Insufficient nutrient consumption to meet metabolic needs

• Altered taste perception
• Depressive symptoms
• Difficulty establishing social interaction
• Difficulty independently performing activities of daily living
• Difficulty independently performing instrumental activities of daily living
• Dry mouth
• Food aversion
• Food insecurity
• Impaired oral mucous membrane integrity
• Impaired swallowing
• Inaccurate information
• Inadequate appetite
• Inadequate caregiver knowledge of feeding strategies
• Inadequate caregiver knowledge of metabolic needs
• Inadequate caregiver knowledge of strategies to manage appetite
• Inadequate cooking skills
• Inadequate food supply
• Inadequate interest in food
• Inadequate knowledge of nutrient requirements
• Inadequate physical activity for nutrient absorption
• Inadequate social support
• Inappropriate management of food allergies
• Inappropriate utensils
• Interrupted chestfeeding
• Satiety immediately upon ingesting food
• Unaddressed inadequate dentition
• Unattractive food presentation
• Unpleasant ambient environment
• Unrealistic expectation of ability to ingest food
• Weakened muscles required for swallowing
• Weakening of muscles required for mastication

• Altered metabolism
• Body dysmorphic disorders
• Chronic diseases
• Digestive system diseases
• Immunosuppression
• Mental disorders
• Neoplasms
• Polypharmacy
• Sensation disorders

• Age, sex, height, and weight
• Gastrointestinal (GI) assessment, including antibiotic therapy, auscultation of bowel sounds, change in bowel habits, stool characteristics (color, amount, size, and consistency), history of GI disorder or surgery, inspection of abdomen, pain or discomfort, usual bowel elimination pattern, palpation for masses and tenderness, percussion for tympany and dullness, and nausea and vomiting
• Nutritional status, including change in type of food tolerated, financial resources, meal preparation, serum albumin level, sociocultural influences, usual dietary pattern, and weight fluctuations over past 10 years
• History of eating disorders
• Change in intrapersonal or interpersonal factors, including internal or external cues that trigger desire to eat, rate of food consumption, and stated food preference
• Cultural influences, including education level, occupation, nationality, or ethnic group; beliefs, values, and attitudes about health and illness; and health practices and customs
• Psychosocial status
• Activity level
• Coping behaviors
• Body image, including perception of observer and self-perception

• Abdominal cramping
• Abdominal pain
• Altered metabolism with elevation of resting energy expenditure
• Capillary fragility
• Constipation
• Delayed wound healing
• Diarrhea
• Excessive hair loss
• Food intake less than estimated requirements
• Food intake less than recommended daily allowance
• Hyperactive bowel sounds
• Inadequate head circumference growth for age and gender
• Increased muscle catabolism
• Inflammation
• Lethargy
• Low Z-Score for individual anthropometric measurement in children < 30g per day
• Muscle hypotonia
• Neonatal weight gain< 30g per day
• Pale mucous membranes
• Unaddressed hypoglycemia
• Underweight for age and gender
• Unintended weight loss despite adequate food intake

• Patient will show no further evidence of weight loss.
• Patient will tolerate oral, tube, or IV feedings without adverse effects.
• Patient will take in ___ calories daily.
• Patient will gain ___ lb weekly.
• Patient will identify emotional and psychological factors that interfere with eating.
• Patient will develop plan to monitor and maintain target weight at discharge.
• Patient and family members will communicate understanding of special dietary needs.
• Patient and family members will demonstrate ability to plan diet after discharge.
• Patient will use community resources to improve nutritional status as needed.

