Alteration in Nurtition: More Than Body Requirements

Alteration
in Nurtition: More Than Body Requirements

(_)Actual (_)
Potential

Related
To:
[Check
those that apply]
(_)
Altered satiety patterns
(_) Medications (steroids)
(_) Lack of knowledge

(_) Decreased activity
(_) Decreased metabolic needs
(_) Other:_____________________________
____________________________________
____________________________________

 

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

(Must be
present
)

(_)
Overweight (weigh 10% to 20% over ideal for height and
frame.
(_) Obese (weigh over 20% of ideal).
Minor:

(May be
present
)

(_)
Reported undesirable eating patterns.
(_) Intake in excess of metabolic requirements.
(_) Sedentary activity patterns.

 

Date &
Sign.
Plan and Outcome
[Check
those that apply]
Target
Date:
Nursing Interventions
[Check
those that apply]
Date

Achieved:

  The
patient will:

(_)
Decrease total calories ingested.

(_) Increase activity
level.

(_) Loose weight:

(_____ pounds by discharge).

(_) Other:

  (_)
Assess and document patient’s dietary history, patterns
of ingestion, activity patterns.

(_) Discuss with patient potential
causative factors for weight gain.

(_) Assess motivation
to correct overweight.

(_) Consult with
dietician regarding balanced plan for weight loss.
Reinforce teaching. Discuss realistic weight loss of not
more than 2 pounds per week.

(_) Provide positive
reinforcement for weight loss.

(_) Record intake.

(_) Weigh q ___ days
at ____ am/pm.

(_)
Other:________________
________________________

________________________
________________________

 

 

__________________________
Patient/Significant other signature

 

__________________________
RN signature