00002 Imbalanced nutrition: Lower Than Body Needs

Domain 2: nutrition
Class 1: ingestion
Diagnostic Code: 00002
Nanda label: Nutritional imbalance: lower than body needs
Diagnostic focus: nutritional balance
Approved 1975 • Revised 2000, 2017, 2020 • Level of evidence 2.1

NANDA Nursing Diagnosis Definition

Nanda nursing diagnosis « Nutritional imbalance: lower than bodily needs »  is defined as: consumption of insufficient nutrients to meet metabolic needs.

Definite characteristics

  • Abdominal colic
  • Abdominal pain
  • Body weight below the ideal weight of weight according to age and sex
  • Capillary fragility
  • Constipation
  • Delay in wound healing
  • Diarrhea
  • Excessive hair fall
  • Ingest lower than the recommended daily quantities (CDR)
  • Hyperactive intestinal noises
  • Hypoglycemia
  • Inadequate cephalic circumference growth for age and sex
  • Increase in inappropriate height for age and sex
  • lethargy
  • Muscle hypotonia
  • Weight increase <30 g per day
  • Palencia de Muchosas
  • Weight loss with adequate nutrient consumption

Related factors

  • Alteration of the perception of taste
  • Depressive symptoms
  • Difficulty in swallowing
  • Aversion towards food
  • Incorrect information
  • Inappropriate nutritional contribution
  • Inappropriate interest in food
  • Inappropriate knowledge of nutritional requirements
  • Injured oral cavity
  • Insufficient breast milk production
  • breastfeeding of breastfeeding
  • erroneous perception about the ability to eat food
  • Immediate satiety with food intake
  • Irritated oral cavity
  • Weakness of the necessary muscles for swallowing
  • Weakness of the necessary muscles for chewing

Risk population

  • Competition athletes
  • Displaced people
  • People at economic disadvantage
  • People with low educational level
  • Premature infants

Associated problems

  • Dymorphic body disorders
  • Digestive system diseases
  • Immunosuppression
  • Kwashiorkor
  • Malabsorption syndromes
  • Mental disorders
  • Neoplasms
  • Neurocognitive disorder
  • Parasitological disorders

Suggestions of use

  • This label should be used for patients who are able to eat but who cannot ingest, digest or absorb nutrients to adequately meet their metabolic needs. Inadequate intake can occur by a decrease in appetite, nausea or poverty, among many other situations. Some examples of patients who are not able to digest food or absorb private nutrients are those suffering from allergies, diarrhea, lactose intolerance, or who have teeth fixing problems.
  • This label should not be used routinely for people with
  • NPO (nothing oral) or that they are totally unable to eat food for other reasons (for example, unconscious patients). The nursing professional cannot prescribe independent nursing interventions for diagnoses such as nutritional imbalance: lower intake to NPO needs. They cannot supply nutrients that are missing and cannot alter the NPO order. In addition, patients usually have an NPO order for a short period before and after surgery; Therefore, any lack of nutrients will be temporary and will be resolved without the need for the intervention of the nursing professional. A long -term NPO is a risk factor for other nursing diagnoses, such as deterioration of the oral mucosa, as well as for collaboration problems, as a possible complication by the imbalance of electrolytes.
  • It is possible that the patient presents a total nutrient deficit or only has the deficiency of a nutrient. When the deficit is not total, it should be specified as in the following example: Nutritional imbalance: Protein intake lower than needs, related to the lack of knowledge about nutritional foods and a limited food budget.

Suggested alternative diagnostics

NOC Results

  • APETIT: I WISHE TO EAT A SICK PATIENT OR WHO RECEIVES TREATMENT
  • Compliance behavior: prescribed diet: Personal actions to ingest food and liquids recommended by a health professional for a specific health condition
  • Behavior to gain weight: personal actions to gain weight after a significant weight loss voluntarily or involuntary
  • Nutritional status: degree in which nutrients are available to meet metabolic needs
  • Nutritional status: biochemical indicators: components of body fluids and chemical indexes of the nutritional status
  • Nutritional status: Nutrient intake: Nutrient ingested to meet metabolic needs
  • Gastrointestinal function: process in which food (ingested or administered by probe) goes from ingestion to excretion
  • Weight: Body mass: Degree in which weight, muscles and body fat are suitable for height, complexion, gender and age

