Risk for Imbalanced Nutrition: Less than Body Requirements

Nursing diagnosis: risk for Imbalanced Nutrition: Less than Body Requirements

Risk factors may include
Prolonged anorexia, altered intake preoperatively
Hypermetabolic state—preoperative inflammatory disease; healing process
Presence of diarrhea; altered absorption
Restriction of bulk and residue-containing foods

Possibly evidenced by
(Not applicable; presence of signs and symptoms establishes an actual diagnosis)

Desired Outcomes/Evaluation Criteria—Client Will
Nutritional Status
Maintain weight or demonstrate progressive weight gain toward goal with normalization of laboratory values and be free of signs of malnutrition.
Plan diet to meet nutritional needs and limit gastrointestinal (GI) disturbances.

Nursing intervention with rationale:
1. Obtain a thorough nutritional assessment.
Rationale: Identifies deficiencies and needs to aid in choice of interventions.

2. Auscultate bowel sounds.
Rationale: Return of intestinal function indicates readiness to resume oral intake.

3. Resume solid foods slowly.
Rationale: Reduces incidence of abdominal cramps and nausea.

4. Identify odor-causing foods, for instance, cabbage, fish, and beans, and temporarily restrict from diet. Gradually reintroduce one food at a time.
Rationale: Sensitivity to certain foods is not uncommon following intestinal surgery. Client can experiment with food several times before determining whether it is creating a problem.

5. Recommend client increase use of yogurt, buttermilk, and acidophilus preparations.
Rationale: May help prevent gas and decrease odor formation.

6. Suggest client with ileostomy limit prunes, dates, stewed apricots, strawberries, grapes, bananas, cabbage family, and beans, and avoid foods high in cellulose, such as peanuts.
Rationale: These products increase ileal effluent. Digestion of cellulose requires colonic bacteria that are no longer present.

7. Discuss mechanics of swallowed air as a factor in the formation of flatus and some ways client can exercise control. Discuss use of a pouch with a filter to help with the management of gas.
Rationale: Drinking through a straw, snoring, anxiety, smoking, ill-fitting dentures, and gulping down food increase the production of flatus. Too much flatus not only necessitates frequent emptying, but also can cause leakage from too much pressure within the pouch.

8. Consult with dietitian and nutrition specialist.
Rationale: Helpful in assessing client’s nutritional needs in light of changes in digestion and intestinal function, including absorption of vitamins and minerals.

9. Advance diet from liquids to low-residue food when oral intake is resumed.
Rationale: Low-residue diet may be maintained during first 6 to 8 weeks to provide adequate time for intestinal healing.

10. Administer enteral or parenteral feedings when indicated.
Rationale: In the presence of severe debilitation or intolerance of oral intake, parenteral or enteral feedings may be given to supply needed components for healing and prevention of catabolic state.