Alteration in Nutrition: Less Than Body Requirements (_)Actual (_) Potential Related To: [Check those that apply]

(_) Dysphagia caused by:_________________ (_) Absorptive disorders (_) Anorexia (_) Allergy (_) Burns (_) Cancer (_) Chemotherapy (_) Chemical dependence (_) Crash or fad diet (_) Depression (_) Inability to obtain food (_) Infection (_) Lack of knowledge of adequate nutrition (_) Nausea and vomiting (_) Radiation Therapy (_) Social isolation (_) Stress (_) Trauma (_) Other:___________________________ __________________________________ __________________________________ As evidenced by: [Check those that apply] Major: (Must be present) (_) Reported inadequate food intake less than recommended daily allowance with or without weight loss and/or actual or potential metabolic needs in excess of intake. Minor: (May be present) (_) Weight 10% to 20% or more below ideal for height and frame. (_) Tachycardia on minimal exercise and bradycardia at rest. (_) Muscle weakness and tenderness. (_) Mental irritability or confusion. (_) Decreased serumm albumin. Date & Sign. Plan and Outcome [Check those that apply] Target Date: Nursing Interventions [Check those that apply]

Date Achieved: http://www.rncentral.com/careplans/plans/nlt.html (1 of 4)09/27/2005 10:36:27 AM Alteration in Nutrition: Less Than Body Requirements The patient will: (_) Experience adeuqate nutrition through oral intake. (_) Experience an increase in the amount or type of nutrients ingested. (_) Gain weight. (_) Other: (_) Assess and document patient's dietary history, patters of ingestion, intolerance to foods. (_) Assess patient likes and dislikes. Inform dietary. (_) Teach techniques to maintain adequate nutritional intake and stimulate appetite: l administer/instruct pt. on good oral hygiene before and after feedings l maintain pleasant environment for patient (_) Determine proper denture fit and profice adhesive as necessary. (_) Increase social contact with meals by: ____________________ _______________________ (_) Plan care so that unpleasant/ painful tests/tx's don't take place before meals. (_) Medicate pt. for pain 2 hrs before meals per physician's orders. (_) Consult with dietitian re: l calorie count l change in food consistency l spacing meals l provision of high caloric supplements l provision of high protein

supplementation http://www.rncentral.com/careplans/plans/nlt.html (2 of 4)09/27/2005 10:36:27 AM Alteration in Nutrition: Less Than Body Requirements l food intolerances/ preferences l extra fluids on tray l dietetic teaching, food selelction l therapeutic diet restrictions: __________________ (_)Consult with PT/PT re: l strengthening exercises l prosthetic devices l swallowing disorders (_) Environmental support to improve intake: l be sure pt. is alert and responsive before eating l sit upright 60-90 degrees for 15-20 min. before, during & after eating l decrease distractions l demonstrate patience by providing specific directions until finished l assure good mouth care (_) Weigh patient q______ at _______ a.m./p.m. (_) Other:________________ ________________________ ________________________ ________________________ __________________________ Patient/Significant other signature http://www.

Nursing Interventions: 1. Monitor nutritional intake and weigh patient regularly. 2. Monitor CBC and serum vitamin B12 levels to detect anemia, and monitor albumin and prealbumin levels to determine if protein supplementation is needed. 3. Provide comfort measures and administer analgesics as ordered. 4. Frequently turn the patient and encourage deep breathing to prevent pulmonary complications, to protect skin, and to promote comfort.

5. Maintain nasogastric suction to remove fluids and gas in the stomach and prevent painful distention. 6. Provide oral care to prevent dryness and ulceration. 7. Keep the patient nothing by mouth as directed to promote gastric wound healing. Administer parenteral nutrition, if ordered. 8. When nasogastric drainage has decreased and bowel sounds have returned, begin oral fluids and progress slowly. 9. Avoid giving the patient high-carbohydrate foods and fluids with meals, which may trigger dumping syndrome because of excessively rapid emptying of gastric contents. 10. Administer protein and vitamin supplements to foster wound repair and tissue building. 11. Eat small, frequent meals rather than three large meals. 12. Reduce fluids with meals, but take them between meals. 13. Stress the importance of long term vitamin B12 injections after gastrectomy to prevent surgically induced pernicious anemia. 14. Encourage follow-up visits with the health care provider and routine blood studies and other testing to detect complications or recurrence.