Nursing Diagnosis for a PT with Malnutrition

[Daytonite, BSN, RN]

Nanda has no official nursing diagnosis called "muscle weakness". So, if this is a nursing diagnosis your nursing program approves, you would have to look at it's definition and symptoms to see if they can be related to malnutrition.

However with malnutrition, muscle weakness is a symptom of it, so it would seem to me, to be incorrect to give a symptom its own nursing diagnosis.

With ineffective breathing pattern, the decreased energy is often due to the expended effort required to maintain their breathing. The patients with this diagnosis are often experiencing dyspnea and the effort to keep their breath is what fatigues them along with the oxygen expenditure.

As for the risk for constipation, I think that a more appropriate related factor would be insufficient fiber intake as opposed to nutrient intake. Patients can be on low fiber diets or even tpn, still get adequate nutrient intake and be constipated.

Keep in mind that when you are looking for nursing diagnoses, you are matching patient symptoms with the defining characteristics for each nursing diagnosis. Malnutrition is due to a lack of the required food, inability of the body to absorb and distribute the food substances ingested, deficient diet or deficient breakdown, assimilation or utilization of food. The symptoms of malnourishment can be any of the following and in any degree depending on the seriousness of the malnutrition:

• dull, dry thin, fine, straight, easily plucked hair
• hair loss
• areas of light or dark spots of hair
• generalized swelling of the face
• dark areas on the cheeks and under the eyes
• lumpy or flaky skin around the nose and mouth
• enlarged parotid glands
• their eyes have a dull appearance
• eye membranes are either pale or reddened
• there may be triangular, shiny gray spots on the conjunctivae
• the corners of the eyelids are red with fissures
• there will be a bloodshot ring around the cornea
• fatigue of visual accommodation
• lips will be red and swollen, especially at the corners (cheilosis)
• the tongue will be swollen, purple and raw-looking
• there may be sores on the tongue
• thrush
• may be missing teeth
• gums will be spongy and bleeding
• teeth will be in general disrepair
• swollen thyroid gland
• pallor
• dry, flaky skin
• rough skin (toad skin)
• poor skin turgor
• wrinkling of the skin on light stroking
• thickening and pigmentation of skin over bony prominences
• lack of subcutaneous fat
• spoon-shaped, brittle, ridged fingernails
• muscle wasting
• poor muscle tone
• swollen joints
• bumps on ribs
• musculoskeletal hemorrhages
• tachycardia (heart rate above 100 beats/minute)
• arrhythmias
• elevated b/p
• enlarged liver and spleen
• amenorrhea
• irritability
• confusion
• paresthesias in hands and feet
• decreased ankle and knee reflexes
• inability to maintain posture or just bad posture
• changes in equilibrium, especially with movement
• anemia

You are likely to see malnutrition states in patients with HIV, hypothyroidism, pernicious anemia, cancer (especially where they are on chemotherapy or radiation therapy), any number of GI diseases (cirrhosis, crohn's, gastritis, hepatitis) alcoholism, hard core drug addiction and just plain old starvation for any reason.

You base your nursing diagnosis on the underlying cause of the symptoms. So, if your patient is malnourished, you must think about why they are malnourished and what is the absolute underlying cause for this condition. In many cases, these become your r/t (related factors) on your nursing diagnosis:

• not eating enough of the right food
• pathophysiological body processes inhibiting the digestion and absorption of the food ingested
• (ex: imbalanced nutrition: less than body requirements r/t insufficient food intake [or others could be: loss of appetite or inability of body to absorb nutrients because of biological factors or unwillingness to eat or increased metabolic needs caused by disease process ] aeb muscle weakness and decreased energy)

The problem with helping you with a nursing diagnosis is that malnutrition is a medical diagnosis that can have a lot of symptoms as well as causes, none of which you have given except for the muscle weakness.

I suspect the patient also has breathing problems since you bring that up with a diagnosis related to it, and constipation which may or may not be related to the malnutrition. You need to take a good look at your patient's symptoms. See if any match the list I've given you and then re-examine possible nursing diagnoses.

Possible ones to use (and this list is by no means comprehensive):

• imbalanced nutrition: less than body requirements r/t insufficient food intake aeb muscle weakness and decreased energy
• deficient fluid volume
• adult failure to thrive
• ineffective therapeutic regimen management
• ineffective protection
• impaired skin integrity
• fatigue
• activity intolerance
• disturbed sensory perception
• risk for infection
• risk for falls
• risk for injury

[burn out]

Alteration in nutrition is an acceptable nursing diagnosis but related to what? Why is the patient malnourished?

Is constipation really a concern if the patient isn't eating?

How about alterations in activity r/t generalized weakness

Alterations in fluid and electrolyte balance related to poor dietary intake.