HELP imbalanced nutrtion less than body requirements...

[TD2011]

Hey i was just wondering if i could have some help on my careplan i have a pt who has ulcertive colitis and has had diahrrea since admission and only weighs 99lbs at 5 6"...ik that with the inflammation in her colon she is unable to absorb needed nutrients..my diagnosis is imbalanced nutrition r/t inability to absorb nutrients AEB low sodium levels..

im trying to come up with some independant (things i can do) and dependant ( things i have to go to the doctor and have him order ) actions and im really struggling..she has a ensure shake that i can give her.. and i was thinking encourage foods with potassium..but does that really fix the problem of her not being able to absorb it? maybe i need interventions that will help fix the fact that she cant absorb anything?!? idk im confused..please help!!

[blondy2061h, MSN, RN]

While she obviously does need medical intervention, there are nursing interventions you can help with, as well. While she may be having trouble absorbing the nutrients, the more she is able to eat, the more she will absorb.

Many people know what foods settle well for them and which don't. You can encourage her to think of what those foods are and encourage them. You can encourage and provide frequent smaller meals throughout the day instead of larger meals. You can encourage eating nutrient dense foods when she does eat. You can provide a relaxing environment to eat in. Some people do better with their foods hotter or colder. You can see which she prefers and try and arrange for her food to be served that way.

[phoenixfire]

With ulcerative colitis, think of things that are non-irritating to the GI tract (ex. stay away from caffiene, spicy foods, etc). Stick with a bland diet that is higher in the elements your patient specifically needs (check your nutrition book). Also, you need to think about electrolyte imbalances past just sodium.. what else can a person with ulcerative colitis NOT absorb? B12. You can give it IM, but you need an order for it. You also need to monitor the condition of the perianal skin because of the diarrhea, that area can get very sore very quick, making your patient extremely uncomfortable and opening the door for skin breakdown. Grab your path book, and look at your medical diagnosis. If you understand the patho behind the diagnosis, you can figure out what to do/not do. This patient probably needs anti-inflammatories, and at worst case, may need TPN until the GI tract has had time to rest. Check with your hospital/clinical area's protocols to see what the requirements are. TPN has a high infection risk, and has to be put through a central line. It is best if you can avoid it, but if the GI tract can not heal, it may be the only option left. Good luck with your careplan!

[LivingWithTheBreeze]

I would change my AEB and maybe put the patient's weight. I agree with the above poster that there is more in play to nutrition than just the patient's sodium level.

[annaRNC]

I would expand your AEB to include body weight. Also note if there has been a weight loss over a period of time which would also be evidence of AEB. Sodium on its own does not support your chosen diagnosis. As for nursing interventions you could weight the patient daily, do strict intake and output, offer smaller more frequent nutrient dense meals, and as another poster mentioned watch the perianal area because the patient is already thin and at risk for breakdown due to frequent stooling. For medical interventions you could ask the MD to write for a nutrition consult. How low in the sodium and what do the other labs look like? See how frequently labs are being checked and if there is a general trend. TPN may need to be considered but that's another post entirely.