Failure to Thrive in Adults

Failure To Thrive Adults Nursing Care Plans Diagnosis and Interventions

Failure To Thrive Adults NCLEX Review Care Plans

Nursing Study Guide for Failure to Thrive in Adults

Failure to thrive (FTT) in adults is defined as a weight loss of more than 5%, decreased appetite, poor nutrition, and physical inactivity.

These 4 criteria can be present in a wide range of diseases from neurologic, psychiatric, endocrine, infectious, and gastrointestinal, among others. Weight loss of 5% alone is already considered a red flag and could be a symptom of life-threatening disorders, such as malignancies.

Nursing Stat Facts 1

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Nursing Stat Facts 1

Adult FTT is common in the elderly age group due to their increased vulnerability not only physically but also socially and mentally.

The mechanism by which a person fails to thrive can be multifactorial. Endocrine disorders such as hyperthyroidism and malignancies increase the body’s metabolism and thus result in weight loss.

Gastrointestinal disorders like malabsorption syndromes and psychiatric disorders like bulimia nervosa and poor appetite due to depression decrease the body’s intake of nutrients.

Some medications may also cause weight loss and decreased appetite by their action on the brain’s satiety center.

Signs and Symptoms of Failure to Thrive

It is important to know the associated signs and symptoms for the various diseases that cause failure to thrive in adults to detect a disease early. These include:

  1. General Signs and Symptoms
  • Any recent and/or rapid weight of more than 5% of body weight.
  • Change in appetite
  • Physical inactivity
  • Signs of poor nutrition such as
    •  thinning hair
    • teeth falling off
    •  dry skin
    •  decreased energy
    •  frequent infections
    • pale and sallow skin

2. Signs and symptoms associated with specific disorders

  • Always worried and anxious
  • Loss of interest in activities that a person used to find pleasurable
  • Inability to initiate or maintain sleep
  • Excessive sleeping
  • Hallucinations
  • Irritability
  • Mood swings
  • Motor weakness
  • Chronic headache
  • Fatigue
  • Frequent urination
  • Being thirsty all the time
  • Tremors
  • Bulging eyeballs
  • Generalized itching
  • Being hungry all the time
  • Irregular menstrual cycles
  • Palpable mass
  • Gastrointestinal bleeding
  • Coughing out of blood
  • Recurrent abdominal pain
  • Blood in the urine
  • Ascites
  • Chronic cough

Causes of Failure to Thrive in Adults

Most conditions that affect the body’s metabolism and nutrient intake will cause failure to thrive. These diseases may be organic or functional.

  • Stress and Anxiety
  • Depression
  • Uncontrolled blood sugar e.g., Diabetes Mellitus
  • Hypermetabolic states e.g., Hyperthyroidism
  • Intestinal Parasitism
  • Malignancies
  • Malabsorption syndromes such as gluten sensitivity
  • Physical, Mental, Emotional, and Sexual abuse
  • Alcoholism
  • Recreational Drug Abuse
  • Chronic infections such as Tuberculosis
  • Food deprivation
  • Medications that affect the hypothalamic-pituitary axis
  • Connective tissue disorders
  • Autoimmune disorders
  • Acquired immune deficiency syndrome

Nursing Care Plan for Failure to Thrive in Adults

  1. Possible Nursing Diagnoses

2. Nursing Assessment

InterventionRationale
Complete the patient’s general data and history using the standard hospital forms. Pertinent data to be included are:
Name
Age
Gender
Marital Status
Religion
Address
Chief Complaint
History of Present Illness
Past Medical History
Personal and Social History
Family History
Obstetric history for females
Sexual history
Physical Examination findings
Admitting Impression
A complete history and physical examination ensure that all possible causes of failure to thrive are covered. Some data may appear irrelevant at first but may turn out to be contributory to the diagnosis and management.
Assess the patient’s awareness of his/her condition and reasons for seeking medical intervention.Some patients seek consultation not just because of their signs and symptoms but also to escape from stressors that may be the reason they are failing to thrive. Identifying this early on will result in timely management.
Get the patient’s consent for medical intervention and care and explain the reason for each.An informed patient is an empowered patient. Patients become more cooperative with their treatment plans if they know about what’s going on.
Obtain vital signs such as blood pressure, temperature, heart rate, respiratory rate, oxygen saturation, height, and weight.These vital signs are the basic indicators of underlying pathologic processes. Any derangement will show up as abnormal values and point to the possible etiology of the condition.
Obtain a list of medications that the patient is currently taking including details such as dosage, drug strength, frequency, brand names, and status of compliance.Some medications may suppress appetite or cause malabsorption of certain nutrients. The indications for such medications also provide a background of the severity of illness and the patient’s risk for failure to thrive e.g., chronic kidney disease (CKD) medication for a diabetic patient.
Check the results of the initial lab tests and refer to the physician.Baseline values of laboratory tests add valuable data to the initial impression generated from history and physical examination. Low values for electrolytes like sodium, potassium, and calcium are evident in malnutrition.
Bring the patient for imaging studies such as chest x-ray and CT scan.Like the laboratory tests, imaging aids in the diagnosis of the patient’s underlying condition. Tuberculosis and lung malignancies can be identified with imaging studies.

