{
  "name": "Imbalanced Nutrition (Malnutrition)",
  "slug": "imbalanced-nutrition",
  "url": "https://nursingplex.com/care-plans/imbalanced-nutrition",
  "category": "Endocrine & Metabolic",
  "summary": "Intake below metabolic needs; calorie counts, supplements and dietitian collaboration.",
  "nursing_diagnoses": [
    "Imbalanced nutrition: less than body requirements",
    "Fatigue",
    "Risk for infection"
  ],
  "overview": [
    "Imbalanced nutrition: less than body requirements exists when intake of nutrients is insufficient to meet metabolic needs. It ranges from mild under-eating to protein-energy malnutrition with visible muscle and fat wasting.",
    "Hospitalized patients are especially vulnerable: illness raises requirements while nausea, pain, NPO orders, depression, dysphagia and unfamiliar food reduce intake. Malnutrition then delays wound healing, weakens immunity and respiratory muscles, and lengthens hospital stay.",
    "Nursing care starts with routine screening, then removes barriers to eating, fortifies what the patient does eat, and escalates to supplements or enteral support when oral intake cannot meet needs."
  ],
  "key_facts": [
    {
      "label": "Warning threshold",
      "text": "Unintentional loss of more than 5% of body weight in a month or 10% in six months is clinically significant."
    },
    {
      "label": "Screening",
      "text": "Use a validated tool such as MUST or MNA on admission and weekly thereafter."
    },
    {
      "label": "Prealbumin",
      "text": "Reflects recent protein status better than albumin, though both fall with inflammation."
    },
    {
      "label": "Use the gut",
      "text": "If the GI tract works, enteral feeding is preferred over parenteral nutrition."
    }
  ],
  "nursing_priorities": [
    "Identify malnutrition risk early with formal screening.",
    "Determine and address the barriers to eating.",
    "Increase calorie and protein delivery.",
    "Monitor weight, intake and laboratory trends.",
    "Escalate to supplements or tube feeding when needed."
  ],
  "assessment": {
    "subjective": [
      "Reports of poor appetite, early satiety, nausea or altered taste",
      "Reports of difficulty chewing, swallowing or affording food",
      "Complaints of fatigue and weakness",
      "Diet history showing inadequate variety or quantity"
    ],
    "objective": [
      "Low BMI or documented unintentional weight loss",
      "Temporal and interosseous muscle wasting, loss of subcutaneous fat",
      "Poor wound healing, pressure injuries, brittle hair and nails",
      "Low prealbumin, albumin, hemoglobin, lymphocyte count",
      "Documented intake below estimated needs on calorie counts"
    ],
    "related_factors": [
      "Anorexia from illness, medication or depression",
      "Nausea, vomiting, pain, dysphagia or oral disease",
      "Increased requirements from sepsis, burns, cancer or surgery",
      "Malabsorption syndromes",
      "Poverty, isolation and limited food access"
    ]
  },
  "goals": [
    "The client will consume at least the prescribed percentage of meals.",
    "The client will gain weight at the agreed rate.",
    "The client will show improving prealbumin and wound healing.",
    "The client will identify high-protein, high-calorie food choices."
  ],
  "interventions": [
    {
      "title": "Assess and measure",
      "points": [
        "Perform a validated nutrition screen on admission and weekly.",
        "Weigh at the same time using the same scale and record percentage of meals eaten.",
        "Complete a calorie count when intake is questionable.",
        "Review labs and consult the dietitian early."
      ]
    },
    {
      "title": "Remove barriers",
      "points": [
        "Treat pain, nausea and constipation before meals; schedule analgesia and antiemetics accordingly.",
        "Provide oral care before eating and ensure dentures fit.",
        "Minimize procedures and unpleasant sights and smells at mealtimes.",
        "Reschedule NPO tests promptly and re-order missed meals."
      ]
    },
    {
      "title": "Increase intake",
      "points": [
        "Offer small frequent nutrient-dense meals and preferred foods, including family-brought items when allowed.",
        "Fortify foods with milk powder, butter, cheese or protein supplements.",
        "Provide feeding assistance, adaptive utensils and proper upright positioning.",
        "Advocate for enteral feeding if oral intake remains inadequate after a defined trial."
      ]
    }
  ],
  "patient_teaching": [
    "Teach high-protein, high-calorie choices that fit budget and preference.",
    "Encourage eating by the clock rather than waiting for appetite.",
    "Explain how to use oral nutrition supplements between rather than with meals.",
    "Advise weighing weekly at home and reporting continued loss."
  ]
}