Alteration in Nutrition: Less Than Body Requirements
Alteration in Nutrition: Less Than Body Requirements
(_)Actual (_) Potential
| (_)
Dysphagia caused by:_________________ (_) Absorptive disorders (_) Anorexia (_) Allergy (_) Burns (_) Cancer (_) Chemotherapy (_) Chemical dependence (_) Crash or fad diet (_) Depression |
(_)
Inability to obtain food (_) Infection (_) Lack of knowledge of adequate nutrition (_) Nausea and vomiting (_) Radiation Therapy (_) Social isolation (_) Stress (_) Trauma (_) Other:___________________________ __________________________________ __________________________________ |
| Major:
(Must be present) |
(_) Reported inadequate food intake less than recommended daily allowance with or without weight loss and/or actual or potential metabolic needs in excess of intake. |
| Minor:
(May be present) |
(_)
Weight 10% to 20% or more below ideal for height and
frame. (_) Tachycardia on minimal exercise and bradycardia at rest. (_) Muscle weakness and tenderness. (_) Mental irritability or confusion. (_) Decreased serumm albumin. |
| Date & Sign. |
Plan and Outcome [Check those that apply] |
Target Date: |
Nursing Interventions [Check those that apply] |
Date Achieved: |
| The
patient will: (_) Experience adeuqate nutrition through oral intake. (_) Experience an increase in the amount or type of nutrients ingested. (_) Gain weight. (_) Other: |
(_)
Assess and document patient's dietary history, patters of
ingestion, intolerance to foods. (_) Assess patient likes and dislikes. Inform dietary. (_) Teach techniques to maintain adequate nutritional intake and stimulate appetite:
(_) Determine proper denture fit and profice adhesive as necessary. (_) Increase social
contact with meals by:____________________ (_) Plan care so that unpleasant/painful tests/tx's don't take place before meals. (_) Medicate pt. for pain 2 hrs before meals per physician's orders. (_) Consult with dietitian re:
(_)Consult with PT/PT re:
(_) Environmental support to improve intake:
(_) Weigh patient
q______ (_)
Other:________________ |
__________________________
Patient/Significant other signature
__________________________
RN signature
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