Maintaining balanced nutrition is fundamental to overall health and well-being. Altered nutrition, also sometimes referred to as imbalanced nutrition or inadequate nutritional intake, occurs when an individual’s nutrient consumption is either excessive or insufficient compared to their body’s requirements and metabolic demands. This condition can affect anyone, regardless of age or health status. Understanding the nuances of altered nutrition is crucial for healthcare professionals, especially nurses, in providing effective patient care.
In this guide, we will delve into the multifaceted aspects of altered nutrition as a nursing diagnosis. We will explore the various factors that contribute to nutritional imbalances, potential complications, expected patient outcomes, comprehensive nursing assessments, targeted interventions, and detailed nursing care plans. This resource aims to provide an in-depth understanding and practical strategies for managing patients experiencing altered nutrition, ensuring optimal recovery and health maintenance.
Causes (Related To) of Altered Nutrition
Several factors can lead to altered nutrition. Recognizing these underlying causes is the first step in developing an effective nursing diagnosis care plan. Common causes include:
- Age-Related Changes: As individuals age, physiological changes can impact nutrition. These include a decline in taste and smell sensitivity, reduced appetite, and age-related gastrointestinal changes affecting nutrient absorption.
- Underlying Illnesses: Various medical conditions significantly affect nutritional status. Chronic diseases like cancer, which increases metabolic demands and can cause anorexia, and severe burns, which lead to hypermetabolism and nutrient loss, are prime examples.
- Mechanical Difficulties: Problems with the physical processes of eating can severely limit nutrient intake. Difficulty chewing (mastication) or swallowing (dysphagia), often due to dental issues, stroke, or neurological conditions, are significant barriers to adequate nutrition.
- Cognitive Impairment: Conditions like dementia and Alzheimer’s disease can impair an individual’s ability to remember to eat, recognize hunger cues, or manage meal preparation, leading to nutritional deficits.
- Medication Effects: Many medications can have side effects that impact appetite, nutrient absorption, or metabolism. Chemotherapy, for example, is notorious for causing nausea and loss of appetite, while certain drugs can interfere with nutrient uptake.
- Socioeconomic Factors: Economic disadvantage and food insecurity are major determinants of nutrition. Limited financial resources can restrict access to a variety of healthy foods, leading to nutrient deficiencies or reliance on inexpensive, calorie-dense but nutrient-poor options.
- Limited Food Access: Geographical location, mobility issues, or lack of transportation can limit access to grocery stores and healthy food sources, particularly for elderly or disabled individuals.
- Mental Health Conditions: Depression and other mental health disorders often manifest with changes in appetite and eating habits. Depression can lead to decreased appetite and energy, resulting in inadequate food intake.
- Substance Abuse: Alcoholism and other substance dependencies can interfere with nutrient absorption, increase nutrient excretion, and often replace food intake, leading to severe nutritional imbalances.
Alt text: A concerned nurse assists an older adult patient who is having difficulty eating, highlighting age-related challenges in nutrition.
Complications of Altered Nutrition
If left unaddressed, altered nutrition can lead to a cascade of complications that negatively impact health outcomes and quality of life. These complications include:
- Compromised Immune Function: Nutritional deficiencies weaken the immune system, making individuals more susceptible to infections, slower to recover from illness, and less responsive to medical treatments.
- Impaired Wound Healing: Adequate nutrition is crucial for tissue repair and regeneration. Deficiencies, particularly in protein, vitamins, and minerals, delay wound healing, increasing the risk of infection and prolonged hospital stays.
- Muscle Weakness and Bone Density Loss: Insufficient protein and calorie intake leads to muscle wasting (sarcopenia) and decreased bone mineral density (osteoporosis). This results in weakness, increased risk of falls and fractures, and reduced mobility.
- Increased Hospitalization Rates: Individuals with altered nutrition are more likely to experience complications during illness and require longer hospital stays. Malnutrition upon admission is also associated with poorer prognoses and higher mortality rates.
Expected Outcomes for Nursing Care Plans
The primary goals of nursing care planning for altered nutrition are to restore nutritional balance and improve patient well-being. Expected outcomes typically include:
- Weight Management: The patient will achieve and maintain a weight within a healthy, desired range, appropriate for their age, body composition, and health status.
- Understanding Contributing Factors: The patient will be able to identify and articulate the factors contributing to their underweight or overweight condition, fostering self-awareness and promoting lifestyle modifications.
- Nutritional Knowledge: The patient will demonstrate an understanding of their individual nutritional needs and dietary requirements, enabling informed food choices and self-management.
