Balanced nutrition is vital to an individual’s health and well-being. Imbalanced nutrition refers to either nutrition that is more than or less than the body’s requirements and metabolic needs. It can occur with any individual. Listed below is a brief list of potential causes that may result in an individual experiencing an imbalance in their nutrition status.
In this article:
- Causes (Related to)
- Complications
- Expected Outcomes
- Nursing Assessment
- Nursing Interventions
- Nursing Care Plans
- References
Causes (Related to)
The following are common causes of imbalanced nutrition:
- Age-related changes in taste, smell, or appetite
- Other illness (i.e. cancer, burns)
- Difficulty chewing or swallowing
- Dementia
- Medications
- Economically disadvantaged
- Limited access to food
- Depression
- Alcoholism
Complications
Imbalanced nutrition can increase an individual’s risk for other problems as well such as:
- Weaker immune system
- Poor wound healing
- Muscle weakness and decreased bone mass
- Higher rates of hospitalization
Expected Outcomes
The following are the common nursing care planning goals and expected outcomes for imbalanced nutrition:
- Patient will maintain weight in desired goal range.
- Patient will recognize factors that are contributing to being under or overweight.
- Patient will identify appropriate nutritional needs/requirements.
- Patient will consume adequate nutrition.
- Patient will verbalize appropriate management of nutrition at home.
Nursing Assessment
The first step of nursing care is the nursing assessment, during which the nurse will gather physical, psychosocial, emotional, and diagnostic data. In the following section, we will cover subjective and objective data related to imbalanced nutrition.
1. Complete a thorough nutrition screening.
This will allow the nurse to understand where the patient’s present nutritional status is and assess needs.
2. Assess the patient’s lab values.
Certain laboratory values may be abnormal when a patient is suffering from imbalanced nutrition (i.e. albumin and prealbumin can be indicators of the inflammatory response). This may also help to identify the underlying cause of the imbalanced nutrition.
3. Assess the patient’s mobility status.
Patients may become weak and unable to complete their regular activities if not taking in the appropriate nutrition. Additional collaboration with other disciplines (i.e. PT and OT) may be necessary.
4. Assess the reason for imbalanced nutrition (i.e. other medical or environmental conditions).
Possible reasons for imbalanced nutrition can be extensive. Identifying the potential cause can further assist with overcoming that challenge and treating the appropriate underlying condition. (i.e. difficulty chewing or swallowing may warrant a referral to speech therapy).
5. Weigh patient routinely (for acute care – weigh daily; long-term care – weigh weekly or monthly as appropriate).
Weighing patients routinely will allow the healthcare team to have objective data to trend and monitor the patient’s progress.
6. Assess the patient’s overall safety.
Imbalanced nutrition can decrease the patient’s strength and overall safety. If a patient displays signs of weakness, collaboration with other disciplines may be necessary to improve strength and endurance. In addition, assistive devices may need to be utilized.
7. Repeat nutrition screenings regularly if a patient’s imbalanced nutrition is due to an acute cause.
For example, if a patient’s nutrition is imbalanced due to stroke or burns their nutritional needs can change frequently. Ensuring the patient is reassessed frequently will allow for an individualized plan to be made depending on where the patient is in the recovery phase.
8. Assess oral care/hygiene.
Good oral care can enhance an individual’s appetite.
9. Assess the need of assistance devices to aid in feeding.
Patients with disabilities affecting motor function may need specialized eating utensils in order to successfully eat and feed oneself, provide these as appropriate.
Nursing Interventions
Nursing interventions and care are essential for the patients recovery. In the following section, you’ll learn more about possible nursing interventions for a patient with imbalanced nutrition.
1. Discuss with MD the potential need for referral to a dietitian.
Utilizing appropriate resources is a vital part of being a nurse. The dietitian will be able to appropriately assess the patient and individualize the patient’s plan of care regarding nutrition.
2. Provide nutritional supplements as appropriate or ordered.
Nutritional supplements may be prescribed as necessary by the MD or dietician. The RN should ensure the patient is receiving and taking these supplements to further strengthen the body.
3. Educate the patient on the body’s nutritional needs.
This will allow the patient to gain knowledge in the area of how to independently care for oneself upon discharge.
4. Provide the patient with resources regarding nutrition.
The patient will be able to take these resources home upon discharge and will further help in the patient being independent in their care.
5. If underweight, provide the patient with additional snacks in between meals.
Patients may not be able to meet all the body’s requirements during regular meal times. Providing snacks in between meals can be another way to meet the body’s extra nutritional needs.
6. Provide good oral hygiene.
Good oral hygiene can increase an individual’s appetite. The oral mucosa is also a vital part of salvia production which will further aid in the digestion of food.
7. Administer antiemetics as needed before meals.
Other underlying medical conditions may cause nausea limiting the patient’s intake of food. Providing appropriate antiemetics will allow for the patient’s appetite to potentially increase and tolerate intake better.
8. Administer enteral feedings as ordered.
In a more critical care setting enteral feedings may be necessary, ensure these are administered as ordered to meet the body’s needs.
