Wednesday, February 3, 2010

Alteration in Nutrition: Less Than Body Requirements

Alteration in Nutrition: Less Than Body Requirements

SCENARIO: Former baseball player Rick Bender speaks at UVSC about surviving oral cancer caused by chewing tobacco. He lost part of his tongue and jaw in surgeries.
Surgeons successfully removed the cancerous cells from Bender's mouth and throat, taking a chunk of his tongue and the lymph nodes on the right side of his neck in the process. But removing the cancer also caused nerve damage that limited the use of his right arm, a tough blow to the former minor league baseball player.
His right arm, after all, was his throwing arm. Radiation therapy later caused an infection in the right side of Bender's jaw. As a result, it deteriorated and doctors had to remove it.

Nursing Diagnosis: Alteration in Nutrition: Less Than Body Requirements

Related to : conditions that interfere with nutrient need or increase nutrient need/metabolic demand; eg, cancer ( mouth cancer), surgery, dysphasia/difficulty swallowing.
Possible evidence by: body weight 10% or more under ideal, decreased fat, muscle mass, poor muscle tone.
Desired outcome/evaluation criteria- patient will:
NUTRITIONAL STATUS
Demonstrate stable weight or progressive weight gain toward goal with normalized of laboratory values and no signs of malnutrition.


NURSING DIAGNOSIS GOALS
SHORT TERM
LONG TERM IMLEMENTATIONS RATIONALE EVALUATION
Nursing Diagnosis: Alteration in Nutrition: Less Than Body Requirements Patient will get used to the diet regimen by the end of week.
Assess gag reflex, ability to chew and swallow and motor skills. May require additional interventions ex: retraining by dysphasia expert( speech therapist) or long term nutritional support.

Patient will adapt and feel comfortable with the new eating regimen within 1 month Consult with dietitian re:

* calorie count
* change in food consistency
* spacing meals
* provision of high protein supplementation
* food intolerances/preferences
* extra fluids on tray
* dietetic teaching, food selection
* therapeutic diet restrictions
Recommenend client a /SO keep a food dairy, including estimation of ingested caloreis, elcetrolytes of indiviaul concern( eg: sodium, chloride, magnesium, phosphorous) and protein helps patient relaize big picture and allows opportunity to alter dietary choices to meet individual desires within identified restrictions
Encourage client to participate in menu planning:_- -------- may enhance oral intake and promotes sense of control responsibility.
Provide small frequent meals and snacks: ---------helps prevent gastric distention/ discomfort and may enhance intake.
Encourage patient to sit up for meals and visit with others--------- ----sitting helps prevent aspiration and aids in proper digestion of food. Socailition promotes relaxation and may enhance intake.
Encourage patient to participate in menu planning May enhance oral intake and promotes sense of control responsibility.

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