Having a balanced nutrition is vital to an individual’s health and well-being. Imbalanced nutrition refers to either nutrition that is more than or less than the body’s requirements and metabolic needs. It can occur with any individual. Listed below is a brief list of potential causes that may result in an individual experiencing an imbalance in their nutrition status.
Causes
- Age-related changes in taste, smell, or appetite
- Other illness (i.e. cancer, burns)
- Difficulty chewing or swallowing
- Dementia
- Medications
- Economically disadvantaged
- Limited access to food
- Depression
- Alcoholism
Complications
Having an imbalanced nutrition can increase an individual’s risk for other problems as well such as:
- Weaker immune system
- Poor wound healing
- Muscle weakness and decreased bone mass
- Higher rates of hospitalization
Expected Outcomes
- Patient will maintain weight in desired goal range
- Patient will recognize factors that are contributing to being under or overweight
- Patient will identify appropriate nutritional needs/requirements
- Patient will consume adequate nutrition
- Patient will verbalize appropriate management of nutrition at home
Nursing Assessment for Imbalanced Nutrition
1. Complete a thorough nutrition screening.
This will allow the nurse to understand where the patient’s present nutritional status is and assess needs.
2. Assess patient’s lab values.
Certain laboratory values may be abnormal when patient is suffering from imbalanced nutrition (i.e. albumin and prealbumin can be indicators of the inflammatory response).
3. Assess patient’s mobility status.
Patients may become weak and unable to complete their regular activities if not taking in the appropriate nutrition. Additional collaboration with other disciplines (i.e. PT and OT) may be necessary.
4. Assess reason for imbalanced nutrition (i.e. other medical or environmental conditions).
Possible reasons for imbalanced nutrition can be extensive. Identifying the potential cause can further assist with overcoming that challenge and treating the appropriate underlying condition. (i.e. difficulty chewing or swallowing may warrant a referral to speech therapy).
5. Weigh patient routinely (for acute care – weigh daily; long-term care – weigh weekly or monthly as appropriate).
Weighing patients routinely will allow the healthcare team to have objective data to trend and monitor the patient’s progress.
6. Assess patient’s overall safety.
Imbalanced nutrition can decrease the patient’s strength and overall safety. If patient displays signs of weakness collaboration with other disciplines may be necessary to improve strength and endurance. In addition, assistive devices may need to be utilized.
7. Repeat nutrition screenings regularly if patient’s imbalanced nutrition is due to an acute cause.
For example, if patient’s nutrition is imbalanced due to stroke or burns their nutritional needs can change frequently. Ensuring the patient is reassessed frequently will allow for an individualized plan to be made depending on where the patient is in the recovery phase.
8. Assess oral care/hygiene.
Good oral care can enhance an individual’s appetite.
9. Assess the need of assistance devices to aid in feeding.
Patients with disabilities affecting motor function may need specialized eating utensils in order to successfully eat and feed oneself, provide these as appropriate.
Nursing Interventions for Imbalanced Nutrition
1. Discuss with MD the potential need for referral to a dietitian.
Utilizing appropriate resources is a vital part of being a nurse. The dietitian will be able to appropriately assess the patient and individualize the patient’s plan of care regarding nutrition.
2. Provide nutritional supplements as appropriate or ordered.
Nutritional supplements may be prescribed as necessary by the MD or dietician. The RN should ensure the patient is receiving and taking these supplements to further strengthen the body.
3. Educate the patient on the body’s nutritional needs.
This will allow the patient to gain knowledge in the area of how to independently care for oneself upon discharge.
4. Provide the patient with resources regarding nutrition.
The patient will be able to take these resources home upon discharge and will further help in the patient being independent in their care.
5. If underweight, provide patient with additional snacks in between meals.
Patients may not be able to meet all the body’s requirements during regular meal times. Providing snacks in between meals can be another way to meet the body’s extra nutritional needs.
6. Provide good oral hygiene.
Good oral hygiene can increase an individual’s appetite. The oral mucosa is also a vital part of salvia production which will further aid in the digestion of food.
7. Administer antiemetics as needed before meals.
Other underlying medical conditions may cause nausea limiting the patient’s intake of food. Providing appropriate antiemetics will allow for patient’s appetite to potentially increase and tolerate intake better.
8. Administer enteral feedings as ordered.
In a more critical care setting enteral feedings may be necessary, ensure these are administered as ordered to meet the body’s needs.
References and Sources
- Ackley, B.J., Ladwig, G.B., Flynn Makic M.B., Martinez-Kratz, M., & Zanotti, M. (2019). Nursing diagnosis handbook: An evidence-based guide to planning care (12th edition). Mosby.
- Mayo Clinic. (2019). Senior health: how to prevent and detect malnutrition. https://www.mayoclinic.org/healthy-lifestyle/caregivers/in-depth/senior-health/art-20044699