9. Initiate a referral to a social worker or case manager
If the patient does not have sufficient resources to afford sufficient healthy food, consider a referral to a social worker or case manager.
Nursing Care Plans
Nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for imbalanced nutrition.
Care Plan #1
Diagnostics statement:
Imbalanced nutrition related to wired jaw secondary to fracture as evidenced by weight >10% below ideal.
Expected outcomes:
- Patient will progressively gain 1 pound per week.
- Patient will consume adequate nourishment through vegetables, fruits, and protein sources.
Assessment:
1. Monitor weight.
Weight is the primary indicator to evaluate the patient’s nutritional status improvement.
2. Assess the ability to chew.
The wires installed in the patient’s jaw may impede their ability to chew food. Assessing the degree of difficulty will help the nurse plan the level of assistance. Food often needs to be blenderized.
3. Evaluate ability to feed self.
Additional interfering factors, such as injuries to hands or arms, may require multiple providers’ and therapists’ input to develop individualized care plans.
Interventions:
1. Ensure a pleasant environment, facilitate proper positioning, and provide good oral hygiene.
Patients are more likely to eat in a setting without unpleasant odors and noisy distractions. Oral hygiene before meals has a positive effect on appetite and the taste of food. Elevating the head of the bed at least 30 degrees to aid in swallowing and reduces the risk of aspiration while eating.
2. Provide dietary, environmental, and behavioral modifications such as:
- Mechanical soft or blenderized tube feedings
- High-calorie, nutrient-rich nutritional supplements, such as meal-replacement shake
- Appetite stimulants, if indicated.
- Encourage the patient to choose foods or have family members bring appealing foods to stimulate appetite.
These modifications help to optimize the intake of calories and macronutrients within needs.
3. Consider soft prepared foods.
Blenderized foods may be unpleasant, but baby foods, drinkable yogurts, puddings, and miso soup with tofu may be more appealing.
4. Refer to an occupational therapist for adaptive devices.
Occupational therapists can offer devices that can help patients feed themselves.
5. Discuss the possible need for enteral or parenteral nutritional support.
If the patient cannot take foods through the oral route, other means of nutritional support may be indicated. Patients with a healthy gastrointestinal tract should receive nutrition through an enteral tube. Patients who cannot tolerate enteral feedings may need parenteral nutrition. Enteral and parenteral feeding formulations can be adjusted to include macro and micronutrients. These feedings can be used at home, in long-term care facilities, and in subacute care settings.
Care Plan #2
Diagnostics statement:
Imbalanced nutrition related to anorexia nervosa, as evidenced by muscle weakness and decreased serum albumin.
Expected outcomes:
- Patient will attain a normal BMI of 18.5 to 24.9.
- Patient will report decreased muscle weakness and improved energy levels.
- Patient will have serum albumin levels within the normal range of 3.4 to 5.4 g/dL.
Assessments:
1. Obtain comprehensive nutritional history.
A comprehensive nutritional history should not only include diet recalls but also eating patterns and dietary habits to assess the precipitating factors for anorexia further.
2. Assess the patient’s attitudes and beliefs towards eating and food.
Many psychological, psychosocial, religious, and cultural factors determine the type, amount, and appropriateness of food consumed.
3. Limit the use of scales.
Patients with anorexia nervosa may feel afraid or uncomfortable when they see they number on the scale, especially when the finding shows an increase in weight. Other methods like laboratory values and calorie intake are more appropriate approaches to evaluate nutritional status.
4. Monitor laboratory values.
Various laboratory tests may be used to monitor the patient’s nutritional status. Serum Albumin indicates the degree of protein depletion. Transferrin is a plasma protein for iron transfer and typically decreases as serum protein decreases. Anemia and leukopenia occur in malnutrition, leading to weakness, and are usually reduced in malnutrition. Potassium is typically increased, and sodium is generally decreased in malnutrition.
Interventions:
1. Offer high-calorie drinks and snacks often.
Higher-calorie diets lead to faster weight gain in hospitalized patients.
2. Make a selective menu and allow the patient to choose meals as much as possible.
A patient who gains self-confidence and feels in control of the environment is more likely to eat preferred foods.
3. Establish a strict eating schedule.
Patients with anorexia nervosa often skip meals or fast. A rigid eating schedule with a snack or meal every 3 hours will help in optimizing eating patterns and acquire needed nutrients to gain weight and improve health.
4. Encourage fluids and fiber.
Patients with anorexia nervosa oftens struggle with constipation. Adequate fluid and fiber intake of 25 to 28 grams per day will improve bowel movement.
5. Collaborate with a dietitian trained in managing patients with eating disorders.
Managing patients with eating disorders require complex interventions with the help of a dietitian who had an advanced training in these cases. Aside from the formulation of an appropriate meal plan, they know helpful psychosocial approaches to help the patient develop better eating patterns.
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.
- Mayo Clinic. (2019). Senior health: how to prevent and detect malnutrition. https://www.mayoclinic.org/healthy-lifestyle/caregivers/in-depth/senior-health/art-20044699
