Nutrition is fundamental to life, serving as the bedrock for cellular metabolism and overall bodily functions. Optimal nutrition, characterized by an adequate intake of vitamins and nutrients, is crucial for sustaining health. Conversely, malnutrition arises from nutritional imbalances – be it deficiency, excess, or disproportionate intake – manifesting in various forms, from being underweight to overweight, or lacking essential micronutrients.
While malnutrition encompasses a broad spectrum of nutritional imbalances, one particularly concerning manifestation, especially in pediatric populations, is failure to thrive (FTT). Failure to thrive is a term used to describe infants and children who are not gaining weight or growing as expected. It is a sign of undernutrition and can have serious long-term consequences on a child’s development. Nurses are at the forefront of identifying and addressing malnutrition, including failure to thrive, through comprehensive assessment, targeted interventions, and well-structured care plans.
This article will delve into the critical aspects of malnutrition, with a specific focus on nursing diagnoses related to failure to thrive. We will explore the risk factors, assessment strategies, and nursing interventions essential for managing malnutrition and failure to thrive across different patient populations.
Risk Factors for Malnutrition and Failure to Thrive
Malnutrition, including failure to thrive, is a multifaceted condition influenced by a range of factors. Recognizing these risk factors is the first step in proactive identification and intervention. Common risk factors include:
- Genetic Predisposition: Genetic factors can influence metabolism and nutrient absorption, predisposing individuals to malnutrition.
- Stress: Physiological and psychological stress can impact appetite, nutrient absorption, and metabolic demands, contributing to malnutrition.
- Depression: Depression and other mental health conditions can significantly affect appetite and dietary intake, leading to nutritional deficiencies.
- Obesity: Paradoxically, obesity is also considered a form of malnutrition, representing an imbalance due to excessive calorie intake and often nutrient-poor food choices.
- Imbalanced Diet: Consistently consuming a diet lacking in essential nutrients or excessively high in processed foods contributes significantly to malnutrition.
- Poverty and Food Insecurity: Limited financial resources directly impact access to nutritious food, increasing the risk of undernutrition and failure to thrive in vulnerable populations.
- Malabsorption and Digestive Disorders: Conditions like celiac disease, cystic fibrosis, and inflammatory bowel disease impair nutrient absorption, predisposing individuals to malnutrition.
- Eating Disorders: Anorexia nervosa, bulimia nervosa, and binge eating disorder are severe mental health conditions that drastically disrupt eating patterns and nutritional intake.
- Cancer and Chronic Diseases: Cancer and other chronic illnesses often increase metabolic demands, reduce appetite, and impair nutrient absorption, leading to cachexia and malnutrition.
- Age Extremes: Infants, young children, and older adults are particularly vulnerable to malnutrition due to specific nutritional needs and physiological changes. For infants, conditions affecting feeding or nutrient absorption directly contribute to failure to thrive.
Understanding these risk factors enables nurses to conduct targeted assessments and implement preventive strategies, especially for high-risk populations.
The Nursing Process in Malnutrition and Failure to Thrive
Nurses are pivotal in the effective management of malnutrition and failure to thrive. Their role spans from initial screening and assessment to implementing interventions and providing crucial patient education. The nursing process provides a structured framework for delivering comprehensive nutritional care.
Nursing Assessment: Gathering Crucial Data
The nursing assessment is the cornerstone of nutritional care. It involves a systematic collection of subjective and objective data to identify nutritional status and underlying issues. In the context of malnutrition and failure to thrive, a thorough assessment is paramount.
Review of Health History: Uncovering Clues
1. General Symptom Evaluation: Nurses should meticulously note any general symptoms that may indicate malnutrition. These can be varied and subtle:
- Skin and Hair Changes: Dry, scaly skin, hair loss, and brittle nails are common signs of nutrient deficiencies.
- Oral Manifestations: Mouth ulcers and glossitis (inflammation of the tongue) can signal vitamin deficiencies.
- Growth and Development Delays: In children, poor weight gain, stunted growth, and delayed development are critical indicators of failure to thrive and malnutrition.
