Risk for Imbalanced Nutrition: Less than Body Requirements | NCP for Bariatric Surgery

Risk factors may include
Decreased intake, dietary restrictions, early satiety
Increased metabolic rate and healing
Malabsorption of nutrients and impaired absorption of vitamins

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

Desired Outcomes/Evaluation Criteria—Client Will
Knowledge: Diet
Identify individual nutritional needs.
Nutritional Status
Display behaviors to maintain adequate nutritional intake.
Demonstrate appropriate weight loss with normalization of laboratory values.

Nursing intervention with rationale:
1. Establish hourly intake schedule. Measure and provide food and fluids in amount specified.
Rationale: After gastric restriction procedures, stomach capacity is reduced to approximately 30 to 50 mL, necessitating frequent, small feedings. Ultimately, management of optimal nutrition depends on reducing the amount of food passing through the gastrointestinal (GI) system at one time.

2. Instruct in how to eat slowly. Take small bites, using a baby spoon. Chew food thoroughly. Take 3 to 60 minutes to eat meal, then refrain from eating until next scheduled mealtime.
Rationale: Increases satiety and reduces risk of overeating.

3. Avoid taking fluids with meals and for 30 minutes before or after meals. Encourage almost constant sipping of fluids between scheduled eating times.
Rationale: Although fluids are a necessary part of the client’s intake, the stomach is too small to hold food and fluids at the same time.

4. Avoid high-calorie fluids—milkshakes, sodas, and alcoholic beverages.
Rationale: These can sabotage weight loss.

5. Emphasize importance of recognizing satiety and stopping intake.
Rationale: Overeating may cause nausea and vomiting, as well as having the potential to damage surgical anastomosis.

6. Require that client sit up to drink and eat.
Rationale: Reduces possibility of aspiration.

7. Determine foods that are gas forming and eliminate them from diet.
Rationale: May cause nausea and bloating, interfering with digestion and causing client to restrict nutritional intake.

8. Discuss food preferences with client and include those foods in puréed diet when possible.
Rationale: May enhance intake and promote sense of participation and control.

9. Weigh on regular schedule.
Rationale: Monitors losses and aids in assessing nutritional needs and effectiveness of therapy.

10. Refer to dietitian or multidisciplinary team.
Rationale: Provides assistance in planning a diet that meets client’s nutritional needs as well as offering individualized treatment and support. Note: Because quantity is strictly limited, foods should be nutrient dense, low in fat and sugars, and high in protein (Beauchamp-Johnson, 2006).