Imbalanced nutrition: less than body requirements is when an individual fails to consume sufficient nutrients to meet metabolic needs. This nursing diagnosis focuses on identifying and addressing inadequate nutritional intake, preventing complications, and promoting optimal nutritional status.
Causes (Related to)
Imbalanced nutrition can occur due to various factors that affect a patient’s ability or willingness to maintain adequate nutritional intake:
- Physiological Factors
- Inability to ingest food
- Difficulty swallowing (dysphagia)
- Nausea and vomiting
- Poor appetite
- Altered metabolism
- Psychological Factors
- Depression
- Anxiety
- Eating disorders
- Poor body image
- Social and Economic Factors
- Limited access to food
- Financial constraints
- Lack of knowledge about nutrition
- Cultural beliefs affecting food choices
- Medical Conditions
- Cancer
- Gastrointestinal disorders
- Chronic diseases
- Recovery from surgery
- Dementia
Signs and Symptoms (As evidenced by)
Subjective: (Patient reports)
- Decreased appetite
- Early satiety
- Fatigue
- Weakness
- Food aversions
- Difficulty swallowing
- Abdominal pain
- Weight loss
Objective: (Nurse assesses)
- Weight loss of ≥5% in 1 month or ≥10% in 6 months
- Body mass index (BMI) below normal range
- Poor muscle tone
- Decreased subcutaneous fat
- Poor wound healing
- Laboratory values indicating malnutrition
- Pale mucous membranes
- Dry, brittle hair and nails
Expected Outcomes
The following outcomes indicate successful management of imbalanced nutrition:
- The patient will demonstrate weight gain or maintenance
- The patient will consume 75-100% of daily nutritional requirements
- The patient will maintain an adequate hydration status
- The patient will show improved laboratory values
- The patient will demonstrate increased energy levels
- The patient will report an improved appetite
- The patient will show signs of proper wound healing
Nursing Assessment
1. Evaluate Nutritional Status
- Calculate BMI
- Measure weight and track changes
- Assess muscle mass and fat stores
- Review dietary intake
- Check skin integrity
2. Monitor Physical Signs
- Assess vital signs
- Check laboratory values
- Evaluate wound healing
- Monitor energy levels
- Assess oral health
3. Review Contributing Factors
- Assess the ability to obtain and prepare food
- Evaluate swallowing ability
- Check psychological status
- Review medication effects
- Assess knowledge of nutrition
4. Document Intake
- Monitor meal consumption
- Track fluid intake
- Record supplements taken
- Note food preferences
- Document feeding ability
5. Assess for Complications
- Monitor for signs of malnutrition
- Check for pressure ulcers
- Assess for infections
- Monitor organ function
- Evaluate mental status
Nursing Care Plans
Nursing Care Plan 1: Inadequate Dietary Intake
Nursing Diagnosis Statement:
Imbalanced Nutrition: Less Than Body Requirements related to the inability to ingest adequate nutrients as evidenced by weight loss of 10% body weight in the past 3 months and BMI of 17.5.
Related Factors:
- Poor appetite
- Difficulty swallowing
- Inadequate food intake
- Physical weakness
Nursing Interventions and Rationales:
- Assess current dietary intake and preferences
Rationale: Establishes baseline and identifies areas for improvement - Provide small, frequent meals
Rationale: Increases total daily intake when appetite is poor - Monitor weight daily
Rationale: Tracks effectiveness of nutritional interventions
Desired Outcomes:
- The patient will demonstrate weight gain of 1-2 pounds per week
- The patient will consume 75% or more of meals
- The patient will verbalize understanding of nutritional needs
Nursing Care Plan 2: Impaired Swallowing
Nursing Diagnosis Statement:
Imbalanced Nutrition: Less Than Body Requirements related to dysphagia as evidenced by difficulty swallowing and fear of choking.
