Imbalanced Nutrition: Less than Body Requirements | NCP Liver Cirrhosis

Nursing diagnosis: imbalanced Nutrition: Less than Body Requirements related to Inadequate diet; inability to process, digest nutrients, Anorexia, nausea, vomiting, indigestion, early satiety (ascites), Abnormal bowel function

Possibly evidenced by
Weight loss
Changes in bowel sounds and function
Poor muscle tone, muscle wasting; fatigue
Imbalances in nutritional studies

Desired Outcomes/Evaluation Criteria—Client Will
Nutritional Status
Demonstrate progressive weight gain toward goal with client-appropriate normalization of laboratory values.
Experience no further signs of malnutrition.

Nursing intervention with rationale:
1. Evaluate client’s risk for malnutrition.
Rationale: Eighty-five percent to 90% of the blood that leaves the stomach and intestines carries nutrients to the liver where they are converted into substances the body can use. The client with liver dysfunction often has malnutrition because of inadequate dietary intake due to poor food choices or preference for alcohol rather than food and may currently have malabsorption syndrome due to inability to process or digest nutrients, anorexia, nausea or vomiting, indigestion, or early satiety associated with ascites. Because of the decreased secretion of bile into the gut, client may have difficulty absorbing fat and fat-soluble vitamins A, D, E, and K. These deficiencies can lead to such complications as decreased vision in the dark, due to vitamin A deficiency; bone disease, due to vitamin D deficiency; neurological impairment, due to vitamin E deficiency; and decreased production of clotting proteins in the liver, due to vitamin K deficiency (Brettler, 2003).

2. Determine interest in eating and ability to chew, swallow, and taste. Discuss eating habits, including food preferences, intolerances, or aversions. Note availability and use of support systems.
Rationale: Factors that affect ingestion and digestion of nutrients.

3. Determine dietary intake and perform calorie count if client is eating.
Rationale: Provides information about intake, needs, and deficiencies. Client with cirrhosis requires a balanced protein diet providing 2,000 to 3,000 calories per day to permit liver cell regeneration.

4. Weigh, as indicated. Compare changes in fluid status and recent weight history.
Rationale: It may be difficult to use weight as a direct indicator of nutritional status in view of edema and ascites. Note: Undigested fat that passes into the large intestine can cause diarrhea and lead to weight loss (Brettler, 2003).

5. Assist or encourage client to eat; explain reasons for the types of diet. Feed client if tiring easily, or have SO assist client. Consider preferences in food choices.
Rationale: Improved nutrition is vital to recovery. Client may eat better if family is involved and preferred foods are included as much as possible. Client and family must understand protein intake limitations and how best to meet needs and desires within limitations.

6. Encourage client to eat all meals and supplementary feedings.
Rationale: Client may demonstrate loss of interest in food because of nausea, generalized weakness, and fatigue—which is often first reported symptom and seen in approximately 70% of clients with cirrhosis (Taylor, 2008).

7. Recommend or provide small, frequent meals.
Rationale: Poor tolerance to larger meals may be due to increased intraabdominal pressure or ascites.

8. Limit such high-salt foods as canned soups and vegetables, processed meats, and condiments. Provide salt substitutes if allowed, avoiding those containing ammonia.
Rationale: Salt limitations can help manage fluid complications in cirrhosis, including ascites or tissue edema. Salt substitutes enhance the flavor of food and aid in increasing appetite; ammonia potentiates risk of encephalopathy.

9. Restrict intake of caffeine and gas-producing or spicy and excessively hot or cold foods.
Rationale: Aids in reducing gastric irritation, diarrhea, and abdominal discomfort that may impair oral intake and digestion.

10. Encourage or provide frequent mouth care, especially before meals.
Rationale: Client is prone to sore and bleeding gums and bad taste in mouth, which contributes to anorexia.