3. Nursing Planning and Intervention

InterventionRationale
Educate the patient on nutrition and the importance of proper food intake to maintain a healthy body.Some adults with failure to thrive are not aware that they are deliberately depriving their bodies of important nutrients with extreme dieting. Patients with chronic illnesses such as diabetes may not be aware of the specialized diet that they need to follow. Informing patients of the importance of proper diet increases their chances of recovery.
Collect body fluid samples for monitoring such as CBC, blood glucose level, thyroid function tests, liver function tests, urinalysis, stool, tumor markers, electrolytes.As the reasons for failure to thrive can be varied, monitoring for changes in laboratory parameters is important in preventing life-threatening emergencies like hypokalemia, hyperglycemia, and hyponatremia as well as arriving with the right diagnosis.
Checking for signs of self-harm and putting away sharp objects.Because depression, anxiety, and stress are major causes of failure to thrive, it is a must that precautions against self-harm are in place to prevent suicide events.
Checking for adequate food intake.Intake of the right caloric requirements is one of the most important factors to monitor since weight loss is a major feature of failure to thrive.
Assisting in passive exercises to regain strength and muscle bulk.Muscle atrophy is quite common in patients with failure to thrive. They need assistance in the initial phases of their exercises to perform correctly. The encouragement will also boost their morale.
Educate the patient on mindfulness activities to lessen anxiety.Suggesting calming mindfulness activities can help with stress and anxiety and improve their appetite
Educate patients on the danger of taking medications that are not prescribed by the doctor.A portion of patients with failure to thrive have anorexia nervosa and may be taking medications that are self-prescribed leading to incorrect dosage and dangerous side effects.
Educate the family members and immediate relatives on the importance of family support.Patients with supportive families recover quickly and are less prone to recurrence. Such information can also help them to identify other family members and friends who are suffering from the same condition.
Let patient vent out and talk about life stresses and identify possible stressors.Identifying the stressor and eliminating it will be significant to avoid recurrence of the condition.
Refer the patient to other health care specialties as needed. These teams may include:
Nutritionist
Psychiatric service
Neurologic service
Endocrine service
Gastrointestinal service
Oncology service
Protection services such as police and legal
ENT service
Group therapy
Social Workers
Protection against women and children
Labor Union
Labor protection services
Insurance services
Child care a services
Dental Services
To gather a multidisciplinary team for a more effective holistic management of the patient.

4. Nursing Evaluation

InterventionRationale
Assess the patient’s willingness to follow dietary guidelines as prescribed by the nutritionist.Consistency is the key to successful treatment outcomes. Diligently following the management plan is of vital importance to maintain the patient’s recovering state.
Assess for new-onset symptoms.Some illnesses may masquerade as another illness and may only be diagnosed upon the emergence of other associated symptoms.
Assess for the severity of existing symptoms such using standardized scales such as the FACES scale for pain.Any change in the intensity, frequency, and location of existing symptoms could imply an ongoing pathologic process that needs immediate attention.
Monitor the vital signs, pain status, and patient’s general well-being.To assess the response to treatment and monitor for side effects brought about by medications, procedures, and other interventions.
Assess the patient’s adherence to treatment and supportive management.Continuous compliance to treatment and management indicates good insight on the patient while poor compliance might need additional intervention.
Monitor for signs of recent self-harm and substance abuse.Most patients hide their harmful tendencies from health workers and caregivers and tend to give alibis. It is important to detect if such activities are still ongoing.

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines, policies, and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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