional Assessment Short-Form (MNA), particularly for geriatric patients.
Comparison of Common NANDA Nutritional Diagnoses
| Feature | Imbalanced Nutrition: Less than Body Requirements | Imbalanced Nutrition: More than Body Requirements | Readiness for Enhanced Nutrition |
|---|---|---|---|
| Problem | Nutrient intake is insufficient to meet metabolic needs. | Excessive caloric intake and/or metabolic needs are mismatched. | A patient expresses a desire to improve their nutrition. |
| Etiology (Causes) | Altered taste, depression, dysphagia, limited food access, metabolic disorders. | Excessive intake, sedentary lifestyle, emotional eating, lack of nutrition knowledge. | Patient motivation and awareness of the benefits of improved nutrition. |
| Signs & Symptoms (Evidence) | Weight loss, fatigue, muscle wasting, poor wound healing, abnormal labs (albumin). | Weight gain, high BMI, elevated blood pressure, high cholesterol, increased body fat. | Expressed interest in learning, asks questions, requests dietary information. |
| Nursing Focus | Increase nutrient intake, address underlying causes, provide supplements, monitor labs. | Educate on portion control, healthy eating patterns, encourage exercise, monitor weight. | Provide tailored education, counseling, and resources to support motivation and empower the patient. |
Creating a Nursing Care Plan for Nutrition Issues
Once a NANDA diagnosis is made, the nurse develops a care plan with specific interventions aimed at addressing the etiology and achieving desired outcomes. For example, for a diagnosis of 'Imbalanced Nutrition: Less than Body Requirements,' interventions might include:
- Consulting with a registered dietitian for a personalized meal plan
- Offering smaller, more frequent meals that are nutrient-dense
- Providing a pleasant mealtime environment with companionship
- Administering appetite stimulants as prescribed
- Educating the patient and family on nutritional needs and available resources
- Monitoring patient's weight, intake, and laboratory values to track progress
Conclusion
Accurately identifying and addressing nutritional issues through a NANDA diagnosis is a foundational skill in nursing practice. By focusing on the patient's holistic response to a health condition, nurses can develop comprehensive, patient-centered care plans that go beyond a medical diagnosis. Using standardized terminology, nurses ensure clear communication among the healthcare team, leading to more effective interventions and improved patient outcomes. A deep understanding of the different types of nutritional diagnoses and the PES statement format empowers nurses to provide the highest quality of care.
For more information on NANDA nursing diagnoses, visit the National Center for Biotechnology Information (NCBI) and review resources such as their guide on nursing fundamentals: Chapter 14 Nutrition – Nursing Fundamentals - NCBI Bookshelf.
