Imbalanced Nutrition: Less than Body Requirements | NCP Hepatitis

Nursing diagnosis: Imbalanced Nutrition: Less than Body Requirement related to Insufficient intake to meet metabolic demands—anorexia, nausea, vomiting, Altered absorption and metabolism of ingested foods—reduced peristalsis (visceral reflexes), bile stasis, Increased caloric needs, hypermetabolic state

Possibly evidenced by
Aversion to eating, lack of interest in food; altered taste sensation
Abdominal pain, cramping
Loss of weight, poor muscle tone

Desired Outcomes/Evaluation Criteria—Client Will
Treatment Behavior: Illness or Injury
Initiate behaviors and lifestyle changes to regain or maintain appropriate weight.
Nutritional Status
Demonstrate progressive weight gain toward goal with normalization of laboratory values and no signs of malnutrition.

Nursing intervention with rationale:
1. Monitor dietary intake and calorie count. Provide meals in several small feedings and offer largest meal at breakfast.
Rationale: Large meals are difficult to manage when client is anorexic. Anorexia may also worsen during the day, making intake of food difficult later in the day.

2. Encourage mouth care before meals.
Rationale: Eliminating unpleasant taste may enhance appetite.

3. Recommend eating in upright position.
Rationale: Reduces sensation of abdominal fullness and may enhance intake.

4. Encourage intake of fruit juices, carbonated beverages, and hard candy throughout the day.
Rationale: These supply extra calories and may be more easily digested and tolerated than other fluids and foods.

5. Consult with dietitian or nutritional support team to provide diet according to client’s needs, with fat and protein intake as tolerated.
Rationale: Useful in formulating dietary program to meet individual needs. Fat metabolism varies according to bile production and excretion and may necessitate restriction of fat intake if diarrhea develops. If tolerated, a normal or increased protein intake helps with liver regeneration. Protein restriction may be indicated in severe disease, such as fulminating hepatitis, because the accumulation of the end products of protein metabolism can potentiate hepatic encephalopathy.

6. Monitor serum glucose, as indicated.
Rationale: Hyperglycemia or hypoglycemia may develop, necessitating dietary changes or insulin administration. Fingerstick monitoring may be done by client on a regular schedule to determine therapy needs.

7. Administer medications, as indicated, for example: Antiemetics, such as metoclopramide (Reglan) and trimethobenzamide (Tigan)
Rationale: Given before meals these drugs may reduce nausea and increase food tolerance. Note: Prochlorperazine (Compazine) is contraindicated in hepatic disease.

8. Antiulcer agents and antacids, such as lansoprazole (Prevacid), esomeprazole (Nexium), and magnesium hydroxide/aluminum hydroxide (Maalox, Mylanta)
Rationale: Counteracts gastric acidity, reducing irritation and risk of bleeding.

9. Vitamins, such as B complex, C, and other dietary supplements, as indicated
Rationale: Corrects deficiencies and aids in the healing process.

10. Provide supplemental feedings, enteral or parenteral nutrition if needed.
Rationale: May be necessary to meet nutrient requirements if marked deficits are present and intestinal symptoms are prolonged.