- Energy and Muscle Function: Decreased muscle mass, weakness, and persistent fatigue are hallmarks of protein-energy malnutrition.
- Neurological and Cognitive Changes: Irritability, confusion, and mental changes can be associated with various nutritional deficiencies.
- Electrolyte Imbalances: Malnutrition can disrupt electrolyte balance, leading to a range of symptoms.
2. Identifying Specific Nutrient Deficiencies: Recognizing patterns of symptoms can point to specific micronutrient deficiencies:
- Iron Deficiency: Manifests as fatigue, anemia, pallor, shortness of breath, cognitive impairment, headache, glossitis, and brittle nails. Crucial in failure to thrive as iron deficiency anemia can impact development.
- Iodine Deficiency: Leads to goiter, developmental delays, and intellectual disabilities. Particularly important in infants and pregnant women.
- Vitamin D Deficiency: Causes hypocalcemia, rickets (in children), and poor bone growth. Vitamin D is essential for calcium absorption and bone health, critical in growing children and those with failure to thrive.
- Vitamin A Deficiency: Results in night blindness, xerophthalmia (dry eyes), growth retardation, frequent infections, and infertility.
- Folate Deficiency: Presents with glossitis, fatigue, muscle weakness, vision abnormalities, megaloblastic anemia, and neural tube defects in developing fetuses.
- Zinc Deficiency: Linked to anemia, dwarfism, hepatosplenomegaly, hyperpigmentation, hypogonadism, acrodermatitis enteropathica, and impaired immunity. Zinc is vital for growth, immune function, and wound healing, all relevant in failure to thrive and malnutrition.
3. Monitoring Weight Changes: Unintentional weight loss is a significant red flag for undernutrition. In failure to thrive, inadequate weight gain or weight loss is the defining characteristic. Malnutrition should be suspected with a 5-10% unintentional weight loss over 3-6 months. Conversely, it’s also important to remember that overnutrition and obesity are forms of malnutrition too.
4. Risk Factor Identification (Undernutrition & Overnutrition): A detailed history should explore risk factors for both undernutrition and overnutrition:
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Undernutrition Risk Factors:
- Eating Difficulties: Nausea, dysphagia (difficulty swallowing), feeding problems in infants.
- Calorie Depletion: Chronic diarrhea, cancer, malabsorptive conditions.
- Increased Caloric Needs: Pregnancy, breastfeeding, puberty, growth spurts (especially relevant in failure to thrive).
- Eating Disorders: Anorexia nervosa, bulimia nervosa, avoidant/restrictive food intake disorder (ARFID).
- Malabsorption: Pancreatic insufficiency, inflammatory bowel disease, celiac disease.
- Mental Health Conditions: Depression, dementia, anxiety, autism spectrum disorder (in children, can contribute to feeding difficulties and failure to thrive).
- Chronic Enteral/Parenteral Feeding: Complications or inadequate provision can lead to malnutrition.
- Disinterest in Eating: Restricted diets, food allergies, sensory sensitivities (common in children with failure to thrive).
- Financial Constraints & Food Insecurity: Limited access to healthy food due to poverty.
- Limited Access to Healthy Food: Food deserts, lack of transportation.
- Social Isolation: Especially in older adults, can lead to reduced food intake.
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Overnutrition Risk Factors:
- Eating Disorders: Binge eating disorder.
- Mental Health Conditions: Chronic stress, anxiety, depression (can lead to emotional eating).
- Metabolic Slowdown: Hypothyroidism.
- Hormonal Imbalances: Affecting hunger and satiety cues.
- Processed Food Availability: High-calorie, nutrient-poor diets.
- Sedentary Lifestyle: Reduced calorie expenditure.
5. Supplement Review: Documenting current vitamin and supplement use is crucial. Both deficiencies and excesses can contribute to malnutrition. For example, excessive vitamin C can cause diarrhea, and iron overload can lead to toxicity.
