- Physical factors (dysphagia, facial trauma, inability to digest food)
- Physiological factors (inability to absorb food, increased metabolic needs)
- Psychological factors (unwillingness to eat; mental disorders; eating disorders)
- Economic/sociocultural factors
Subjective Data: patient’s feelings, perceptions, and concerns. (Symptoms)
- Verbalizes the dislike of foods
- Expresses feeling weak and tired
- Reports altered taste sensation
Objective Data: assessment, diagnostic tests, and lab values. (Signs)
- Abnormal BMI; weight is 20% below the ideal body weight (IBW)
- Excessive weight loss
- Loss of subcutaneous tissue/ decreased skinfold measurements
- Generalized poor muscle tone/ muscle weakness/ muscle wasting (cachexia)
- Decreased activity intolerance
- Intolerance to cold
- Stooped posture
- Sore, pale oral mucous membranes, and conjunctivae
- Dry, brittle hair/ hair loss
- Dry, flaky skin/ dermatitis
- Poor wound healing
- Increased risk for infection
- Sunken eyes
- Abdominal pain/ abdominal cramping/ diarrhea
- Abnormal serum albumin and prealbumin levels
- Abnormal vital signs: Increased BP and HR
- Refusal to ingest food
- The patient will steadily gain weight toward ideal weight for height and age
- The patient will know factors causing weight loss
- The patient will make appropriate food selections to maintain the goal weight
|Obtain the patient’s height and weight. Weigh the patient daily at the same time with the same clothes before breakfast. |
These measurements are required to determine nutritional needs. Daily weights provide feedback about whether the treatment plan needs adjustments.
|Record a thorough diet history. Points to consider are|
Type of food preference
Times of meal intake
Number of times of meal intake (frequency)
Food preferences because of religion
Food that causes indigestion
Taste or chewing problems
Presence of dentures
This assessment focuses on dietary intake and food preferences, allergies, and areas such as the patients’ ability to eat.
|Cross-reference this gathered information with family and friends, if possible. |
Usually, the patient is considered the best source of information; however, eating habits might be reported distorted from the patient’s perspective, especially if eating disorders are present. People that are close to the patient might be able to provide more accurate information about eating habits.
|Consider the patient’s past medical history, comorbidities, and acute situation. |
Health conditions that affect the gastrointestinal tract, hormones, and acute illnesses such as large wounds, surgery, or trauma contribute to nutritional changes. Being aware of these factors helps create a more targeted treatment plan. Etiological factors for malnutrition need to be identified to guide appropriate treatment.
|Complete a medication reconciliation. Include over-the-counter medications, herbal supplements, and vitamins. |
Various medications can affect appetite or alter absorption and metabolism. Some medications’ side effects may act as appetite stimulants, and others might cause a decrease in appetite. Furthermore, drugs may interact with particular vitamins and decrease absorption.
|Assess the patient’s relationship to food. |
The reason for not eating appropriate amounts of food may be physical, physiological, or psychological.
|Assess the environment in which the patient consumes food. |
Many people eat their food on the go and between tasks and do not prepare a healthy meal but instead rely on take-out food. In addition, older adults may be too weak to prepare meals for themselves.
|Monitor lab values that provide information about the patient’s nutritional status. |
Serum albumin (3.5 – 5.0/dL)
Serum albumin is a plasma protein that shows the patient’s nutritional state a few weeks before testing. However, fluid status may influence test results.
Hemoglobin & Hematocrit
Decreased hemoglobin may be secondary to low serum albumin, whereas increased hematocrit may indicate hemoconcentration and dehydration.
Prealbumin (15 – 36 mg/dL or 150 – 360 mg/L)
Prealbumin is a plasma protein that can provide more recent data about nutritional status because of its short half-life of two days.
Transferrin is a plasma protein that is important for iron transport. Its half-life is eight to ten days, and it usually decreases alongside serum albumin.