- Adequate Nutritional Intake: The patient will consistently consume sufficient nutrients and calories to meet their body’s needs, supporting physiological functions and overall health.
- Home Management Skills: The patient will verbalize and demonstrate appropriate strategies for managing their nutrition at home, ensuring continuity of care and long-term health maintenance.
Nursing Assessment for Altered Nutrition
A thorough nursing assessment is essential for identifying altered nutrition and guiding the development of personalized care plans. Key assessment components include:
1. Comprehensive Nutrition Screening: Initiate a detailed nutrition screening to establish the patient’s baseline nutritional status. This involves gathering information about dietary habits, food preferences, cultural or religious dietary restrictions, allergies, and any difficulties with eating. Standardized screening tools can aid in this process.
2. Laboratory Value Analysis: Evaluate relevant laboratory values as indicators of nutritional status. Serum albumin and prealbumin levels, for instance, are markers of protein status and can be decreased in malnutrition. Electrolyte imbalances, vitamin and mineral deficiencies can also be identified through blood tests.
3. Mobility Status Evaluation: Assess the patient’s mobility and functional status. Impaired mobility can affect food access, preparation, and intake. Weakness and fatigue associated with malnutrition can further reduce mobility, creating a cycle of decline. Collaboration with physical and occupational therapists may be needed to address mobility limitations.
4. Identification of Underlying Causes: Thoroughly investigate potential underlying medical, social, or environmental factors contributing to altered nutrition. This includes reviewing medical history, current medications, socioeconomic circumstances, and living situation. Identifying the root cause is crucial for targeted interventions. For example, difficulty chewing or swallowing may necessitate a referral to speech therapy and dietary modifications.
5. Routine Weight Monitoring: Implement regular weight monitoring. In acute care settings, daily weights are often necessary, while weekly or monthly measurements may suffice in long-term care or home settings. Consistent weight tracking provides objective data to monitor nutritional progress and detect changes early.
6. Safety Assessment: Evaluate the patient’s overall safety, considering the impact of altered nutrition on strength and balance. Weakness and dizziness due to malnutrition increase the risk of falls and injuries. Assistive devices and safety precautions may be necessary to ensure patient safety.
7. Regular Re-screening: For patients with acute conditions contributing to altered nutrition (e.g., stroke, burns, post-surgery), repeat nutrition screenings frequently. Nutritional needs can fluctuate significantly during recovery, requiring ongoing assessment and adjustments to the care plan.
8. Oral Care and Hygiene Assessment: Assess the patient’s oral health and hygiene. Poor oral hygiene, dental problems, or mouth sores can decrease appetite and make eating uncomfortable. Good oral care can enhance appetite and improve food intake.
9. Assistive Device Needs: Determine if the patient requires assistive devices to aid in feeding. Patients with motor impairments or disabilities may benefit from specialized utensils, adaptive plates, or feeding aids to promote independence and improve meal consumption.
Alt text: A nurse attentively reviews a patient’s dietary chart, showcasing the detailed assessment process for altered nutrition.
Nursing Interventions for Altered Nutrition
Effective nursing interventions are crucial for addressing altered nutrition and promoting patient recovery. These interventions are designed to improve nutritional intake, address underlying causes, and educate patients on self-management. Key nursing interventions include:
1. Dietitian Referral: Consult with the physician regarding a referral to a registered dietitian. Dietitians are specialized in nutritional assessment and therapy. They can conduct in-depth nutritional evaluations, develop individualized meal plans, and provide tailored dietary education to meet the patient’s specific needs.
2. Nutritional Supplement Provision: Administer nutritional supplements as prescribed or ordered by the physician or dietitian. Supplements, such as oral nutritional supplements, protein powders, or vitamin/mineral preparations, can help bridge nutritional gaps and ensure adequate intake, especially for patients with poor appetite or increased nutritional demands.
3. Patient Education on Nutritional Needs: Educate the patient about their body’s nutritional requirements and the importance of balanced nutrition for health and recovery. Provide clear, understandable information on food groups, portion sizes, healthy eating habits, and the role of nutrition in managing their specific condition. This empowers patients to make informed choices and actively participate in their care.
4. Nutritional Resource Provision: Provide patients with readily accessible resources about nutrition. This could include printed materials, websites, support groups, or community programs focused on healthy eating and food assistance. Providing resources ensures patients have ongoing support and information even after discharge.
