Nursing Care Plan (NCP) for Nutrition Imbalance

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Outline

Pathophysiology

Nutrition imbalance can be a result of short or excess supply of certain nutrients. Depending on the imbalance, can cause undesirable effects and conditions that usually result into serious disease

Etiology

Nutrition Imbalance can be caused by the body’s inability to absorb certain nutrients or result from a poor diet.

Desired Outcome

Patient will steadily gain/lose weight for their height/age. Patient will make appropriate food selections that will be nutrient dense and maintain goal weight.

Subjective Data

  • Difficulty chewing/swallowing
  • Decrease in oral hygiene 
  • Abdominal cramping/pain
  • Constipation
  • Loss of appetite 
  • Changes in sleeping pattern 
  • Weakness
  • Fatigue 
  • Pica eating (non-nutritive substances)
  • Depression 
  • Hair loss
  • Sedentary lifestyle
  • Eating to Cope 
  • Joint/muscle aches

Objective Data

  • Weight loss/gain
  • Changes in vision
  • Skin lesions 
  • Slow healing wounds 
  • BMI (low or high)
    • Normal (18.5-24.9)
  • Dry skin 
  • Cracking/peeling of skin 
  • Brittle nails 
  • Increased BP & HR
  • Cold intolerance 
  • Poor muscle tone 
  • Hyperglycemia

Nursing Interventions and Rationales

 

Nursing Intervention (ADPIE) Rationale
Obtain a full assessment/Medical History from patient 

-weight & height 

-diet history 

-medications (stimulants, weight loss meds)

-medical conditions (hypothyroidism, cancer, chronic stress/depression, diabetes, stomach ulcer, celiac disease)

getting a full assessment and nutrition assessment can help in getting a plan together to start treatment for the patient 
Assess any barriers to patient eating 

-trouble swallowing

-dentures

-too weak to eat

-chewing problems 

knowing any barriers to a patient not eating can address situations/conditions to be addressed first
Monitor Lab Values (Serum albumin, H&H, Prealbumin, Transferrin) all values can give insight on patient’s nutritional status
Get a Nutrition/Dietician Consult after getting a full assessment/diet history from a patient, a nutritionist or dietician can better set out a meal plan for the patient
Encourage, nutritional supplements and healthy snacks in between meals (Ensures, fruits, veggies)  Ensure drinks have plenty of nutrients (vitamins, minerals, and protein). Fruits and veggies also have plenty of nutrients. 

** if a patient cannot eat a full meal, encourage small frequent meals instead)

Encourage physical activity (walking, swimming, running, weightlifting, cardio, yoga, cycling) assess their activity level at home. Physical activity has multiple health benefits that include better mental health, losing weight, reduce diabetes risk and cardiovascular disease)
Assist patient on how to read food labels  reading labels will help patients make better food choices and know just how much of something they can eat to keep a better food log at home 
PPN/TPN may be necessary if a patient is critically ill and cannot get nutrient PO, PPN/TPN may be necessary to be sure the patient is getting optimal nutrition they need

Writing a Nursing Care Plan (NCP) for Nutrition Imbalance

A Nursing Care Plan (NCP) for Nutrition Imbalance starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.

References

https://www.mayoclinic.org/diseases-conditions/obesity/diagnosis-treatment/drc-20375749

https://www.cdc.gov/physicalactivity/basics/pa-health/index.htm

https://my.clevelandclinic.org/health/articles/16555-snack-ideas-for-weight-gain

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Transcript

Hi everyone. Today, we are going to be creating a nursing care plan for nutrition imbalance. So let’s get started. First, we’re going to go over the pathophysiology. So nutrition imbalance can be a result of shortage or excess supply of certain nutrients, depending on the imbalance. It can cause undesirable effects and conditions that can result in serious disease. Some nursing considerations: nutritional assessment, labs, barriers to eating nutrition, consultation, encouraging supplemental nutrition, and physical activity. Some desired outcomes: the patient will subtly gain or lose weight for their height and age and the patient will make appropriate food selections that will be nutrient based and maintain the goal weight. 

So we’re going to go ahead and go into our care plan and write down some subjective data, and we’re going to be writing down some of the objective data. So what are we going to see with these patients? One of the things you’re going to notice is they’re going to complain of loss of appetite. They’re going to have some weight loss or gain, depending if they’re in excess or loss. Also some skin lesions. They might complain about some difficulty chewing, swallowing, some abdominal cramping and pain, weakness, depression, some hair loss, and eating to cope. There’s also the BMI – it could be high or low. Also brittle nails, poor muscle tone, hyperglycemia, and cracking or peeling of the skin. 

So we’re going to go over some interventions. One of the first things we want to do, we want to obtain a full assessment and medical history from the patient. So to make sure we’re doing a full assessment and history, we want to know their weight and height. We want to know their diet history or have a diet log of what they’ve eaten within the last few days. Maybe their medications such as stimulants, which are weight loss meds, medical conditions, such as hypothyroidism, cancer, chronic stress or depression, diabetes, stomach ulcers, or even celiac disease. Getting a full assessment and nutrition assessment can really help in getting a plan together for the patient. Now there is an invention we’re going to be doing. We want to assess any barriers to the patient eating. So what if there are any barriers to them eating? So that could be trouble swallowing. Maybe they have dentures, they’re too weak to eat anything, or maybe they’re having some chewing problems. We want to know what some of these barriers are so that we can address these situations and be able to get them the correct nutrition that they need. Now, another intervention we’re going to do is we’re going to monitor their lab values. So this will be their albumin and prealbumin – these that are going to give you insight on the patient’s nutritional status. Another intervention we’re going to do is we’re going to get a nutrition or a dietician consult. So once you get a full assessment or a nutrition assessment from your patient, you’re going to see about getting a consultation with a nutritionist or a dietician to be able to get a better meal plan for this patient. Another invention we’re going to be doing. We want to encourage nutritional supplementation and some healthy snacks in between meals such as Ensure drinks as they’re full of vitamins and minerals and proteins as well as those fruits and veggies that have plenty of wholesome nutrients. We can also, if the patient’s not able to eat a full meal, we can encourage small frequent meals. Another invention we want to do. We want to encourage physical activity. So physical activity can be walking, swimming, running, weightlifting, cardio, yoga, or maybe they are into cycling. You want to assess their activity level at home. Physical activities have so many multiple health benefits that include better mental health, helping them lose weight, reducing diabetes risk, cardiovascular disease, and getting some muscle tone. There’s so many benefits to physical activity. And another intervention we want to do is TPN. 

So that total parenteral nutrition. So if a patient is critically ill and is not able to get the nutrients that they need by mouth, it may be necessary and able to get them TPN. So you want to make sure that if you have that you do need to have a central line that is in place for that.

We’re going to move on to the key points here. So pathophysiology and etiology. So this can be a result of shortage or excess supply of certain nutrients. Usually it’s caused by the body’s inability to absorb certain nutrients or result from a poor diet. Some subjective data you’re going to see in the patient. They may have difficulty chewing, some weakness, weight gain or loss, depression, hair loss, skin changes, fatigue, loss of appetite, eating to cope, and poor muscle tone. We’re going to do a full nutritional assessment. We’re going to get some labs on the patient. We’re going to consult that nutritionist or dietary we’re going to offer any sort of supplemental nutrition like those ensure drinks. And we want to encourage physical activity for these patients. And there you have your completed care. 

Awesome job guys. We love you. Go out, be your best self today. And as always happy nursing.

 

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