Imbalanced Nutrition: Less than Body Requirements | NCP Pancreatitis

Nursing diagnosis: imbalanced Nutrition: Less than Body Requirements related to Vomiting, decreased oral intake; prescribed dietary restrictions, Loss of digestive enzymes (related to pancreatic outflow obstruction, necrosis, or autodigestion)

Possibly evidenced by
Reported inadequate food intake
Aversion to eating, reported altered taste sensation, lack of interest in food
Weight loss
Poor muscle tone

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

Nursing intervention with rationale:
1. Assess abdomen, noting presence and character of bowel sounds, abdominal distention, and reports of nausea.
Rationale: Gastric distention and intestinal atony are frequently present, resulting in reduced or absent bowel sounds. Return of bowel sounds and relief of symptoms signal readiness for discontinuation of NG.

2. Provide frequent oral care.
Rationale: Decreases vomiting stimulus and soothes inflamed, dry mucous membranes associated with dehydration and mouth breathing when NG tube is in place.

3. Assist client in selecting food and fluids that meet nutritional needs and restrictions when diet is resumed.
Rationale: Previous dietary habits may be unsatisfactory in meeting current needs for tissue regeneration and healing. Use of gastric stimulants, such as caffeine, alcohol, cigarettes, or gas-producing foods, or ingestion of large meals may result in excessive stimulation of the pancreas and recurrence of symptoms.

4. Observe color, consistency, and amount of stools. Note frothy consistency and foul odor.
Rationale: Steatorrhea may develop from incomplete digestion of fats.

5. Maintain NPO status and gastric suctioning during acute phase.
Rationale: Prevents stimulation and release of pancreatic enzymes (secretin) when chyme and hydrochloric acid enter the duodenum.

6. Resume oral intake with liquids and advance diet slowly to provide high-protein, high-carbohydrate diet, when indicated.
Rationale: Oral feedings given too early in the course of illness may exacerbate symptoms.

7. Provide medium-chain triglycerides (MCTs), such as Portagen.
Rationale: MCTs are elements of enteral feeding that provide supplemental calories or nutrients that do not require pancreatic enzymes for digestion and absorption.

8. Administer enteral or parenteral feedings, as indicated.
Rationale: Enteral feedings may be preferred to prevent gut atrophy when tolerated; however, IV administration of calories, lipids, and amino acids should be instituted before nitrogen depletion is advanced.

9. Administer medications, as indicated, for example: Vitamins, such as A, D, E, and K
Rationale: Replacement required because fat metabolism is altered, reducing absorption and storage of fat-soluble vitamins.

10. Replacement enzymes, such as pancreatin (Dizymes) and pancrelipase (Protilase, Cotazym)
Rationale: Used in chronic pancreatitis to correct deficiencies to promote digestion and absorption of nutrients.