Nutrition is the process of taking in food and fluids to support bodily functions. Nutrients acquired from foods and fluids are used for the body’s cellular metabolism. Optimal nutrition means having adequate vitamins and nutrients to support the body’s processes.
Malnutrition occurs due to inadequate, excessive, or imbalanced nutritional intake. This includes being underweight or overweight or lacking specific nutrients.
Common risk factors for malnutrition include:
- Genetics
- Stress
- Depression
- Obesity
- Imbalanced diet consumption
- Poverty
- Malabsorption or digestive disorders
- Eating disorders
- Cancer
Clinical manifestations of malnutrition can vary and the most obvious signs include dry and scaly skin, hair loss, brittle nails, mouth ulcers, poor weight gain, electrolyte imbalances, decreased muscle mass and weakness, stunted growth, and mental changes including irritability and confusion.
Malnutrition is diagnosed through body composition which includes a thorough assessment of weight loss history, functional status, and nutrient intake. Laboratory tests may also identify electrolyte imbalances or nutrient deficiencies.
The Nursing Process
Management of malnutrition will vary depending on the type of malnutrition and the existing health conditions that caused the malnutrition.
Nurses play an important role in the nutritional screening of all patients, successfully identifying those who are malnourished or those who are at risk of developing malnutrition. Patient education is also an essential part of preventing malnutrition as the nurse reinforces healthy dietary habits and offers resources to support adequate nutrition.
Nursing Care Plans Related to Malnutrition
Imbalanced Nutrition Less Than Body Requirements Care Plan
A lack of nutrients can increase the risk of other health complications like a weakened immune system, osteoporosis, and poor wound healing.
Nursing Diagnosis: Imbalanced Nutrition
Related to:
- Disease processes
- Altered taste perception
- Food aversion
- Inadequate food supply
- Inaccurate information on nutrient requirements
- Difficulty swallowing or chewing
- Depression
- Inability to absorb nutrients
As evidenced by:
- Electrolyte imbalances
- Ineffective wound healing
- Decreased levels of transferrin, protein, and serum albumin
- Loss of muscle tone
- Hypoglycemia
- Pale mucous membranes
- Dry skin
- Excessive hair loss
- Diarrhea or constipation
- Food intake less than the recommended daily allowance
- Body weight below the ideal weight range appropriate for age and gender
Expected Outcomes:
- The patient will maintain a healthy weight for their age and gender
- The patient will display adequate nutrition as evidenced by acceptable electrolyte and iron levels
Imbalanced Nutrition Less Than Body Requirements Assessment
1. Assess BMI.
Nutrition needs will vary depending on age and gender. Body mass index measures weight in relation to height. BMI can quickly determine an underweight patient but still requires further assessment as a BMI does not always accurately portray nutrition requirements.
2. Assess and monitor laboratory results.
Laboratory results are vital in establishing the patient’s nutritional status. Serum laboratory tests like electrolytes, total protein, prealbumin, and albumin tests can help determine which nutrients are inadequate.
3. Assess for physical signs of malnutrition.
Nutritional insufficiency can make the patient appear exhausted and lethargic. Pallor, dry skin, loss of subcutaneous tissue, dull and brittle hair, and mouth fissures can also signal poor nutrition.
4. Assess the patient’s nutritional history.
Patients may experience malnutrition for several reasons. The nurse can assess for opportunities for intervention by first obtaining a history of the patient’s usual dietary intake and habits.
Imbalanced Nutrition Less Than Body Requirements Interventions
1. Treat underlying conditions.
Health conditions such as cystic fibrosis, irritable bowel syndrome, eating disorders, and more can affect nutritional intake. Underlying conditions must be stabilized in order to improve nutrition.
2. Administer parenteral nutrition.
Patients with chronic conditions or illnesses may require parenteral nutrition infusions or tube feedings.
3. Determine the availability of food.
Lack of access to nutritional food due to finances or food deserts is a common barrier. The nurse can direct the patient and family to community resources.
4. Consult with a dietician.
Dieticians can recommend diet modifications to increase calories and other nutrients and create meal plans to improve fat, carbohydrate, and protein intake.
5. Supplement diets.
Patients who have difficulty gaining weight or absorbing nutrients may require meal replacement or protein shakes. Children can be provided with high-calorie snacks and frequent small meals may be better utilized than large ones.
Fatigue Nursing Care Plan
Inadequate intake can cause the muscles to become wasted and weak, which ultimately causes exhaustion, fatigue, and decreased capacity for physical and mental activities.
