Nursing Diagnosis for COPD and Asthma | Imbalanced Nutrition: Less than Body Requirements

Nursing diagnosis: imbalanced Nutrition: Less than Body Requirements related to dyspnea, sputum production; medication side effects; anorexia, nausea or vomiting; fatigue

Possibly evidenced by
Weight loss, loss of muscle mass, poor muscle tone
Reported altered taste sensation, aversion to eating, lack of interest in food

Desired Outcomes/Evaluation Criteria—Client Will
Nutritional Status
Display progressive weight gain toward goal as appropriate.
Demonstrate behaviors and lifestyle changes to regain and maintain appropriate weight.

Nursing intervention with rationale:
1. Assess dietary habits, recent food intake. Note degree of difficulty with eating. Evaluate weight and body size or mass.
Rationale: Client in acute respiratory distress is often anorectic because of dyspnea, sputum production, and medication effects. In addition, many COPD clients habitually eat poorly even though respiratory insufficiency creates a hypermetabolic state with increased caloric needs. As a result, client often is admitted with some degree of malnutrition. People who have emphysema are often thin, with wasted musculature.

2. Auscultate bowel sounds.
Rationale: Diminished or hypoactive bowel sounds may reflect decreased gastric motility and constipation (common complication) related to limited fluid intake, poor food choices, decreased activity, and hypoxemia.

3. Give frequent oral care, remove expectorated secretions promptly, and provide specific container for disposal of secretions and tissues.
Rationale: Noxious tastes, smells, and sights are prime deterrents to appetite and can produce nausea and vomiting with increased respiratory difficulty.

4. Encourage a rest period of 1 hour before and after meals. Provide frequent small feedings.
Rationale: Helps reduce fatigue during mealtime, and provides opportunity to increase total caloric intake.

5. Avoid gas-producing foods and carbonated beverages.
Rationale: Can produce abdominal distention, which hampers abdominal breathing and diaphragmatic movement and can increase dyspnea.

6. Avoid very hot or very cold foods.
Rationale: Extremes in temperature can precipitate or aggravate coughing spasms.

7. Weigh, as indicated.
Rationale: Useful in determining caloric needs, setting weight goal, and evaluating adequacy of nutritional plan. Note: Weight loss may continue initially despite adequate intake, as edema is resolving.

8. Consult dietitian or nutritional support team to provide easily digested, nutritionally balanced meals by mouth, supplemental or tube feedings, and parenteral nutrition.
Rationale: Method of feeding and caloric requirements are based on individual situation and specific needs to provide maximal nutrients with minimal client effort and energy expenditure.

9. Review serum albumin or prealbumin, transferrin, amino acid profile, iron, nitrogen balance studies, glucose, liver function studies, and electrolyte laboratory values as ordered.
Rationale: Determines deficits and monitors effectiveness of nutritional therapy.

10. Administer supplemental oxygen during meals, as indicated.
Rationale: Decreases dyspnea and increases energy for eating, enhancing intake.