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

Sour Lemon · Oct 18, 2017

Hi everyone, I'm doing my very first care plan and I have decided to do it on this 83 year old man who has Aspirated Pneumonia and is NPO with a PEG tube in place. My nursing diagnosis is - Imbalanced Nutrition (Less than body requirements) relating to patient losing weight without trying, as evidenced by 1) Patient has lost 5 pounds within the last 6 weeks (6 foot tall man who's weight went from 118 to 113 pounds) 2) Difficulty swallowing and 3) Doesn't handle PEG tube feedings well.
I was just looking for maybe some guidance as to if my plan so far was decent, also maybe some guidance as far as setting goals or possibly changing my "as evidenced by's"
The patient does have below normal calcium levels if that helps.
Im just kinda lost but maybe I'm not giving myself enough credit. I've been brainstorming possible goals as well as interventions
An obvious goal might be that "patient gains at least 2 pounds within the next 7 days. And Maybe I can advise that the Bolus feedings be administered with a liquid form of foods high in calcium and protein to promote health and prevent possible infection? Or maybe add ensure into the feeding tube. 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? Should I reference them to spearhead therapist for help in aiding swallowing functions even though he has aspirated pneumonia ? Or should I reference to a dietician to increase the amount of the feedings? Or possibly more frequent feedings per say maybe like 4 separate smaller feedings a day every 4 hours? I'm sorry to make this so long but I really appreciate any advice on all of this. Thanks guys. I'm sorry again

Is that your only diagnosis? I think there are at least two that are much bigger. And ...why are you calling yourself "Nurse" if you're not one (yet)? Wait until you earn it. :nurse:

Varsityblues · Oct 18, 2017

Still brainstorming so I don't know

CelticGoddess, BSN, RN · Oct 18, 2017

Still brainstorming so I don't know

What is his diagnosis? You need to think about what is more serious. Think about ABC's. Honestly, while nutrition is an issue, at this point and time, it's definitely NOT a priority.

And per TOS you can't use the title nurse unless you are licensed. You can use nurse to be or future but you are NOT a nurse yet

roser13, ASN, RN · Oct 18, 2017

Still brainstorming so I don't know

You don't know if that's your only diagnosis or you don't know why you're using the title of nurse?

Seriously, please change your username. It's against the law to use a licensed title that you have not earned.

Varsityblues · Oct 18, 2017

This is my very first care plan so sorry that I'm not very knowledgeable. Due to his circumstances my instructor told me my nursing diagnosis was fine but I was up to me to come up with "related to" "as evidenced by's" goals and interventions. So again I apologize for being incompetent lol... but I'm literally a first semester student with no history of Healthcare experience so cut me some slack.

Sour Lemon · Oct 18, 2017

This is my very first care plan so sorry that I'm not very knowledgeable. Due to his circumstances my instructor told me my nursing diagnosis was fine but I was up to me to come up with "related to" "as evidenced by's" goals and interventions. So again I apologize for being incompetent lol... but I'm literally a first semester student with no history of Healthcare experience so cut me some slack.

What is #1 in importance when it comes to assessment? Weight and nutrition are important, but more long term when it comes to goals. What could cause this patient's demise right now?

Editorial Team / Admin · Oct 18, 2017

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studentbear, CNA · Oct 18, 2017

What else is this pt suffering from aside from the weight loss/nutritional issues? What other issues do they have? Remembering ABC= airway, breathing, circulation, is there anything that relates to one of those that you could base a nursing diagnosis on?

amoLucia · Oct 19, 2017

BIG CLUE here - people here are telling you that being skinny is NOT this guy's most critical problem!!!

The fact is he has already experienced aspiration pneumonia with a swallowing deficit and that make that his priority.

This guy has already aspirated - THAT'S his biggest problem. A pneumonia will kill him loooooong before him losing a few pounds will kill him.

The PEG tube poses the bigger problem than weight loss. Continued aspiration and its relation to airway & breathing (as in the ABCs) is his greatest risk. Just to tell you, the dietician and Speech Therapy are most likely following him for his condition. So, my guess is that he's on a hi-calorie formula, with protein and vitamin supplementation. They need to be cautious re the rate of his feeding. Bolus feeding is usually not indicated here. And that would usually be THEIR recommendation to the MD (physicians and nsg usually always defer to them as they are the experts in nutrition/dietetics). Labs are usually included in there also or by house protocol.

Nsg is responsible for the safe administration of feedings with good positioning (HOB elevation), correct order, checking residuals, hydration, bowel management, etc etc etc.

Another diagnosis is r/t to the pneumonia itself. You don't give any data re a compromised respiratory status. Is this guy having breathing issues??? Lungs sounds, O2 sats, chest XR, neb tx, oxygen admin, ABT meds, etc? Again, ABCs ABCs ABCs and this could trump the PEG in its severity and IMPORTANCE. So then you would have all the related nsg interventions.

Another issue would skin integrity/maint. He is skinny - needs all those good skin care interventions.

For your future care plans - any time there's a PEG, risk is ALWAYS ALWAYS addressed. Similarly, infection control issues for foley caths.

Varsityblues · Oct 19, 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

amoLucia · Oct 20, 2017

This is like your other posting with a bit more information added in. Respondents to that post gave you some responses but it's like you're moving for ones that you're prefer.

Per TOS, you really shouldn't be posting same issue in 2 threads.