Alteration in Nurtition: More Than Body Requirements
Alteration in Nurtition: More Than Body Requirements
(_)Actual (_) Potential
| (_)
Altered satiety patterns (_) Medications (steroids) (_) Lack of knowledge (_) Decreased activity (_) Decreased metabolic needs (_) Other:_____________________________ ____________________________________ ____________________________________ |
| Major:
(Must be present) |
(_)
Overweight (weigh 10% to 20% over ideal for height and
frame. (_) Obese (weigh over 20% of ideal). |
| Minor:
(May be present) |
(_)
Reported undesirable eating patterns. (_) Intake in excess of metabolic requirements. (_) Sedentary activity patterns. |
| Date & Sign. |
Plan and Outcome [Check those that apply] |
Target Date: |
Nursing Interventions [Check those that apply] |
Date Achieved: |
| The
patient will: (_) Decrease total calories ingested. (_) Increase activity level. (_) Loose weight: (_) Other: |
(_)
Assess and document patient's dietary history, patterns
of ingestion, activity patterns. (_) Discuss with patient potential causative factors for weight gain. (_) Assess motivation to correct overweight. (_) Consult with dietician regarding balanced plan for weight loss. Reinforce teaching. Discuss realistic weight loss of not more than 2 pounds per week. (_) Provide positive reinforcement for weight loss. (_) Record intake. (_) Weigh q ___ days at ____ am/pm. (_)
Other:________________ |
__________________________
Patient/Significant other signature
__________________________
RN signature
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