Evaluation objectives and criteria

  • Demonstrates nutritional status, as manifested by the following indicators (specify from 1 to 5: severe, substantial, moderate, mild or without deviation from normal limits):
    • Nutrient intake
    • Food intake
    • Liquid intake
    • Energy

Other examples

The patient will be able to:

  • Maintain a weight of __ kg or increase____ kg for ________ (specify date)
  • Describe the components of an adequate nutritionally diet
  • Express verbally willing to follow the diet
  • Tolerate the prescribed diet
  • Maintain mass and body weight within normal limits
  • Have laboratory results (for example, transferrin, albumin and electrolytes) within normal limits (WNL)
  • Report adequate energy levels

NIC Interventions

  • Support in self -care: food: assistance to a person to eat
  • Support to gain weight: facilitation of body weight gain
  • Breastfeeding advice: use of an interactive support process to help maintain a successful breastfeeding
  • Nutrition advice: use of an interactive help process, focused on the need to modify the diet
  • Help in breastfeeding: preparation of a mother to breastfeed her baby
  • Teaching: prescribed diet: prepare a patient to correctly follow the prescribed diet
  • Laboratory data interpretation: Critical analysis of patient laboratory data to help make medical decisions
  • Diarrhea management: control and relief of diarrhea
  • Nutrition management: help or provide a balanced diet in food and liquids
  • Liquid management: favoring water balance and prevention of complications resulting from abnormal or undesirable water concentrations
  • Management of liquids and electrolytes: regulation and prevention of complications derived from the alteration of water and electrolytic concentrations
  • Management of eating disorders: prevention and treatment of serious diet restrictions and excessive exercise, or binge and fluid purges
  • Weight management: facilitation of maintenance of body weight and an optimal body fat percentage
  • Nutritional therapy: Food and liquid administration in support of the metabolic processes of a malnourished patient or at high risk of malnutrition
  • Nutrition surveillance: Patient data collection and analysis to prevent or reduce malnutrition

Nursing Activities

  • General activities for all cases of nutritional imbalance

Valuations

  • Determine the patient’s motivation to change eating habits
  • Determine the patient’s ability to meet their nutritional needs
  • Monitor laboratory results, especially transferrin, albumin and electrolytes
  • (NIC) Nutrition Management
    • Establish the patient’s food preferences
    • Monitor the calories and nutritional content of the registered intake
    • Weigh the patient at regular intervals

Patient and family education

  • Teach the patient a method to plan meals
  • Instruct the patient and relatives about nutritional and economic foods
  • (NIC) Nutrition Management: Provide information on nutritional needs and how to meet them

Collaboration activities

  • Consult a nutritionist to establish the protein protein requirements with inadequate protein or loss of protein (patients with nervous anorexia, glomerular disease or peritoneal dialysis)
  • Consult a doctor about the need for appetite stimulant, supplementary foods, tube feeding or total parenteral nutrition to maintain adequate caloric intake
  • Channel a doctor to determine the cause of nutritional alteration
  • Channel to adequate community nutritional programs (for example, food at home, food bank) if the patient cannot acquire or prepare adequate food
  • (NIC) Nutrition management: Determine (in collaboration with the nutritionist, if necessary) the number of calories and the type of nutrients necessary to meet the nutritional requirements (especially in the case of patients with high energy needs, as postoperative patients or burns, trauma, fever, wounds).

Others

  • Design with the patient a meal plan that includes the schedules, the dining room environment, the preferences and rejections of the patient, as well as the temperature of the food
  • Recommend to relatives to take the favorite foods prepared at home to the patient
  • Help the patient write realistic weekly objectives and food intake
  • Encourage the patient to place the feeding and exercise objectives in a visible place and to review them daily
  • Offer the most abundant food at the time of the day when the patient shows a greater appetite
  • Create a pleasant environment for meals (for example, withdraw unpleasant elements and excretions)
  • Avoid invasive procedures before meals
  • feed the patient as required
  • (NIC) Nutrition Management:
    • Offer the patient foods and liquids rich in proteins, calories and nutrients that can be easily consumed, as required
    • Teach the patient to take a food diary, if required
    • Difficulties in chewing and swallowing
    • Also see the nursing activities corresponding to the general activities for all nutritional imbalance, and nursing activities for the diagnosis of swallowing, deterioration of the.

