Nursing Care Plan (NCP) for Nutrition Imbalance
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Outline
Lesson Objective for Nutrition Imbalance Nursing Care Plan
- Identify Nutritional Imbalances:
- Develop the ability to recognize signs and symptoms of nutritional imbalances, including malnutrition, overnutrition, or specific nutrient deficiencies.
- Understand Contributing Factors:
- Comprehend the various factors contributing to nutritional imbalances, such as inadequate dietary intake, malabsorption, chronic illnesses, or lifestyle factors.
- Assessment Skills:
- Develop assessment skills to perform a comprehensive nutritional assessment, considering anthropometric measurements, biochemical markers, clinical observations, and dietary history.
- Individualized Care Planning:
- Learn to create individualized care plans tailored to the specific nutritional needs and challenges of each patient, considering their medical history, preferences, and cultural factors.
- Educational Strategies:
- Acquire effective communication and educational strategies to empower patients with knowledge about healthy nutrition, dietary choices, and lifestyle modifications to achieve and maintain optimal nutritional status.
Pathophysiology of Nutrition Imbalance
- Inadequate Nutrient Intake:
- Nutrition imbalance can result from insufficient intake of essential nutrients, including macronutrients (carbohydrates, proteins, fats) and micronutrients (vitamins and minerals). This can occur due to poor dietary choices, restricted diets, or food insecurity.
- Malabsorption Disorders:
- Conditions affecting the absorption of nutrients in the gastrointestinal tract, such as celiac disease, Crohn’s disease, or chronic pancreatitis, can lead to malnutrition. Malabsorption prevents the body from absorbing nutrients effectively, even if they are present in the diet.
- Excessive Caloric Intake:
- Overconsumption of calories, particularly from unhealthy sources like processed foods high in sugars and fats, can lead to obesity and nutrient imbalances. In this scenario, individuals may have an excess of certain nutrients while lacking others essential for overall health.
- Metabolic Disorders:
- Conditions such as diabetes mellitus and thyroid disorders can impact the body’s metabolism, affecting the utilization of nutrients. Diabetes, for example, can lead to problems with insulin regulation, influencing how the body processes carbohydrates.
- Eating Disorders:
- Conditions like anorexia nervosa, bulimia nervosa, or binge-eating disorder are associated with distorted eating patterns, which can result in severe nutritional imbalances. These disorders may involve excessive dieting, purging behaviors, or uncontrollable eating episodes.
- Gastrointestinal Surgery:
- Surgical procedures involving the gastrointestinal tract, such as gastric bypass surgery, can alter the normal absorption of nutrients. This surgical intervention may lead to nutrient deficiencies if individuals do not adhere to recommended dietary guidelines or supplementation.
Etiology of Nutrition Imbalance
- Poor Dietary Choices:
- Individuals may develop nutrition imbalances due to a diet that lacks variety and essential nutrients. Consuming an excessive amount of processed foods, sugary snacks, and high-fat items while neglecting fruits, vegetables, and whole grains can contribute to nutritional deficiencies.
- Eating Disorders:
- Conditions such as anorexia nervosa, bulimia nervosa, and binge-eating disorder are characterized by distorted eating behaviors. Individuals with eating disorders may restrict their food intake, engage in purging behaviors, or have episodes of uncontrollable overeating, leading to imbalances in nutrient intake.
- Medical Conditions:
- Underlying medical conditions, such as gastrointestinal disorders (Crohn’s disease, celiac disease, chronic pancreatitis), metabolic disorders (diabetes mellitus), and malabsorption syndromes, can interfere with the absorption and utilization of nutrients, resulting in imbalances.
- Gastrointestinal Surgery:
- Surgical procedures involving the gastrointestinal tract, such as gastric bypass surgery, can impact nutrient absorption. Post-surgery, individuals may experience challenges in obtaining adequate nutrients from their diet, necessitating careful dietary management and supplementation.
- Food Insecurity:
- Lack of access to a variety of nutritious foods due to economic constraints can lead to nutrition imbalances. Individuals facing food insecurity may rely on low-cost, energy-dense foods that are deficient in essential nutrients, contributing to malnutrition.
- Medication Effects:
- Some medications can interfere with nutrient absorption or increase nutrient excretion. For example, certain diuretics may lead to potassium loss, and long-term use of proton pump inhibitors (PPIs) can affect the absorption of calcium, magnesium, and vitamin B12.
- Age-Related Factors:
- Infants, children, and older adults may be more vulnerable to nutrition imbalances due to specific dietary requirements at different life stages. Infants require proper feeding practices, while older adults may face challenges in maintaining a balanced diet.