6. Eating Habit Assessment: Inquire about dietary patterns, food choices, and the patient’s relationship with food. Poor food choices, restrictive diets without proper guidance, and limited access to healthy options are key factors in malnutrition. In failure to thrive, detailed feeding history including frequency, volume, types of food, and feeding behaviors is crucial.
7. Thorough Medical History: A comprehensive medical history provides context for potential causes and risks of malnutrition. This includes past illnesses, surgeries, medications, allergies, and social history.
Physical Assessment: Objective Signs
1. Physical Examination for PEM: Protein-energy malnutrition (PEM) is a common form of undernutrition, particularly in hospitalized patients and those with failure to thrive. Physical signs include:
- Central Nervous System (CNS): Irritability, decreased concentration, apathy, lethargy.
- Head, Eyes, Ears, Nose, and Throat (HEENT): Papillary atrophy (smooth, shiny tongue), angular cheilitis (cracked lips), stomatitis (oral mucosa inflammation).
- Gastrointestinal (GI): Hepatomegaly (enlarged liver), steatosis (fatty liver), abdominal distention, weak abdominal muscles.
- Integumentary: Reduced subcutaneous tissue, hyperpigmented skin plaques, dry skin, ridged nails, brittle hair, hair loss, poor wound healing.
- Lymphatics: Peripheral edema, anasarca (generalized edema).
2. Vital Sign Measurement: Vital signs can reveal subtle signs of malnutrition:
- Undernutrition: Hypothermia (low body temperature), bradycardia (slow heart rate), hypotension (low blood pressure).
- Overnutrition: Hypertension (high blood pressure).
3. BMI Calculation: Body Mass Index (BMI) is a widely used screening tool. A BMI below 18.5 suggests underweight and potential malnutrition. However, BMI has limitations, especially in assessing muscle mass versus fat mass. It should be used as one indicator among others, particularly in children with failure to thrive where growth charts are more specific.
4. Malnutrition Screening Tools: Utilize validated screening tools, especially in pediatric populations for failure to thrive. Tools like the Pediatric Yorkhill Malnutrition Score (PYMS) or Subjective Global Nutritional Assessment (SGNA) can be helpful. For children under 2, growth charts are essential for tracking weight, length, and head circumference percentiles, which are key in diagnosing failure to thrive.
- Growth Charts for Children < 2 years: Monitor weight-for-age, length-for-age, weight-for-length, and head circumference-for-age using WHO growth standards. Failure to thrive is often diagnosed when weight falls below the 3rd or 5th percentile, or there is a significant drop across percentiles.
- BMI for Children > 2 years and Adults: Use age-appropriate BMI percentiles for children and BMI categories for adults.
5. Mid-Upper Arm Circumference (MUAC): MUAC is a quick and useful measure for assessing acute malnutrition, particularly in children and in resource-limited settings. WHO classifications for MUAC can help identify severe acute malnutrition.
6. Growth and Developmental Assessment in Children: In children, particularly with suspected failure to thrive, assess developmental milestones alongside growth parameters. Malnutrition can significantly impair cognitive and physical development. Poor nutrition in the first 1000 days of life has long-lasting effects.
7. Dehydration and Acidosis Assessment: Protein-energy malnutrition can be associated with dehydration and metabolic acidosis. Assess for signs of dehydration (poor skin turgor, dry mucous membranes) and metabolic acidosis (headache, confusion, tachycardia).
Diagnostic Procedures: Objective Confirmation
1. Blood Samples for Nutrient Imbalances: Blood tests are crucial for identifying specific nutrient deficiencies. Common tests include:
- Complete Blood Count (CBC): To assess for anemia (iron, folate, B12 deficiency).
- Iron Studies: Serum iron, ferritin, transferrin saturation to diagnose iron deficiency.
- Vitamin Levels: Vitamin D, B12, folate, vitamin A, and others as clinically indicated.
- Electrolytes: Sodium, potassium, calcium, magnesium, phosphate – often imbalanced in malnutrition and refeeding syndrome.