Nursing Diagnosis: Fatigue
Related to:
- Reduced metabolic energy production
- Malnutrition
- Physical deconditioning
As evidenced by:
- Expresses extreme lack of energy
- Difficulty maintaining usual physical activity
- Expresses tiredness or weakness
- Reduced concentration level
- Lethargy or sluggishness
- Increased need to rest
- Inability to perform desired activities
Expected Outcomes:
- The patient will be able to identify the source of exhaustion and the control aspects that affect it.
- The patient will verbalize an improved sense of energy.
- The patient will be able to complete tasks and participate in hobbies.
Fatigue Assessment
1. Assess the patient’s description of the fatigue.
Have the patient rate on a 1 to 10 scale to help determine the patient’s level of fatigue or exhaustion. Proper evaluation of fatigue and its impact can help formulate an appropriate treatment regimen.
2. Assess compounding causes of fatigue.
Malnutrition causes fatigue. Additional factors that may be causing or caused by malnutrition should also be considered such as pregnancy, depression, anemia, and cancer.
Fatigue Interventions
1. Determine the patient’s nutritional intake.
One of the most dominant symptoms of malnutrition is persistent fatigue. Have the patient keep a food diary and track their intake. They may not be taking in enough calories to meet their energy requirements.
2. Establish realistic goals.
Patients who experience fatigue due to a chronic condition and malnutrition may not be able to partake in strenuous activity. Increased rest periods and sleep may be required. Activity can be increased as tolerated.
3. Include the patient’s family members in patient care.
The patient’s social support is important to help the patient implement lifestyle modifications intended to reduce exhaustion.
4. Encourage easy-to-prepare, nutritionally dense foods.
Large meals or difficult-to-prepare foods may worsen fatigue. Provide plenty of healthy, easy grab-and-go foods such as nut butters, fruit, cheese, and yogurt.
Deficient Knowledge Care Plan
Nutrition education is an essential part of the management of malnutrition as patients are encouraged to learn new ways to supplement diets, prevent nutrient deficiencies, and make better food choices.
Nursing Diagnosis: Deficient Knowledge
Related to:
- Incomplete or unreliable information about nutrition
- Inadequate access to resources
- Inadequate awareness of resources
- Inadequate knowledge surrounding nutrition
- Lack of interest or motivation
- Misinformation about diets
As evidenced by:
- Inadequate follow-through of instructions
- Insufficient adherence to dietary recommendations
- Frequent requests for information about new diets
- Development of preventable disorders
Expected Outcomes:
- The patient will verbalize two dietary changes to support proper nutrition
- The patient will set a personal dietary goal and effectively formulate a plan to achieve it
Deficient Knowledge Assessment
1. Assess the patient’s understanding and perception of nutritional needs.
Understanding how the patient perceives their own nutritional needs will enable the healthcare team to plan the best approach to delivering accurate information and care.
2. Assess for poor health literacy.
Patients with a poor understanding of diet and how certain foods affect their health may not be making appropriate food choices. Do not assume patients are aware of what is healthy or not.
Deficient Knowledge Interventions
1. Provide information about vitamins and minerals.
Patients often do not possess accurate knowledge surrounding the importance of vitamins and minerals. Most Western diets lack sufficient nutrients. Provide information on foods that contain necessary nutrients.
2. Develop a plan to prevent overeating.
Holidays, travel, and social events can lead to overconsumption. Help the patient recognize scenarios that lead to poor decision-making and plan ahead to prevent diet fluctuations.
3. Promote community resources.
Cooking classes, exercise groups, eating disorder support groups, and health departments and clinics can support the patient in learning ways to improve nutrition.
4. Encourage the patient to continue follow-up care.
Nutrition needs change throughout life. Toddlers, adolescents, pregnant or breastfeeding women, and elderly patients all have different nutritional needs. Encourage patients to discuss concerns with their primary care providers or a registered dietician.
References and Sources
- Lewis’s Medical-Surgical Nursing. 11th Edition, Mariann M. Harding, RN, PhD, FAADN, CNE. 2020. Elsevier, Inc.
- Malnutrition. NHS. Page last reviewed: 07 February 2020. https://www.nhs.uk/conditions/malnutrition/
- Malnutrition: What you need to know. Medical News Today. Last medically reviewed on May 5, 2022. https://www.medicalnewstoday.com/articles/179316
- Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care. 9th Edition. Donna D. Ignatavicius, MS, RN, CNE, ANEF. 2018. Elsevier, Inc.
- Saunders, J., & Smith, T. (2010). Malnutrition: causes and consequences. Clinical medicine (London, England), 10(6), 624–627. https://doi.org/10.7861/clinmedicine.10-6-624
- What is Malnutrition. Academy of Nutrition and Dietetics. Contributors: Esther Ellis, MS, RDN, LDN. Published August 4, 202. Reviewed August 2021 https://www.eatright.org/food/nutrition/healthy-eating/what-is-malnutrition