- Psychological Factors:
- Emotional stress, depression, and anxiety can impact eating habits, leading to either overeating or undereating. These psychological factors contribute to nutritional imbalances and may require holistic interventions addressing mental health and nutrition.
Desired Outcome for Nutrition Imbalance
- Achievement of Optimal Nutrient Levels:
- The primary goal is to restore and maintain optimal levels of essential nutrients within the body, ensuring a well-balanced intake of carbohydrates, proteins, fats, vitamins, and minerals to support overall health and physiological functions.
- Normalization of Body Weight:
- For individuals with weight-related nutrition imbalances, the desired outcome includes achieving and maintaining a healthy body weight through a balanced and nutritious diet. This is essential for promoting overall well-being and preventing complications associated with undernutrition or overnutrition.
- Resolution of Underlying Medical Conditions:
- If nutrition imbalances are linked to specific medical conditions or disorders, the desired outcome involves addressing and managing these underlying health issues. Effective management may include medical treatments, dietary modifications, and lifestyle changes to support optimal health.
- Improved Energy Levels and Vitality:
- A well-balanced and nutritionally adequate diet contributes to increased energy levels, vitality, and overall well-being. The desired outcome is to help individuals feel more energetic, alert, and capable of engaging in daily activities without fatigue or lethargy.
- Enhanced Immune Function and Disease Prevention:
- Optimal nutrition supports a robust immune system, reducing the risk of infections and contributing to overall disease prevention. The desired outcome is to strengthen the body’s defense mechanisms, promoting resilience against illnesses and supporting long-term health.
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 Assessment for Nutrition Imbalance
- Anthropometric Measurements:
- Measure and document height, weight, BMI (Body Mass Index), and waist circumference to assess overall nutritional status and identify potential imbalances.
- Biochemical Markers:
- Monitor laboratory values such as albumin, prealbumin, hemoglobin, and serum electrolytes to assess specific aspects of nutritional status and identify deficiencies or excesses.
- Clinical Observations:
- Observe for physical signs of malnutrition or overnutrition, including muscle wasting, edema, skin changes, and hair abnormalities. Assess overall appearance and energy levels.
- Dietary History:
- Conduct a thorough dietary history, including food preferences, dietary restrictions, eating patterns, and habits. Identify any challenges or barriers to maintaining a balanced diet.
- Functional Assessment:
- Evaluate the patient’s ability to perform activities of daily living (ADLs) and assess any limitations related to nutritional imbalances. Consider factors such as chewing and swallowing difficulties.
- Psychosocial Assessment:
- Assess the patient’s psychological and emotional relationship with food, addressing factors such as stress, depression, or eating disorders that may impact nutritional health.
- Cultural Considerations:
- Recognize and respect cultural influences on dietary choices. Consider cultural preferences, religious dietary restrictions, and traditional food practices when planning nutritional interventions.
- Medication Review:
- Evaluate the patient’s medication list for any medications that may impact nutritional status, such as appetite suppressants, diuretics, or medications affecting nutrient absorption.
Implementation for Nutrition Imbalance Nursing Care
- Nutritional Counseling:
- Provide individualized nutritional counseling based on the assessment findings, addressing specific nutritional needs, dietary modifications, and lifestyle changes.
- Meal Planning and Assistance:
- Collaborate with the patient to develop a well-balanced meal plan that meets their nutritional requirements. Offer assistance with meal preparation or coordinate with a dietitian as needed.
- Supplementation:
- Administer or oversee the administration of nutritional supplements, vitamins, or minerals as prescribed to address deficiencies or support nutritional goals.
- Education on Healthy Eating Habits:
- Educate the patient on healthy eating habits, portion control, and the importance of a balanced diet. Provide resources and materials to enhance nutritional knowledge.
- Collaboration with Multidisciplinary Team:
- Collaborate with other healthcare professionals, including dietitians, physicians, and therapists, to address complex nutritional issues and ensure a holistic approach to care.
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 |
Evaluation for Nutrition Imbalance Nursing Care
- Nutritional Status Improvement:
- Assess and document improvements in nutritional status based on anthropometric measurements, biochemical markers, and clinical observations.
- Patient Adherence:
- Evaluate the patient’s adherence to the recommended dietary plan, including meal plans, dietary restrictions, and nutritional interventions.
- Resolution of Deficiencies or Excesses:
- Monitor laboratory values to assess whether specific nutrient deficiencies or excesses have been adequately addressed through interventions.
- Functional Improvement:
- Evaluate improvements in the patient’s ability to perform ADLs and overall functional status related to enhanced nutritional health.
- Patient Satisfaction and Education:
- Seek feedback from the patient regarding satisfaction with the care provided and the effectiveness of educational interventions. Reassess the patient’s understanding of nutritional principles.
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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