Valuations

  • Value and document the degree of difficulty to chew and swallow

Collaboration activities

  • Request a consultation with an occupational therapist

Others

  • Reassure the patient and provide a relaxed environment during meals
  • Have aspiration probes next to the bed and aspire during meals, as required
  • Place the patient in the semi-Fowler or Fowler high position to facilitate swallowing; Make the patient remain in that position for 30 minutes after meals to avoid bronchaspiration
  • Place food in the mouth zone that is not affected to facilitate swallowing
  • If necessary, use a syringe to feed the patient and facilitate swallowing
  • (NIC) Nutrition Management: Encourage the patient to carry the properly adjusted denture or to receive dental care
    • nausea/vomiting
    • See also the nursing activities corresponding to the general activities of the deterioration of nutrition, as well as nursing activities for the diagnosis of nausea.

Valuations

  • Identify the factors that cause nausea and vomiting
  • Document the color, quantity and frequency of vomiting

Patient and family education

  • Teach the patient to breathe deeply and slowly, as well as voluntarily swallowed to reduce nausea and vomiting

Collaboration activities

  • Administer antiemetics or analgesics before eating, or according to the prescribed program

Others

  • Minimize the factors that may cause nausea and vomiting; Specify the factors
  • Provide fresh and wet cloths to place them on the forehead or in the neck
  • Make oral hygiene before meals
  • Limit the diet to pieces of ice and clear liquids if the symptoms are serious; Continue with the diet, as required
    • Loss of appetite
    • See also nursing activities corresponding to general activities for all patients with nutritional imbalance.

Valuations

  • Identify the factors that could contribute to the loss of patient appetite (medications, emotional problems, etc.)

Others

  • Provide positive feedback to the patient when you manifest an appetite increase
  • Offer food according to the patient’s personal, cultural and religious preferences
  • (NIC) Nutrition management: offer snacks (for example, frequent drinks and fresh fruit or fruit juices), as required
  • Offer a variety of hypercaloric nutritional foods to choose
    • Eating disorders
    • Also see the nursing activities corresponding to the general activities for deterioration of nutrition.

Valuations

  • Monitor the patient to detect behaviors related to weight loss

Collaboration activities

  • Consult the nutritionist to determine the daily caloric intake necessary to achieve the proposed weight
  • Notify the doctor if the patient refuses to eat
  • Work with the doctor, the nutritionist and the patient, to establish object and weight objectives
  • Channel to mental health services

Others

  • Establish a relationship of trust and support with the patient
  • Communicate the expectations of an adequate food and liquid intake, as well as the amount of exercise
  • Limit the patient’s intake to meals and scheduled snacks
  • Accompany the patient to the bathroom after meals or snacks to detect self -induced vomiting
  • Design a specific behavior modification program for patient needs
  • Provide positive reinforcement for weight gain and adoption of adequate feeding behaviors, but without concentrating on food interactions or eating
  • Examine with the patient and their closest people other personal aspects (for example, body image) that affect food behavior
  • Communicate that the patient is responsible for decisions related to food and physical activity
  • Comment on the advantages of healthy food behavior and the consequences of breach

At home

  • above interventions are adequate or can adapt to home care
  • If depression is diagnosed, channel the patient to psychiatric care services at home

Babies and Children

  • Base communication on the child’s development stage
  • Instruct parents and children about the importance of choosing healthy snacks (such as fresh fruits and vegetables, corn pop (sweets, fried potatoes, ice cream, etc.)
  • If possible and is necessary, limit the child’s milk intake to have appetite for other foods; Some children prefer to drink milk almost exclusively
  • Inform parents about nutritional needs during different stages of development
  • Do not allow food to become a reason for the fight between parents and children
  • Motivate the family to turn meals into a pleasant social event
  • Offer small portions and varied foods

Older people

  • Evaluate the cognitive and functional skills that could reduce the patient’s ability to prepare and ingest food (for example, ability to reach the shelves where food is saved, open cans, monitor the fire; state of the denture or teeth)
  • Value if the patient can pay for adequate foods
  • If the patient lives alone, help him find a community center that offers meals for older people at least once a day or at least the delivery of home meals
  • Organize transport to buy food, if necessary
  • Assess protein and energy malnutrition, which is very common among older people
  • Offer hyperproteic supplements, as required; Offer liquid supplements, according to needs
  • Assess depression as a cause of appetite loss
  • Assess the side effects of medications that could cause the lack of appetite