2. Protein Malnutrition Assessment: Serum protein markers reflect protein nutritional status.
- Serum Albumin: A common but less sensitive marker as it’s affected by hydration and inflammation.
- Prealbumin (Transthyretin): More sensitive marker with a shorter half-life, reflecting recent nutritional changes.
- Retinol-Binding Protein: Another protein with a short half-life, responsive to nutritional changes.
- Transferrin: Reflects iron status but also protein status.
- Creatinine and Blood Urea Nitrogen (BUN): Can be affected by protein intake and muscle mass.
3. Hormone Level Assessment: Hormone imbalances can contribute to or result from malnutrition.
- Thyroid Hormones (TSH, T4, T3): To rule out hypothyroidism (can cause weight gain and altered metabolism).
- Cortisol: Elevated in stress, affecting metabolism.
- Insulin and Glucose: To assess for diabetes and metabolic dysregulation.
- Growth Hormone: Especially in children with failure to thrive, to investigate growth disorders.
4. Electrolyte and Enzyme Assessment: Imbalances can indicate metabolic disturbances and organ dysfunction.
- Electrolytes: Calcium, potassium, magnesium, chloride, phosphate – monitor for imbalances, especially in refeeding syndrome.
- Liver Enzymes (AST, ALT): Elevated in fatty liver disease (steatosis) associated with both over and undernutrition.
- Pancreatic Enzymes (Amylase, Lipase): To assess for pancreatic insufficiency (malabsorption risk).
5. Peak Height Velocity Assessment (Children): In children with growth issues, assessing growth velocity curves can help identify growth disorders. Abnormal height velocity may warrant further investigation into thyroid function or cystic fibrosis (sweat chloride test).
6. Stool Specimens: If there’s a history of diarrhea, abnormal stools, or suspected malabsorption, stool studies (fecal fat, stool culture, ova and parasites) can be informative.
Nursing Interventions: Reversing and Preventing Malnutrition
Nursing interventions are crucial for both reversing existing malnutrition and preventing its occurrence. A multi-faceted approach is essential, tailored to the individual’s needs and the underlying causes of malnutrition.
Reversing Malnutrition and Failure to Thrive
1. Treat Underlying Cause: Addressing the root cause of malnutrition is paramount. This may involve:
- Medical Management: Medications for chronic diseases, treatment of infections, management of malabsorption syndromes.
- Mental Health Support: Therapy for depression, anxiety, eating disorders, and family therapy for children with failure to thrive related to psychosocial factors.
- Financial and Social Resources: Connecting patients and families with food banks, WIC, SNAP, and other community support programs.
- Multidisciplinary Team: Collaboration with physicians, dietitians, speech therapists (for swallowing difficulties), occupational therapists (for feeding skills in children), and social workers.
2. Provide Recommended Caloric Intake: Increasing caloric intake is fundamental for reversing undernutrition and promoting growth in failure to thrive.
- Oral Nutritional Support: For mild to moderate malnutrition, encourage increased oral intake with nutrient-dense foods.
- High-Calorie Supplements: Utilize customized, high-calorie nutritional formulas, especially for children with failure to thrive and individuals with poor appetite or increased needs.
- Vitamin and Mineral Supplementation: Address specific nutrient deficiencies with appropriate supplements as prescribed.
3. Increase Protein Intake: Protein is essential for muscle building, immune function, and overall recovery from malnutrition.
- Dietary Protein Sources: Encourage consumption of lean meats, poultry, fish, eggs, dairy, nuts, legumes, and beans.
- Protein Supplements: Consider protein powders or liquid protein supplements if dietary intake is insufficient.
4. Increase Calorie Density: For patients with poor appetite, nausea, or feeding difficulties (common in failure to thrive), focus on calorie-dense foods in smaller portions:
- Calorie-Dense Food Choices: Smoothies, nut butters, avocados, cheese, whole milk, yogurt, potatoes with butter or olive oil, fortified foods.
- Frequent Small Meals: Easier to tolerate than large meals, especially for those with reduced appetite.
