Alteration in Nutrition: Less Than Body Requirements

Alteration
in Nutrition: Less Than Body Requirements

(_)Actual (_)
Potential

Related
To:
[Check
those that apply]
(_)
Dysphagia caused by:_________________
(_) Absorptive disorders
(_) Anorexia

(_) Allergy
(_) Burns
(_) Cancer
(_) Chemotherapy
(_) Chemical dependence
(_) Crash or fad diet

(_) Depression

(_)
Inability to obtain food
(_) Infection
(_) Lack of knowledge of adequate nutrition
(_) Nausea and vomiting

(_) Radiation Therapy
(_) Social isolation
(_) Stress
(_) Trauma
(_) Other:___________________________
__________________________________

__________________________________

 

As
evidenced by:
[Check
those that apply]
Major:

(
Must be
present
)
(_)
Reported inadequate food intake less than recommended
daily allowance with or without weight loss and/or actual
or potential metabolic needs in excess of intake.
Minor:

(
May be
present
)
(_)
Weight 10% to 20% or more below ideal for height and
frame.
(_) Tachycardia on minimal exercise and bradycardia at
rest.
(_) Muscle weakness and tenderness.

(_) Mental irritability or confusion.
(_) Decreased serumm albumin.

 

Date &

Sign.

Plan and Outcome
[Check
those that apply]
Target
Date:
Nursing Interventions
[Check
those that apply]
Date
Achieved:
  The
patient will:

(_)
Experience adeuqate nutrition through oral intake.

(_) Experience an
increase in the amount or type of nutrients ingested.

(_) Gain weight.

(_) Other:

  (_)
Assess and document patient’s dietary history, patters of
ingestion, intolerance to foods.

(_) Assess patient likes and dislikes.
Inform dietary.

(_) Teach techniques
to maintain adequate nutritional intake and stimulate
appetite:

  • administer/instruct
    pt. on good oral hygiene before and after
    feedings
  • maintain pleasant
    environment for patient

(_) Determine proper
denture fit and profice adhesive as necessary.

(_) Increase social
contact with meals by:____________________

_______________________

(_) Plan care so that
unpleasant/painful tests/tx’s don’t take place before
meals.

(_) Medicate pt. for
pain 2 hrs before meals per physician’s orders.

(_) Consult with
dietitian re:

  • calorie count
  • change in food
    consistency
  • spacing meals
  • provision of high
    caloric supplements
  • provision of high
    protein supplementation
  • food
    intolerances/preferences
  • extra fluids on
    tray
  • dietetic
    teaching, food selelction
  • therapeutic diet
    restrictions:
    __________________

(_)Consult with PT/PT
re:

  • strengthening
    exercises
  • prosthetic
    devices
  • swallowing
    disorders

(_) Environmental
support to improve intake:

  • be sure pt. is
    alert and responsive before eating
  • sit upright 60-90
    degrees for 15-20 min. before, during & after
    eating
  • decrease
    distractions
  • demonstrate
    patience by providing specific directions until
    finished
  • assure good mouth
    care

(_) Weigh patient
q______
at _______ a.m./p.m.

(_)
Other:________________
________________________
________________________
________________________

 

 

__________________________
Patient/Significant other signature

 

__________________________
RN signature