nursing diagnosis for a pt with malnutrition

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    Hi, i have another question (SORRY) are these nursing diagonosis r/t to malnutrition??? or if not can u guys tell me better one please!

    Muscle weakness r/t to insufficient nutritional intake
    Risk for ineffective breathing pattern r/t to decreased energy
    Risk for constipation r/t insufficient nutrient intake
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  4. 6 Comments so far...

  5. 0
    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.
    Last edit by burn out on Feb 28, '07
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    :P)______
    Last edit by futgirl on Feb 28, '07
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    Why just a two part? My first semester in nursing school, my instructors said OVER and OVER, "You have to write a THREE part nursing diagnois, don't think you can do a bunch of 'risk for' ones!"
  8. 0
    How about:
    Imbalanced Nutrition: Less than Body Requirements r/t caloric intake does not meet activity levels.

    p.s. for a 3 part diagnosis you can add: as evidenced by... (subjective and objective data)
    Last edit by mixyRN on Feb 28, '07
  9. 0
    When I was in nursing school we all had a nursing diagnosis handbook, and our instructors prefered for us to refer to it for this unpleasant task. It really made life easier.
  10. 0
    first off, 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, from what i know about malnutrition, muscle weakness is a symptom of it, so it would seem to me, to be incorrect to give a symptom it's 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 shopping 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
    • bowledggedness
    • 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 aids, 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:
    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. and 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


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