5. Correct Nutrient Deficiencies: Address identified vitamin and mineral deficiencies through supplementation.
- Prescribed Supplements: Administer vitamins, iron, folate, zinc, or other nutrients as ordered by the physician or dietitian.
- Monitor for Side Effects: Educate patients about potential side effects of supplements and monitor for adverse reactions.
6. Refeeding Syndrome Prevention: In severely malnourished patients, refeeding must be initiated cautiously to prevent refeeding syndrome, a potentially life-threatening electrolyte and fluid shift.
- Slow and Gradual Refeeding: Start with a low caloric intake and gradually increase over several days, closely monitoring electrolytes.
- Electrolyte Monitoring and Replacement: Frequently monitor and replace potassium, phosphate, magnesium, and calcium levels.
- Thiamine Supplementation: Administer thiamine before starting refeeding to prevent Wernicke encephalopathy.
7. Weight Loss Strategies (for Overnutrition/Obesity): For malnutrition due to overnutrition, guide patients on healthy weight loss strategies.
- Dietary Modifications: Reduce intake of sugary drinks, processed foods, and unhealthy fats. Increase intake of fruits, vegetables, whole grains, and lean protein.
- Exercise Regimen: Encourage regular physical activity, aiming for at least 150 minutes of moderate-intensity exercise per week.
- Behavioral Therapy: Address emotional eating and develop healthy coping mechanisms.
- Medications or Procedures: In some cases, medications or bariatric surgery may be considered under medical supervision.
8. Promote Patient Adherence: Long-term support is crucial for maintaining nutritional improvements.
- Counseling and Behavioral Therapy: Address underlying psychological or behavioral factors contributing to malnutrition.
- Support Groups: Connect patients with support groups for eating disorders, obesity, or chronic diseases.
- Nutrition Education: Provide ongoing education on healthy eating habits and meal planning.
9. Enteral or Parenteral Nutrition: For moderate to severe malnutrition or when oral intake is insufficient or contraindicated, consider enteral or parenteral nutrition.
- Enteral Nutrition (Tube Feeding): Preferred if the gut is functional. Nasogastric, nasojejunal, gastrostomy, or jejunostomy tubes may be used.
- Parenteral Nutrition (IV Feeding): Used when enteral nutrition is not possible. Administered intravenously, bypassing the digestive system.
10. Monitor Progress: Regularly assess and document the patient’s progress.
- Weight and Growth Monitoring: Track weight, height (length in infants), and BMI regularly. In failure to thrive, meticulous growth charting is essential.
- Dietary Intake Monitoring: Food diaries, calorie counts, and dietitian consultations to assess dietary intake.
- Laboratory Monitoring: Repeat blood tests to assess improvement in nutrient status and electrolyte balance.
11. Dietitian Consultation: Refer patients to a registered dietitian for individualized dietary counseling and meal planning. Dietitians are experts in nutritional assessment and intervention. In failure to thrive, a dietitian is a critical member of the team.
12. Monitor for Complications: Be vigilant for potential complications of malnutrition and refeeding.
- Hospitalization: Severe malnutrition may require hospitalization for close monitoring and intensive nutritional support.
- Abuse and Neglect Assessment: In children, older adults, and cognitively impaired individuals with malnutrition, assess for potential neglect or abuse.
13. Appetite Stimulants: In certain situations, appetite stimulants may be used under medical supervision.
- Megestrol Acetate: May be used to stimulate appetite in patients with cancer-related anorexia, cachexia, or AIDS-related wasting syndrome.
Preventing Malnutrition: Proactive Strategies
1. Financial and Community Resources: Address food insecurity by connecting at-risk families with resources.
- WIC (Women, Infants, and Children): Provides nutritional support for pregnant women, infants, and children up to age 5.
- SNAP (Supplemental Nutrition Assistance Program): Provides food assistance to low-income individuals and families.
- Food Banks and Pantries: Offer emergency food assistance.
- Community Meal Programs: Provide meals for seniors and individuals with disabilities.
