Imbalanced Nutrition: Less than Body Requirements | Nursing Diagnosis for Renal Dialysis

Nursing diagnosis: imbalanced Nutrition: Less than Body Requirements related to gastrointestinal (GI) disturbances (result of uremia or medication side effects)—anorexia, nausea, vomiting, and stomatitis, sensation of feeling full—abdominal distention during continuous ambulatory peritoneal dialysis (CAPD), dietary restrictions—bland, tasteless food; lack of interest in food, loss of peptides and amino acids (building blocks for proteins) during dialysis

Possibly evidenced by
Inadequate food intake, aversion to eating, altered taste sensation
Poor muscle tone, weakness
Sore, inflamed buccal cavity; pale conjunctiva and mucous membranes

Desired Outcomes/Evaluation Criteria—Client Will
Nutritional Status
Demonstrate stable weight or gain toward goal with normalization of laboratory values and no signs of malnutrition.

Nursing intervention with rationale:
1. Monitor food and fluid ingested and calculate daily caloric intake.
Rationale: Identifies nutritional deficits and therapy needs, which are extremely variable, depending on client’s age, stage of renal disease, other coexisting conditions, and the type of dialysis being planned.

2. Recommend client/significant other (SO) keep a food diary, including estimation of ingested calories, protein, and electrolytes of individual concern—sodium, potassium, chloride, magnesium, and phosphorus.
Rationale: Helps client realize “big picture” and allows opportunity to alter dietary choices to meet individual desires within identified restriction.

3. Note presence of nausea and anorexia.
Rationale: Symptoms accompany accumulation of endogenous toxins that can alter or reduce intake and require intervention.

4. Encourage client to participate in menu planning.
Rationale: May enhance oral intake and promote sense of control.

5. Recommend small, frequent meals. Schedule meals according to dialysis needs.
Rationale: Smaller portions may enhance intake. Type of dialysis influences meal patterns; for instance, clients receiving HD might not be fed directly before or during procedure because this can alter fluid removal, and clients undergoing PD may be unable to ingest food while abdomen is distended with dialysate.

6. Encourage use of herbs and spices such as garlic, onion, pepper, parsley, cilantro, and lemon.
Rationale: Adds zest to food to help reduce boredom with diet, while reducing potential for ingesting too much potassium and sodium.

7. Suggest socialization during meals.
Rationale: Provides diversion and promotes social aspects of eating.

8. Encourage frequent mouth care.
Rationale: Reduces discomfort of oral stomatitis and metallic taste in mouth associated with uremia, which can interfere with food intake.

9. Refer to nutritionist or dietitian to develop diet appropriate to client’s needs.
Rationale: Necessary to develop complex and highly individual dietary program to meet cultural and lifestyle needs within specific kilocalorie and protein restrictions while controlling phosphorus, sodium, and potassium.

10. Provide a balanced diet, usually of 2,000 to 2,200 calories/day of complex carbohydrates and ordered amount of high-quality protein and essential amino acids.
Rationale: Provides sufficient nutrients to improve energy and prevent muscle wasting (catabolism); promotes tissue regeneration and healing and electrolyte balance. Although client with kidney disease is often advised to limit protein intake, that changes with the start of dialysis. Protein-rich foods, such as fresh meats, poultry, fish and other seafood, eggs and egg whites, and small servings of dairy products are needed for building muscles, repairing tissue, and fighting infection. However, some protein-rich foods may contain a high level of phosphorus, so a dietitian’s input is essential in determining the right amount to eat (Paton, 2007).