5. Between-Meal Snacks for Underweight Patients: For underweight patients struggling to meet calorie needs at mealtimes, offer nutritious snacks between meals. Frequent, small snacks can increase overall calorie and nutrient intake without overwhelming the patient’s appetite. Healthy snack options include yogurt, fruits, nuts, cheese, or protein bars.
6. Oral Hygiene Promotion: Provide and encourage good oral hygiene practices. Regular tooth brushing, mouth rinsing, and dental care can improve appetite, enhance taste perception, and facilitate comfortable eating. Good oral hygiene also reduces the risk of oral infections that can further decrease appetite.
7. Antiemetic Administration: Administer antiemetics as needed, particularly before meals, for patients experiencing nausea. Nausea is a common side effect of medications or medical conditions and can significantly reduce appetite and food intake. Pre-meal antiemetics can alleviate nausea, improve comfort, and encourage better food consumption.
8. Enteral Feeding Administration: In critical care settings or for patients unable to eat orally, administer enteral feedings as prescribed. Enteral nutrition, delivered via feeding tubes, provides liquid nutrition directly into the stomach or small intestine. Ensure proper administration, monitoring, and maintenance of the feeding tube to meet the patient’s nutritional needs safely and effectively.
9. Social Worker/Case Manager Referral: If socioeconomic factors are contributing to altered nutrition, initiate a referral to a social worker or case manager. These professionals can assess the patient’s access to food resources, financial assistance programs, and community support services. Connecting patients with appropriate resources can address food insecurity and improve long-term nutritional status.
Nursing Care Plans for Altered Nutrition: Examples
Nursing care plans provide a structured framework for delivering patient-centered care. Here are three examples of nursing care plans for altered nutrition, each addressing a different underlying cause:
Care Plan #1: Altered Nutrition Related to Wired Jaw
Diagnostic Statement: Altered nutrition related to wired jaw secondary to fracture, as evidenced by weight >10% below ideal.
Expected Outcomes:
- Patient will gain 1 pound per week progressively.
- Patient will consume adequate nourishment through blenderized vegetables, fruits, and protein sources.
Assessment:
- Monitor weight daily: Weight fluctuations are a key indicator of nutritional status changes in patients with wired jaws. Daily monitoring helps track progress and identify potential issues early.
- Assess chewing ability: Evaluate the patient’s ability to manage food with a wired jaw. The wiring significantly restricts chewing, necessitating dietary modifications.
- Evaluate self-feeding ability: Assess any additional factors that might impede self-feeding, such as arm or hand injuries. This comprehensive assessment ensures all barriers to adequate nutrition are addressed.
Interventions:
- Create a pleasant eating environment: Ensure a calm, odor-free environment during mealtimes. Proper positioning (head elevated at least 30 degrees) and pre-meal oral hygiene enhance appetite and reduce aspiration risk.
- Provide modified diets and nutritional support:
- Offer mechanical soft or blenderized tube feedings to accommodate chewing restrictions.
- Supplement with high-calorie, nutrient-rich meal replacement shakes to boost caloric intake.
- Consider appetite stimulants if medically indicated to improve hunger and intake.
- Encourage appealing food choices, potentially involving family to bring favorite blenderized foods.
- Offer soft, palatable food options: While blenderized food is necessary, enhance appeal by suggesting baby foods, drinkable yogurts, puddings, and miso soup, which may be more palatable.
- Occupational therapy referral: Consult an occupational therapist for adaptive feeding devices. These devices can improve the patient’s ability to self-feed despite physical limitations.
- Discuss enteral or parenteral nutrition: If oral intake remains insufficient, explore enteral (tube feeding) or parenteral (IV nutrition) support. These methods ensure nutritional needs are met when oral feeding is compromised.
Care Plan #2: Altered Nutrition Related to Anorexia Nervosa
Diagnostic Statement: Altered nutrition related to anorexia nervosa, as evidenced by muscle weakness and decreased serum albumin.
Expected Outcomes:
- Patient will achieve a normal BMI of 18.5 to 24.9.
- Patient will report decreased muscle weakness and improved energy levels.
- Patient will achieve serum albumin levels within the normal range (3.4 to 5.4 g/dL).
Assessments:
- Obtain comprehensive nutritional history: Gather detailed information on diet, eating patterns, and habits. Explore psychological and emotional factors contributing to anorexia to develop a holistic understanding.
- Assess attitudes towards food: Evaluate the patient’s beliefs and attitudes about food, body image, and eating. Understanding these perceptions is crucial for addressing the psychological aspects of anorexia.
- Limit scale use: Minimize focus on weight by limiting scale use. Overemphasis on weight can increase anxiety. Instead, prioritize lab values and calorie intake to assess nutritional progress.