2. Patient-Centered Meal Planning: Involve patients in creating meal plans to enhance adherence and dietary education.
- Collaborative Meal Planning: Work with patients to develop realistic and culturally appropriate meal plans based on their preferences and needs.
- Nutrition Education: Provide education on balanced diets, portion control, and healthy food choices.
3. Malnutrition Prevention in Pregnancy: Ensure adequate nutrition during pregnancy to support both maternal and fetal health.
- Prenatal Nutrition Counseling: Educate pregnant women about increased caloric and nutrient needs.
- Folic Acid Supplementation: Essential to prevent neural tube defects.
- Weight Gain Monitoring: Monitor weight gain during pregnancy according to guidelines.
Nursing Care Plans: Addressing Specific Needs
Nursing care plans are essential tools for organizing and prioritizing care for patients with malnutrition and failure to thrive. They guide assessments and interventions, ensuring both short-term and long-term goals are addressed. Several nursing diagnoses are commonly associated with malnutrition, including:
Deficient Knowledge (Nutrition)
Nursing Diagnosis: Deficient Knowledge related to nutrition, evidenced by inadequate follow-through of instructions and insufficient adherence to dietary recommendations.
Related to:
- Incomplete or unreliable information about nutrition.
- Inadequate access to resources.
- Lack of interest or motivation.
- Misinformation about diets.
As evidenced by:
- Inadequate follow-through of instructions.
- Insufficient adherence to dietary recommendations.
- Frequent requests for information about new diets.
- Development of preventable disorders.
Expected Outcomes:
- Patient will verbalize two dietary changes to support proper nutrition.
- Patient will set a personal dietary goal and effectively formulate a plan to achieve it.
Nursing Interventions:
- Assess Patient’s Understanding: Determine the patient’s current knowledge and perception of nutritional needs.
- Assess Health Literacy: Evaluate the patient’s ability to understand and apply health information related to nutrition.
- Provide Vitamin and Mineral Information: Educate on the importance of vitamins and minerals and food sources.
- Develop Overeating Prevention Plan: Help patients identify situations leading to poor food choices and plan strategies.
- Promote Community Resources: Connect patients with cooking classes, support groups, and health clinics.
- Encourage Follow-Up Care: Emphasize the importance of ongoing nutritional guidance and monitoring.
Disturbed Body Image
Nursing Diagnosis: Disturbed Body Image related to malnutrition, evidenced by negative verbal responses about body and preoccupation with appearance.
Related to:
- Change in appearance (weight loss or gain).
- Cultural and social media influences.
- Eating disorders.
As evidenced by:
- Verbal or nonverbal negative responses about the body (shame, guilt).
- Hiding the body.
- Preoccupation with appearance.
- Negative feelings about the body (helplessness, hopelessness).
- Avoidance of social situations.
Expected Outcomes:
- Patient will implement two strategies to maintain a healthy weight.
- Patient will identify irrational beliefs about body appearance and weight.
- Patient will demonstrate social involvement.
Nursing Interventions:
- Assess Eating Disorder History: Inquire about past or present eating disorders (anorexia, bulimia, body dysmorphic disorder).
- Assess Verbal Remarks about Weight: Be alert to negative self-talk and body dissatisfaction.
- Refer to Mental Health Professional: Recommend counseling for eating disorders and body image issues.
- Demonstrate Positive Self-Talk: Offer positive reinforcement and encouragement.
- Promote Social Interaction: Encourage engagement with friends, family, and group activities.
- Assist with Healthy Weight Gain (if needed): Support patients in achieving healthy weight gain in a safe and structured manner, especially those with eating disorders.
Fatigue
Nursing Diagnosis: Fatigue related to malnutrition, evidenced by expressed lack of energy and difficulty maintaining physical activity.
Related to:
- Reduced metabolic energy production.
- Malnutrition.
- Physical deconditioning.
As evidenced by:
- Expresses extreme lack of energy.
- Difficulty maintaining usual physical activity.
- Expresses tiredness or weakness.
- Reduced concentration.
