Nursing diagnosis inadequate nutrition

[laurelwoods94]

Hi, i'm a second year student nurse. Part of my assignment this week is to create a nursing diagnosis for my pt. They were at end of life, however still ACP-R, so the hospital is still doing everything they can to get him better.

I made my diagnosis Inadequate Nutrition:Less than Body Requirements because that is his presenting problem. I've made my goal, and criteria however I'm having a hard time trying to find applicable interventions with Rationale. The reason being that the interventions had to be things that we did ON OUR CLINICAL SHIFT. I know what I did, but the problem is that many of the interventions were for pt's without the use of an enteral feed. Interventions would be like,

- "provide a relaxing environment" or "have 6 small meals instead of three"

I know the interventions I provided throughout the day, however I cannot find rationales that I will be able to cite. Here are the interventions I instilled:

• L.W. consulted with Doctor in concerns to low PO4 balance on lab work (Critical Thinking) - R- it is important to monitor and supplement as needed oral, enteral or IV potassium, magnesium and phosphate intake - medscape
  
• L.W. consulted with P/T in order in terms of increasing ROM to decrease risk of pressure ulcers (Communication with Staff)
  
• (Accountability and Responsiblity)
  
• L.W. ensured V.K's HOB was always elevated at least 30degress. (Ethical Practise) R- aided in preventing another bout of aspiration penumonia
  
• L.W. anticipated V.K.'s needs and payed attention to his nonverbal communication. R- (Therapeutic Communication)
  
• L.W. provided a complete GI assessment (BS, abdominal tenderness, etc.) during the clinical day. R- reduced or hypoactive bowel sounds may be a sign of reduced gastric motility and constipation d/t low fluid intake poor food choices, reduced activity & hypoxemia. (Provision of Care)
  
  as you can see, some of them i was able to find rationale, but i cannot find legitimate sources for the other rationales. I use a textbook as well, but the textbook was of little help as the interventions were not relevant.
  
  Any help would be so so much appreciated!
  

[Wave Watcher]

Did you give nausea meds or pain meds? If so, that can help with appetite. No one wants to eat while nauseated or in pain. Also, positioning patient where comfortable to eat and maybe even sitting with patient while he/she eats may help encourage eating. All these things you may have done on shift.