Care plan help: Imbalanced Nutrition (Less than body requirements)

Varsityblues · Oct 20, 2017

You really went out of your way just to say that ?

panic36 · Oct 20, 2017

I'm going to recommend that you speak to your instructor because I feel you are missing the bigger picture. I am also a first year nursing student and very new to this, but I feel you need to focus on understanding the PES model for your nurses diagnosis. Also, from what I skimmed your pt's CC was N/V, with your Dx Aspiration Pneumonia. You acknowledged that they are receiving antibiotic therapy which means your pt has an infection. Your pt may be malnourished and underweight, but these are not the reasons why your pt came to the ER. Focus on the N/V being a clinical manifestation of your Dx. Also, for your goal, our instructor requires it to be SMART, and achievable during our shift, your program may be different.

KrCmommy522, BSN, RN · Oct 27, 2017

Like the other posters said the nutrition isn't a priority issue. If your instructor said that nursing diagnosis was fine, then you can go with that and in that case I would say that your goals and interventions are okay. However, I would recommend you go with a more priority diagnosis. Again, like the other posters said this would be the ABCs.

You said in your post that your patient has trouble swallowing - so this could mean a diagnosis for impaired swallowing. Goals could be (1) pt will demonstrate effective swallowing without showing signs of aspiration, and (2) pt will remains freee from aspiration.

Do you have a care plan book? The one I used in school was Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care by Betty J. Ackley and Gail B. Ladwig. This book really has everything in it you would need to make a care plan. The first part dicusses how to use the nursing process and clinical reasoning to come up with nursing diagnoses, related factors, and how to come up with goals and interventions. The next section of the book has a guide to nursing diagnoses, where it has an alphabetical listing of patient symptoms, problems, medical diagnoses, psychosocial diagnoses, and clinical states. If you look up something there, it lists possible nursing diagnoses you can use. The final section of the book is a guide to planning care. You look up the nursing diagnoses there and it defines the nursing diagnosis, gives definining characteristics of the diagnoses, related factors, suggested outcomes, and suggested interventions and patient/family teaching and discharge planning. With this book I never had an issue coming up with diagnoses for my patient.

It jut seems like you are focusing in on the patient's weight loss and not looking at anything else. Again, if your instructor said that diagnosis works, then that is okay of course. However, as you progress in your nursing classes, you are going to be required to look at more priority diagnoses, and not just focus on one particular thing. At my school, we had to come up with actual nursing diagnoses first, then if we had at least 2 of those we could add in any health promotion diagnoses or risk nursing diagnoses. Your diagnosis is important, but not priority. The patient is going to lose weight because he is apparently on his "liquid diet," along with his issue swallowing. The PEG tube poses a risk for infection, the problem with swallowing and the pneumonia pose risk for aspiration. If you look at the ABCs - the risk for aspiration would be priority so you need to come up with diagnoses that are related to the risk for aspiraiton.

Banana nut, BSN, RN, EMT-B · Oct 31, 2017

Hi everyone, I'm doing my very first care plan and I have decided to do it on this 83 year old man. This mans peg tube fell out a few weeks ago and he has been NPO for 17 years. Instead of getting the tube put back in... him and his wife decided to create their own "liquid only diet" by doing this he began to experience nausea and vomiting a short time after which then led to finally going to the ER, there he was diagnosed with Aspirated Pneumonia. Keep in mind he does his own feedings.
Now he is at a nursing home/rehab facility and walks on his own and sometimes with a walker. He is being given IV antibiotics for the pneumomia so that right there needs to be addressed (nurses need to properly care for that line using SASH) ... he does his own tube feedings at 8am, 12pm, 4pm and 8pm The patient does have below normal calcium levels if that helps, he's a 6 foot tall guy but only weighs 112 pounds and has lost a pound each week for the last 6 weeks. So I see that Imbalanced Nutrition could be a possible nursing diagnosis related to losing weight without trying, unable to swallow, and solely relying on the tube feedings for all essential intake of necessary vitamins and minerals to function in every day life. I do understand that his weight loss isn't the priority for this man but it is a concern, a big priority is obviously if he's able to breathe or not because of the water in his lungs, so he should be exercising, and coughing/deep breathing every two hours to help exercise those lungs of his. Exercising those lungs are very important for anyone with pneumonia and should be encouraged to
do so, as well as cough/deep breathe every two hours
Im just kinda lost as far as what "Nursing diagnosis" I should use , breathing is important before anything when it comes to things about his weight loss. Maybe I'm not giving myself enough credit. I've been brainstorming possible goals as well as interventions... but I'm not so sure what to go with, I mean he his at risk for infection due to all of the above circumstances, also risk for pressure ulcers.
An obvious goal might be that "patient gains at least 2 pounds within the next 7 days. Or patient exercises often, cough and deep breathes often, or patient will demonstrate proper way to administer the self feed??? I say this one because maybe the tube came out due to him not remembering the proper way to care for his tubing/ how to administer his feeding , this could be due to his old age (mental status) or possible his hands don't work like they used to before.As I said I'm very new to all this but I'm just needing some guidance on everything I guess; goals; interventions etc. Maybe I can exaggerate the importance of adequate nutritional intake? I mean nutritional intake efficiency is important when it comes to immune responses but there's not much I can do since the doc controls how much of the feeding to give.. I mean I can encourage him to take in all of the ordered feedings as perscribe to receive that full nutritional intake . My care plan has to be an actual diagnosis then I have to have a "related to" statement and then 3 "as evidenced by's" 1 main overall goal, 3 goals and 3 interventions with a rationale for each intervention. Then I have to have a risk diagnosis which is a risk diagnosis followed by a "related to" and then I need a mains goal and 3 goals/interventions/rationales again. I was thinking about "risk for fall" or risk for further infection, I can't use medical
diagnoses in my nursing diagnosis, so I can't just say "Oh Imbalanced Nutrition related to Pneumonia" or "impaired breathing related to pneumonia" it has to have signs/symptoms in there followed by 3 as evidenced by's. I guess I could do "impaired breathing, related to ineffective airway clearance in lungs , as evidenced by..... and then idk lol. A good goal I was also thinking of depending on the diagnosis I select is that "patient will have normal balance of I's & O's , I say this because we don't want them to be constipated but as well as we dont want them dehydrated/diarrhea right? I'm not really sure where or what direction to take all of this. I feel like I have all the pieces of the puzzle but not sure how to start. sorry to make this so long but I really appreciate any advice on all of this. Thanks guys. I'm sorry again . I hope I'm at least kinda going in the right direction ? I'm a first year nursing student and just trying to learn how to prioritize care. Thanks again

I think your definitely on the right track! Here is a list that would apply to your pt. i'm going to list them in in my personal view of priority.

1. ineffective airway clearance

2. impaired gas exchange/Ineffective breathing pattern

3. Risk for infection

4. risk for fall/injury

5. impaired nutrition less than body weight requirement

6.impaired tissue integrity/impaired skin integrity

Those should all be totally acceptable NANDAS for this guy, and the goal as a nursing student is PRIORITIZATION!!! What will kill the pt the fastest, and what issue is keeping them from being transferred to a lower level of care? This should dictate your priorities, plans, goals, assessments, interventions and evaluations.