- Lethargy or sluggishness.
- Increased need to rest.
- Inability to perform desired activities.
Expected Outcomes:
- Patient will identify factors contributing to fatigue.
- Patient will verbalize improved energy levels.
- Patient will be able to complete tasks and participate in hobbies.
Nursing Interventions:
- Assess Fatigue Description: Quantify fatigue level using a scale (e.g., 1-10).
- Assess Compounding Causes: Investigate other factors contributing to fatigue (anemia, depression, chronic illness).
- Determine Nutritional Intake: Review dietary intake to identify calorie and nutrient deficits.
- Establish Realistic Goals: Set achievable activity goals, considering fatigue levels.
- Include Family in Care: Engage family support to promote lifestyle changes.
- Encourage Easy-to-Prepare Foods: Recommend nutrient-dense, convenient food options.
Imbalanced Nutrition: Less Than Body Requirements
Nursing Diagnosis: Imbalanced Nutrition: Less Than Body Requirements related to inadequate intake, evidenced by electrolyte imbalances and weight loss.
Related to:
- Disease processes.
- Altered taste perception.
- Food aversion.
- Inadequate food supply.
- Difficulty swallowing or chewing.
- Depression.
- Inability to absorb nutrients.
As evidenced by:
- Electrolyte imbalances.
- Ineffective wound healing.
- Decreased serum protein levels (albumin, prealbumin).
- Loss of muscle tone.
- Hypoglycemia.
- Pale mucous membranes.
- Dry skin and hair loss.
- Diarrhea or constipation.
- Food intake less than recommended daily allowance.
- Body weight below ideal range.
Expected Outcomes:
- Patient will maintain a healthy weight for age and gender.
- Patient will demonstrate adequate nutrition (normal electrolytes, protein levels).
Nursing Interventions:
- Assess BMI: Calculate and monitor BMI.
- Assess Laboratory Results: Monitor electrolytes, serum proteins, and other nutritional markers.
- Assess Physical Signs: Observe for signs of malnutrition (pallor, dry skin, muscle wasting).
- Assess Nutritional History: Obtain a detailed dietary history and assess eating habits.
- Treat Underlying Conditions: Manage underlying medical conditions affecting nutrition.
- Administer Parenteral Nutrition (if needed): Provide parenteral or enteral nutrition as indicated.
- Determine Food Availability: Assess access to food resources and address food insecurity.
- Consult with Dietitian: Refer to a dietitian for dietary recommendations and meal planning.
- Supplement Diets: Recommend nutritional supplements or meal replacements.
Overweight
Nursing Diagnosis: Overweight related to excessive intake and sedentary lifestyle, evidenced by BMI > 25 and weight 10% over ideal.
Related to:
- Excessive consumption of sugary foods and beverages.
- Excessive food intake.
- Disturbed eating patterns.
- Sedentary lifestyle.
As evidenced by:
- Weight 10% over ideal for height and frame.
- BMI 25 kg/m2 to 29.9 kg/m2.
- Increased triceps skinfold thickness.
Expected Outcomes:
- Patient will achieve a BMI of 18.5 to 24.9.
- Patient will demonstrate healthy food choices and portion control.
- Patient will demonstrate increased physical activity.
Nursing Interventions:
- Assess BMI: Calculate and monitor BMI.
- Assess Weight History: Inquire about past weight fluctuations and eating disorders.
- Inquire About Food Choices: Assess dietary patterns and understanding of healthy eating.
- Teach Food Logging and Calorie Intake: Instruct on keeping food diaries and tracking calorie intake.
- Encourage Physical Activity: Promote regular exercise (at least 150 minutes/week).
- Instruct on Food Labels and Portion Control: Educate on reading food labels and practicing portion control.
- Utilize Motivational Interviewing: Use motivational interviewing techniques to enhance behavior change.
By implementing these nursing diagnoses and tailored interventions, nurses play a vital role in addressing malnutrition and failure to thrive, promoting optimal nutrition and health outcomes across the lifespan.
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