Related Factors:
- Neurological impairment
- Muscle weakness
- Anxiety about choking
- Structural abnormalities
Nursing Interventions and Rationales:
- Implement swallowing precautions
Rationale: Prevents aspiration and promotes safe intake - Position patient upright for meals
Rationale: Facilitates proper swallowing mechanics - Modify food consistency as needed
Rationale: Ensures safe and adequate intake
Desired Outcomes:
- The patient will demonstrate safe swallowing techniques.
- The patient will maintain adequate nutritional intake
- The patient will show no signs of aspiration
Nursing Care Plan 3: Knowledge Deficit
Nursing Diagnosis Statement:
Imbalanced Nutrition: Less Than Body Requirements related to insufficient knowledge of nutritional requirements as evidenced by poor food choices and inadequate meal planning.
Related Factors:
- Limited nutritional knowledge
- Cultural beliefs
- Misconceptions about healthy eating
- Lack of cooking skills
Nursing Interventions and Rationales:
- Provide nutritional education
Rationale: Improves understanding of dietary needs - Teach meal-planning strategies
Rationale: Enables better food choices and preparation - Demonstrate portion control
Rationale: Ensures appropriate intake amounts
Desired Outcomes:
- The patient will demonstrate an understanding of proper nutrition
- The patient will make appropriate food choices
- The patient will plan balanced meals independently
Nursing Care Plan 4: Financial Constraints
Nursing Diagnosis Statement:
Imbalanced Nutrition: Less Than Body Requirements related to insufficient financial resources as evidenced by the inability to purchase adequate nutritious food.
Related Factors:
- Limited income
- Lack of transportation
- High food costs
- Limited access to food sources
Nursing Interventions and Rationales:
- Connect with social services
Rationale: Provides access to food assistance programs - Teach budget-friendly meal planning
Rationale: Maximizes available resources - Identify community food resources
Rationale: Ensures consistent access to nutrition
Desired Outcomes:
- The patient will obtain adequate food supplies
- The patient will utilize available food resources
- The patient will maintain a stable weight
Nursing Care Plan 5: Psychological Barriers
Nursing Diagnosis Statement:
Imbalanced Nutrition: Less Than Body Requirements related to depression and anxiety as evidenced by decreased appetite and minimal food intake.
Related Factors:
- Depression
- Anxiety
- Poor motivation
- Altered body image
Nursing Interventions and Rationales:
- Provide emotional support
Rationale: Addresses psychological barriers to eating - Establish regular meal routines
Rationale: Creates structure and accountability - Monitor mood and anxiety levels
Rationale: Identifies impact on nutritional intake
Desired Outcomes:
- The patient will demonstrate an improved appetite
- The patient will maintain a regular meal schedule
- The patient will show reduced anxiety around eating
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Massironi S, Viganò C, Palermo A, Pirola L, Mulinacci G, Allocca M, Peyrin-Biroulet L, Danese S. Inflammation and malnutrition in inflammatory bowel disease. Lancet Gastroenterol Hepatol. 2023 Jun;8(6):579-590. doi: 10.1016/S2468-1253(23)00011-0. Epub 2023 Mar 15. PMID: 36933563.
- Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
- Teixeira, I. X., Lopes, M. V. D. O., Martins, L. C. G., Diniz, C. M., De Menezes, A. P., & Alves, N. P. (2016). Validation of Clinical Indicators of Imbalanced Nutrition: Less Than Body Requirements in Early Childhood. Journal of Pediatric Nursing, 31(2), 179-186. https://doi.org/10.1016/j.pedn.2015.02.011
- Williams KJ, Wu X. Imbalanced insulin action in chronic over nutrition: Clinical harm, molecular mechanisms, and a way forward. Atherosclerosis. 2016 Apr;247:225-82. doi: 10.1016/j.atherosclerosis.2016.02.004. Epub 2016 Feb 13. Erratum in: Atherosclerosis. 2021 Jul;328:60-61. doi: 10.1016/j.atherosclerosis.2021.05.021. PMID: 26967715.