Suggested NOC Outcomes

• Obtain and record patient's weight at the same time every day to get accurate readings.
• Monitor fluid intake and output because body weight may decrease as a result of fluid loss.
• Maintain parenteral fluids as ordered to provide patient with needed fluids and electrolytes.
• Provide a diet prescribed for patient's specific condition to improve patient's nutritional status and increase weight.
• Determine food preferences and provide them within the limitations of patient's prescribed diet. This enhances compliance with diet regimen.
• Provide opportunities for patient to discuss reasons for not eating to help assess causes of eating disorder.
• Offer high-protein, high-calorie supplements, such as milkshakes, custard, and ice cream. Such foods prevent body protein breakdown and provide caloric energy.
• Serve foods that require little cutting or chewing to help prevent malingering at meals.
• Provide a pleasant environment at mealtime to enhance patient's appetite.
• Keep snacks at the bedside to give patient some control over eating time.
• With some patients, begin with nutritious liquids and gradually introduce solid food. Severely malnourished patient may not be able to chew solid foods immediately.
• Avoid asking whether patient is hungry or wants to eat. Be positive in offering food. A positive, undemanding attitude avoids confrontation with patient.
• Whenever possible, sit with patient for a predetermined length of time during each meal. This inhibits patient from dawdling during the meal and from hiding or hoarding food.
• Set a target weight and have patient record daily weight to involve patient in treatment.
• Monitor electrolyte levels and report abnormal values. Poor nutritional status may cause electrolyte imbalances.
• If patient vomits, record amount, color, and consistency. Keep a record of all stools. Vomitus and stool characteristics indicate status of nutrient absorption.
• Refer patient to a dietitian or nutritional support team for dietary management (possible regimens include yogurt feedings and low-bulk diet). Dietitian or nutritional support team can help patient and health care team individualize patient's diet within prescribed restrictions.
• If bottle-feeding, record the amount ingested at each feeding. If breastfeeding, record the number of minutes the neonate nurses at each feeding as well as ingestion of any supplement to aid in early recognition of inadequate caloric and fluid intake.
• Assess the parents' knowledge of feeding techniques. As needed, teach parents how much and how often to feed neonate, how to prepare formula, how to position neonate during and after feeding, and how to burp neonate. Early detection of knowledge deficits and appropriate instruction help eliminate misconceptions.
• If patient is receiving tube feeding:
  • Add food coloring if patient has an altered state of consciousness or diminished gag reflex to help detect aspiration.
  • If possible, use a continuous infusion pump for tube feeding to avoid diarrhea.
  • Begin the tube feeding regimen with a small amount and diluted concentration to decrease diarrhea and improve absorption. Increase the volume and concentration, as tolerated.
  • Keep the head of the bed elevated during tube feeding to reduce the risk of aspiration.
  • Check the feeding tube placement each shift to verify placement in the GI tract rather than in the lungs.
• If patient is receiving total parenteral nutrition:
  • Ensure delivery, as prescribed. Electrolytes, amino acids, and other nutrients must be tailored to patient's needs.
  • Monitor blood glucose levels and urine specific gravity at least once each shift.
  Because glucose is the main component of total parenteral nutrition, patient may become hyperglycemic if not carefully monitored.
• Monitor bowel sounds once per shift. Normal active bowel sounds may indicate readiness for enteral feedings; hyperactive sounds may indicate poor absorption and may be accompanied by diarrhea.
• Reinforce the medical regimen by explaining to patient and family members the reasons for the present regimen. Collaborative practice enhances patient's overall care.
• Teach the principles of good nutrition for patient's specific condition. This encourages patient and family members to participate in patient's care.
• Provide or assist with oral hygiene to help keep patient comfortable.
• Provide preoperative teaching, if needed, to reduce patient's fear and anxiety and promote understanding.
• Involve family members in meal planning to encourage them to help patient comply with the diet regimen after discharge.
• Identify patients who don't have resources to eat properly or who neglect nutritional needs. Nurses working in community settings frequently encounter patients whose nutritional needs aren't met. Nursing responsibilities include identifying these individuals and intervening on their behalf.
• Depending on patient's resources, help locate soup kitchens for the homeless, senior centers that serve meals for a nominal fee, Meals on Wheels, or similar programs to promote access to appropriate community resources.

Suggested NIC Interventions

• Patient remains at or above specified weight.
• Patient doesn't develop adverse reactions from feedings, such as aspiration of food particles into lungs, diarrhea, and hyperglycemia.
• Patient consumes specified number of calories daily.
• Patient's weight increases by specified amount weekly.
• Patient lists emotional and psychological factors that interfere with eating.
• Patient states plan to monitor and maintain specific target weight after discharge.
• Patient and family communicate understanding of special dietary needs, either verbally or through behavior.
• Patient and family plan appropriate diet for patient to follow after discharge.
• Patient uses community resources as needed.

• Daily weight
• Mouth care
• Maintenance of nasogastric tube
• Intake and output
• Bowel sounds
• Blood glucose levels
• Urine specific gravity
• Patient's ability to eat
• Incidence of vomiting or diarrhea
• Presence of other complications
• Patient's statements of understanding of dietary education
• Evaluations for expected outcomes

• Bishop, A., Witts, S., & Martin, T. (2018). The role of nutrition in successful wound healing. Journal of Community Nursing, 32(4), 44-50.
• de Ridder, D., Kroese, F., Evers, C., Adriaanse, M., & Gillebaart, M. (2017). Healthy diet: Health impact, prevalence, correlates, and interventions. Psychology & Health, 32(8), 907-941. doi:10.1080/08870446.2017.1316849
• Leonard, D., Aquino, D., Hadgraft, N., Thompson, F., & Marley, J. V. (2017). Poor nutrition from first foods: A cross-sectional study of complementary feeding of infants and young children in six remote Aboriginal communities across northern Australia. Nutrition & Dietetics, 74(5), 436-445. doi:10.1111/1747-0080.12386
• Palmeira, L., Cunha, M., & Pinto-Gouveia, J. (2018). The weight of weight self-stigma in unhealthy eating behaviours: The mediator role of weight-related experiential avoidance. Eating & Weight Disorders, 23(6), 785-796. doi:10.1007/s40519-018-0540-z