Help with Nursing Intervention for Imbalanced Nutrition

morte, LPN, LVN · Nov 6, 2012

what is your intervention?

SNLp · Nov 6, 2012

well, that's what I'm trying to figure out as well. I don't know if it would be correct to put RN will:

reassess client's weight in one month

or if I need to put

RN will: have client return in one month to have weight reassessed.

I guess I'm mainly confused about how we make sure they get back in order to evaluate.

morte, LPN, LVN · Nov 6, 2012

Back up, WHAT are you, as a nurse, going to do about absorbtion issues???

well, that's what I'm trying to figure out as well. I don't know if it would be correct to put RN will:
reassess client's weight in one month
or if I need to put
RN will: have client return in one month to have weight reassessed.
I guess I'm mainly confused about how we make sure they get back in order to evaluate.

metal_m0nk, BSN, RN · Nov 6, 2012

Gotta have goals before you decide how to intervene to achieve those goals...

OP, I think you know that your ultimate goal is to improve or balance the patients nutritional status, but for most nursing instructors that's not specific enough.

Think of some indicators of balanced nutritional status...if someone has balanced nutrition, what will you see? What will they look like? How will they behave? What kinds of labs will they have? What will their actions be?

Those are your goals.

Also note that most often, goals are to be stated in terms of what the patient will do, exhibit, say, etc., not the nurse.

For example, if my overall goal is to improve tissue perfusion to the extremities, I first ask myself, "What does adequate tissue perfusion of the extremities look like?" I think back to assessment (this is how we measure the success or failure of our interventions). What assessment findings would I expect from a patient who is adequately perfused? Brisk cap refill? Skin that is warm to the touch? 2+ pulse strength? Those are the things I want to maintain or improve because those are the things that are going to tell me if the patient is adequately perfused.

A sample goal in this case would be:

1. Patient will exhibit brisk capillary refill in all extremities by the end of shift.

Your interventions then, will focus on the things you will do to accomplish that goal. Will you administer IV fluids as ordered? Will you assist with position changes that promote circulation? Will you administer medications that improve cardiac output/vasodilate/reduce swelling and ease physical pressure exerted on vessels? Some of your interventions will be generalized, some generalized interventions may be contraindicated, your choice of medication administration is going to depend on your patient's diagnosis and pathophysiology - tailor your interventions to those factors.

Interventions should be phrased in "the nurse will..." terms. As in, "The nurse will administer IV fluids as ordered."

Hope that helps.

metal_m0nk, BSN, RN · Nov 7, 2012

Evaluation (as you have intuited) comes after you have performed your interventions and reassessed according to your goals. You compare your post-intervention assessment findings to your pre-intervention goals to evaluate the effectiveness of your interventions.

The tricky part of care planning for new nursing students is identifying which goals and interventions are appropriate for the limited amount of time you spend with the patient. So, what you want to do is decide on goals and interventions that have a quick turnaround - something you can re-evaluate given the time you have. If your nursing diagnosis has to do with impaired kidney or genitourinary function for instance, your goal would be for the patient to void an amount that is within normal limits for his/her health status or an improvement from previous pathological voiding patterns. That is something that you will likely be able to evaluate with a reassessment during a single clinical shift.

If you absolutely have to choose a goal and intervention that will take longer to get results - then you measure your success in reaching your goal by evaluating/assessing the patient's progress. If the patient only voided 300 cc in the last 20 hours, you’ll want to see the patient void at least 120 cc in the next 8 hours with 240 cc being ideal. Voiding 120 cc would be no change from the previous 20 hours, but at least it would indicate that the patient isn’t declining. If you get more than 120, then you might be able to say that the patients voiding has improved - that you are that much closer to reaching your long term goal.

Esme12, ASN, BSN, RN · Nov 7, 2012

Hi, I'm in the 1st semester of an ADN program and I am very inexperienced, so all of this nursing process stuff is brand new to me. Forgive me if I sound like a complete idiot, but I seriously need some help. I'm working on an intervention and outcome for a pt. with a diagnosis of Imbalanced Nutrition less than body requirements r/t inability to absorb nutrients.
So my question is, how do I make an outcome that's measurable and realistic? I'm not really sure what a realistic goal should be, because I'v never done this. Also, I was wondering how I would get my evaluation. I mean, patients don't always come back. Is it the nurses job to have the patient return for a reassessment of his weight? for example, could I put RN will: inform patient that he will need to return to have weight reassessed in one month?
Or would I just need to have him call? I'm so confused and I would appreciate any help! Thank you!

Welcome to AN!

The largest online nursing community!

Is this an assigned nursing diagnosis? What is the inability to absorb nutrients....why can't they? Is this a real patient? What is the assessment of this patient?

Let the patient/patient assessment drive your diagnosis. Do not try to fit the patient to the diagnosis you found first. You need to know the pathophysiology of your disease process. You need to assess your patient, collect data then find a diagnosis. Let the patient data drive the diagnosis.