- Monitor laboratory values: Regularly monitor serum albumin, transferrin, electrolytes (potassium, sodium), and complete blood count to assess nutritional status and detect deficiencies.
Interventions:
- Offer frequent, high-calorie snacks and drinks: Provide calorie-dense options frequently to promote weight gain. Higher calorie intake is essential for nutritional rehabilitation in anorexia.
- Provide menu choices: Allow the patient to select meals from a menu to foster a sense of control and encourage intake of preferred foods.
- Establish a structured eating schedule: Implement a rigid eating schedule with meals and snacks every 3 hours to normalize eating patterns and prevent meal skipping, common in anorexia.
- Encourage fluids and fiber: Promote adequate fluid and fiber intake (25-28 grams daily) to prevent constipation, a frequent issue in patients with anorexia.
- Dietitian collaboration: Collaborate with a dietitian specializing in eating disorders. These dietitians have expertise in developing meal plans and employing psychosocial approaches to support patients with anorexia.
Care Plan #3: Altered Nutrition Related to Dysphagia in Parkinson’s Disease
Diagnostic Statement: Altered nutrition related to dysphagia secondary to Parkinson’s disease, as evidenced by weakened swallowing muscles and food intake below daily recommendations.
Expected Outcomes:
- Patient will safely pass food and fluids from mouth to stomach without aspiration.
- Patient will achieve or maintain desired body weight.
- Patient will remain free of complications like dehydration or aspiration pneumonia.
Assessments:
- Daily weight monitoring: Track weight daily to detect early signs of nutritional decline. Consistent weight monitoring is crucial for patients with dysphagia.
- Malnutrition screening: Utilize validated screening tools (MST, MUST, SNAQ) to assess malnutrition risk in older adults, considering factors like food intake, weight loss, and mobility.
- Dysphagia history and assessment: Thoroughly assess swallowing difficulties, including:
- Problems initiating swallowing
- Food sticking sensation
- Gagging, choking, or coughing during swallowing
- Regurgitation through mouth or nose
- Unexplained weight loss due to swallowing problems
- Food refusal due to swallowing difficulties
Recognize that dysphagia in Parkinson’s can range from mild to severe, with aspiration pneumonia as a critical risk.
- Cognitive and sensory-perceptual status: Evaluate cognitive function, sensory awareness, and motor coordination, as these factors impact swallowing ability and safety.
Interventions:
- Dysphagia specialist referral: Refer to a dysphagia specialist (speech-language pathologist) for swallow therapy. Specialists provide exercises and postural techniques to improve swallowing safety and efficiency.
- Nutritionist/Dietitian consultation: Consult a dietitian to develop an optimized dietary plan tailored to dysphagia and Parkinson’s, ensuring adequate nutrition and appropriate food consistencies.
- Allow ample eating time: Provide a relaxed, unhurried mealtime environment. Allow sufficient time for eating to reduce fatigue and frustration associated with slow eating.
- Manage bite size: Cut solids into small, manageable bites (½ tsp or less). Smaller bites are easier and safer to swallow for patients with dysphagia.
- Modify food and fluid consistency: Provide food and fluid consistencies the patient prefers and can swallow safely. Pudding-like consistency or thickened liquids are often easier to manage than thin liquids or solid foods. Speech therapist recommendations are key for consistency choices.
- Encourage high-protein intake: Promote high-protein foods or meal replacement drinks (unless contraindicated) to combat muscle loss associated with aging and Parkinson’s.
References
- Ackley, B.J., Ladwig, G.B., Flynn Makic M.B., Martinez-Kratz, M., & Zanotti, M. (2019). Nursing diagnosis handbook: An evidence-based guide to planning care (12th edition). Mosby.
- Carpenito, L.J. (2013). Nursing diagnosis: Application to clinical practice (14th ed.). Lippincott Williams & Wilkins.
- Doenges, M.E., Moorhouse, M.F., & Murr, A.C. (2019). Nursing care plans: Guidelines for individualising client care across the life span (10th ed.). F.A. Davis Company.
- Gulanick, M. & Myers, J.L. (2014). Nursing care plans: Diagnoses, interventions, and outcomes (8th ed.). Elsevier.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (Eds.). (2024). NANDA-I International Nursing Diagnoses: Definitions and Classification, 2024-2026. Thieme. 10.1055/b000000928
- Mayo Clinic. (2019). Senior health: how to prevent and detect malnutrition. https://www.mayoclinic.org/healthy-lifestyle/caregivers/in-depth/senior-health/art-20044699