Nursing Interventions for Imbalanced Nutrition, Less Than Body Requirements
|Collaborate with a licensed dietitian regarding the nutritional status and diet planning. |
Based on lab values, assessment, and other indicators, the dietitian can determine the patient’s daily caloric and nutritional requirements to increase weight and maintain an ideal weight. The dietitian will also consider the patient’s ability and preferences of food intake.
|Provide good oral care and place the patient in an optimal position. |
Poor oral hygiene and ill-fitted dentures can make the experience of eating unpleasant and make the patient eventually lose interest in eating. Elevating the head of the bed or even placing the patient in the chair while eating ensures the best posture possible for food digestion.
|Provide an inviting environment and offer opportunities to socialize during mealtimes. |
A pleasant environment without distraction, noise, and offensive or medicinal odors makes it more enjoyable for the patient. In addition, socializing during meal times has patients looking forward to mealtimes and might increase motivation to eat.
|Offer assistance with eating. |
Preparing the meal tray, such as opening milk cartons, spreading butter on a dinner roll, or cutting meat in bite-size pieces, facilitates the process and helps the patient conserve energy for eating.
|When feeding a client, be patient and allow enough time to complete the meal. |
Offering enough time between bites to thoroughly chew the food and offering sips to drink makes the meal more enjoyable and encourages the patient to eat as much as possible.
|Encourage nutritional supplements and healthy snacks between meals. |
Extra snacks and supplements, such as nutritional shakes, increase caloric intake. However, advise the patient not to substitute meals with supplemental shakes.
|Collaborate with occupational therapy to assist with individualized utensils for disabled patients. |
Physical impairment and deformities can make it more difficult and energy-consuming to perform tasks such as eating. Adaptive aids such as scoop dishes, curved utensils, or plate rims make eating much more manageable and promote independence.
|If swallowing impairment is suspected, collaborate with speech therapy. |
Speech therapy will evaluate the patient’s impairment, and based on the results, make recommendations about diet modifications, such as food consistency and whether to use a straw.
|Administer pain medication and antiemetics as ordered. |
Nausea and pain may decrease appetite. Treating these conditions well before meal time gives the medication enough time to work and increases patient compliance to consuming meals.
|Provide small frequent meals instead of three full meals. |
If the patient cannot finish meals at designated times, offer more mealtimes with smaller portions. Small, frequent portions might be more tolerable and increase overall calorie intake.
For the critically ill patient
|Anticipate the need for parenteral (PPN/TPN) or enteral nutrition (tube feeding).|
If the patient cannot take in sufficient nutrients by mouth, other options are via a tube to the stomach or intravenously. Either form of nutrition helps maintain muscle mass and immune system functionality. The formula contains proteins, vitamins, and essential electrolytes that can be adjusted to each patient’s needs.
Patient Education for Imbalanced Nutrition, Less Than Body Requirements
|Provide nutritional education about dietary guidelines and the importance of adequate caloric intake to maintain the desired weight. |
Patients and family members need to have nutritional knowledge about food groups to maintain adequate and healthy nutrition at home. MyPlate is a great concept to start learning the basics about different essential food groups.
|Offer referrals to community resources about nutrition. |
Community resources such as “Meals on Wheels” can help elderly clients to maintain food availability consistently.
|If the patient is discharged with a feeding tube, teach the family how to administer bolus feeds and perform tube care.|
Flush before and after feedings
Monitor the insertion site for signs of infection: redness, swelling, presence of drainage, pain
Knowledge about tube care and feedings promotes safety and decreases the risk of complications.
More Care Plans
Ackley, B., & Ladwig, G. (2014). Nursing diagnosis handbook (10th ed). Maryland Heights: Mosby Elsevier.
Gulanick, M., & Myers, J. (2014). Nursing care plans (8th ed.). Elsevier.
Ignatavicius, D., & Workman, M. (2016). Medical-surgical nursing (8th ed.). Elsevier.
Potter, P., & Perry, A. (2013). Fundamentals of nursing (8th ed.). Elsevier.