What is your assessment? What are the vital signs? What is your patient saying?. Is the the patient having pain? Are they having difficulty with ADLS? What teaching do they need? What does the patient need? What is the most important to them now? What is important for them to know in the future. What is YOUR scenario? TELL ME ABOUT YOUR PATIENT...:)

The medical diagnosis is the disease itself. It is what the patient has not necessarily what the patient needs. the nursing diagnosis is what are you going to do about it, what are you going to look for, and what do you need to do/look for first. From what you posted I do not have the information necessary to make a nursing diagnosis.

Care plans when you are in school are teaching you what you need to do to actually look for, what you need to do to intervene and improve for the patient to be well and return to their previous level of life or to make them the best you you can be. It is trying to teach you how to think like a nurse.

Think of the care plan as a recipe to caring for your patient. your plan of how you are going to care for them. how you are going to care for them. what you want to happen as a result of your caring for them. What would you like to see for them in the future, even if that goal is that you don't want them to become worse, maintain the same, or even to have a peaceful pain free death.

Every single nursing diagnosis has its own set of symptoms, or defining characteristics. they are listed in the NANDA taxonomy and in many of the current nursing care plan books that are currently on the market that include nursing diagnosis information. You need to have access to these books when you are working on care plans. You need to use the nursing diagnoses that NANDA has defined and given related factors and defining characteristics for. These books have what you need to get this information to help you in writing care plans so you diagnose your patients correctly.

Don't focus your efforts on the nursing diagnoses when you should be focusing on the assessment and the patients abnormal data that you collected. These will become their symptoms, or what NANDA calls defining characteristics. From a very wise an contributor daytonite.......make sure you follow these steps first and in order and let the patient drive your diagnosis not try to fit the patient to the diagnosis you found first.

Here are the steps of the nursing process and what you should be doing in each step when you are doing a written care plan: ADPIE

Assessment (collect data from medical record, do a physical assessment of the patient, assess ADLS, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
Determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use)
Planning (write measurable goals/outcomes and nursing interventions)
Implementation (initiate the care plan)
Evaluation (determine if goals/outcomes have been met)

Care plan reality: The foundation of any care plan is the signs, symptoms or responses that patient is having to what is happening to them. What is happening to them could be the medical disease, a physical condition, a failure to perform ADLS (activities of daily living), or a failure to be able to interact appropriately or successfully within their environment. Therefore, one of your primary goals as a problem solver is to collect as much data as you can get your hands on. The more the better. You have to be the detective and always be on the alert and lookout for clues, at all times, and that is Step #1 of the nursing process.

Assessment is an important skill. It will take you a long time to become proficient in assessing patients. Assessment not only includes doing the traditional head-to-toe exam, but also listening to what patients have to say and questioning them. History can reveal import clues. It takes time and experience to know what questions to ask to elicit good answers (interview skills). Part of this assessment process is knowing the pathophysiology of the medical disease or condition that the patient has. But, there will be times that this won't be known. Just keep in mind that you have to be like a nurse detective always snooping around and looking for those clues.

A nursing diagnosis standing by itself means nothing. The meat of this care plan of yours will lie in the abnormal data (symptoms) that you collected during your assessment of this patient......in order for you to pick any nursing diagnoses for a patient you need to know what the patient's symptoms are. Although your patient isn't real you do have information available.

What I would suggest you do is to work the nursing process from step #1.

Take a look at the information you collected on the patient during your physical assessment and review of their medical record. Start making a list of abnormal data which will now become a list of their symptoms. Don't forget to include an assessment of their ability to perform ADLS (because that's what we nurses shine at). The ADLS are bathing, dressing, transferring from bed or chair, walking, eating, toilet use, and grooming. and, one more thing you should do is to look up information about symptoms that stand out to you.

What is the physiology and what are the signs and symptoms (manifestations) you are likely to see in the patient.

Did you miss any of the signs and symptoms in the patient? if so, now is the time to add them to your list.

This is all part of preparing to move onto step #2 of the process which is determining your patient's problem and choosing nursing diagnoses. but, you have to have those signs, symptoms and patient responses to back it all up.

Care plan reality: What you are calling a nursing diagnosis is actually a shorthand label for the patient problem.. The patient problem is more accurately described in the definition of the nursing diagnosis.

So tell me about your patient.......What do they need? What is your assessment......What does this tell me about the patient?

This thread is great for the nursing process.

https://allnurses.com/nursing-student-assistance/student-resources-nursing-424826.html

SNLp · Nov 8, 2012

thanks so much for all the advice! This is a scenario we were given in class. The pt. is lactose intolerant and 10% below normal weight. I was having a hard time with the outcome, because I know he needs to gain weight, but I don't know how much would be realistic. So my outcome at first was client will: verbalize 3 foods from every food group and amounts needed for each one by end of visit. Like I said, I have no experience with this and haven't received much help from my instructors. From that outcome, my interventions were as follows...

1.) assess client's understanding of nutritional needs

2.) Provide client with resources for RDA's and list of nutritious foods that are high in calories (choosemyplate.gov)

3.) refer to dietitian

4.) Inform client he will need to return in one month to have weight reassessed

We are supposed to make up an evaluation.

Thanks again for any help! I feel like this shouldn't be hard, but then again I'm new to the whole process.