Risk for Imbalanced Nutrition: Less than Body Requirements | Nursing Diagnosis for Renal Failure

Nursing diagnosis: risk for imbalanced Nutrition: Less than Body Requirements

Risk factors may include
Protein catabolism, dietary restrictions to reduce nitrogenous waste products
Increased metabolic needs
Anorexia, nausea and vomiting, ulcerations of oral mucosa

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

Desired Outcomes/Evaluation Criteria—Client Will
Nutritional Status
Maintain or regain weight as indicated by individual situation; be free of edema.

Nursing intervention with rationale:
1. Assess and document dietary intake.
Rationale: Aids in identifying deficiencies and dietary needs. Uremic symptoms (such as, nausea, anorexia, altered taste) and multiple dietary restrictions affect food intake.

2. Provide frequent, small feedings.
Rationale: Minimizes anorexia and nausea associated with uremic state and diminished peristalsis.

3. Give client and SO a list of permitted foods and fluids and encourage involvement in menu choices.
Rationale: Provides client with a measure of control within dietary restrictions. Food from home may enhance appetite.

4. Offer frequent mouth care and rinse with dilute (0.25%) acetic acid solution; provide gum, hard candy, or breath mints between meals.
Rationale: Mucous membranes may become dry and cracked. Mouth care soothes, lubricates, and helps freshen mouth taste, which is often unpleasant because of uremia and restricted oral intake. Rinsing with acetic acid helps neutralize ammonia formed by conversion of urea.

5. Weigh daily, preferably in the morning before breakfast.
Rationale: The fasting and catabolic client normally loses 0.2 to 0.5 kg/day. Changes in excess of 0.5 kg may reflect shifts in fluid balance.

6. Monitor laboratory studies, such as BUN, prealbumin or albumin, transferrin, sodium, and potassium.
Rationale: Indicators of nutritional needs, restrictions, and necessity for, and effectiveness of, therapy.

7. Consult with dietitian or nutritional support team.
Rationale: Determines individual calorie and nutrient needs within the restrictions and identifies most effective route and product—oral supplements, enteral or parenteral nutrition.

8. Provide high-calorie, low- or moderate-protein diet. Include complex carbohydrates and fat sources to meet caloric needs (avoiding concentrated sugar sources) and to provide essential amino acids.
Rationale: The amount of needed exogenous protein is less than normal unless client is on dialysis. Carbohydrates meet energy needs and limit tissue catabolism, preventing ketoacid formation from protein and fat oxidation. Carbohydrate intolerance mimicking diabetes mellitus may occur in severe renal failure. Essential amino acids improve nitrogen balance and nutritional status, stimulate repair of tubular epithelial cells, and enhance client’s ability to fight systemic complications.

9. Restrict potassium, sodium, and phosphorus intake, as indicated.
Rationale: Restriction of these electrolytes may be needed to prevent further renal damage, especially if dialysis is not part of treatment, and during recovery phase of ARF.

10. Administer medications as indicated, for example: Iron preparations
Rationale: Iron deficiency may occur if protein is restricted, client is anemic, or GI function is impaired.