Malnutrition Nursing Diagnosis and Nursing Care Plans

Malnutrition Nursing Care Plans Diagnosis and Interventions

Malnutrition NCLEX Review and Nursing Care Plans

Malnutrition is a condition in which a person’s diet is deficient in one or more essential nutrients. It can cause major health problems, such as growth retardation, vision problems, diabetes, and cardiovascular disease.  

There are a lot of people suffering from malnutrition. Certain types of malnutrition are more common in some groups than others due to factors such as lifestyle, geography, and access to food. The following sections will discuss malnutrition in detail.  

Types of Malnutrition

  1. Undernutrition. This form of malnutrition is caused by a lack of calories, protein, and micronutrients in the diet. The result is a decrease in the weight-for-height index, stunting, and considerable change in BMI (underweight).
  2. Overnutrition. This form of malnutrition commonly results in obesity and weight gain (overweight). Malnutrition can also result from excessive fat, protein, and caloric intake. 

Signs and Symptoms of Malnutrition

The signs and symptoms of malnutrition may vary depending on the type of malnutrition experienced. In order to aid patients and healthcare practitioners in diagnosing and treating nutritional deficiencies, it is necessary to understand the signs and symptoms of malnutrition.

Undernutrition: Undernutrition is most commonly caused by a lack of sufficient nutrients in one’s diet. Undernourished individuals may exhibit one or more of the symptoms listed below:

  • Fatigue
  • Reduced concentration
  • Weight loss
  • Hollow cheekbones and sunken eyes
  • Dry skin
  • Flaky skin
  • Slow wound healing
  • Irritability
  • Anxiety
  • Bloated stomach
  • Reduced lean mass

Undernourishment can lead to major physical and health problems, which in turn can raise the chance of death. Specific symptoms distinguish some forms of undernutrition.

Kwashiorkor patients experience fluid retention and a protruding abdomen as a result of protein deficiency.

On the other hand, Marasmus is a disorder caused by a severe calorie deficit resulting in wasting and considerable fat and muscle mass loss.

Vitamin deficits are also caused by malnutrition. Some of the most frequent deficits and their associated symptoms are as follows:

  • Vitamin A deficiency is associated with dry eyes and an increased risk of infection. This can also worsen childhood infections and potentially cause mortality. 
  • Iron deficiency causes impaired cognitive function, trouble controlling body temperature, and stomach problems. 
  • Iodine deficiency causes thyroid gland enlargement (goiters), decreased thyroid hormone production, problems with growth and development.
  • Zinc deficiency causes loss of appetite, slowed growth, delayed wound healing, hair loss, and diarrhea. 
  • Vitamin D Deficiency can cause rickets, a juvenile illness that causes skeletal abnormalities (soft bones) in children.

Whereas over-nourished patients are more prone to the development of these diseases:

Causes of Malnutrition

Malnutrition may be caused by a variety of factors. A brief description of these causes is provided in the following.

  1. Lack of adequate and inexpensive food
  2. Food instability
  3. Inadequate dietary consumption. It is possible to become malnourished due to a lacking dietary intake. Patients who have trouble digesting or absorbing nutritional components may also suffer from malnutrition. This can happen as a result of:

  • Malignancies
  • Liver disease
  • Oral health issues
  • Poor oral hygiene routine
  • Poorly fitting dentures
  • Mental illness
  • Nausea inducing medications
  • Nausea inducing conditions

4. Diagnoses of mental illness. Individuals who are malnourished may suffer from the following:

5. Problems with social interaction and mobility. Malnutrition is more likely among people who are fragile, have poor movement, or lack muscle power because of their inability to collect and prepare meals. These challenges hinder food preparation.  

6. Deficiencies in nutrient absorption. These may include diseases such as celiac disease, Crohn’s disease, and systemic infection in the intestines.

7. Heavy alcohol consumption. Alcohol includes calories; thus, a chronic alcohol user may not feel hungry after drinking.

Consequently, they may not consume enough nutrients to meet the body’s needs. Aside from that, gastritis and pancreatic damage can result from excessive alcohol use.

These problems can impede digestion, vitamin absorption, and the production of hormones that control metabolism.

Risk Factors for Malnutrition

  • Individuals who live in poor countries or locations with restricted access to food
  • Pregnant and breastfeeding women, as well as children, are particularly vulnerable to malnutrition. 
  • People who have gastrointestinal issues, particularly those with malabsorption syndrome
  • Individuals that are struggling financially
  • Elderly, especially those who live alone or are disabled. Nutritional status can be adversely affected as a result of aging. Because of physiologic changes, such as difficulty in swallowing, chewing, and the decline in the sense of taste and smell, the desire to eat or consume meals is decreased.

Diagnosis of Malnutrition

  • Screening and Physical Examination. When a patient is being screened for malnutrition, healthcare providers tend to check for indicators of malnutrition.
  • Body Mass Index Charts. 
  • Blood tests
  • History of weight loss

On the other hand, diagnosing vitamin deficiencies caused by overnutrition might be more challenging.

Obese people who eat largely processed meals may be deficient in nutrients, vitamins, and minerals. Consider discussing with a physician to determine nutrient deficiencies. 

Treatment for Malnutrition

  1. Identifying and addressing the underlying problems. Treatment for malnutrition depends on the type and severity. In more serious situations, hospitalization may be necessary. It is also important to remember that certain digestive issues might lead to malnutrition. One of the primary reasons for this is that a person’s body is unable to absorb nutrients because food cannot be digested properly. 
  2. Treatment of underlying infections. Tuberculosis, HIV/AIDS, and malaria are linked to protein-energy malnutrition, a significant yet undermined determinant in susceptibility to infection.
  3. Provide supplementation of zinc, iron, iodine, and other food supplements. The supplementation of additional nutrients may be necessary if dietary changes are insufficient. Supplementation should only be done under the guidance of a qualified healthcare provider.
  4. Dietary changes. This includes tailoring an individualized dietary plan, consumption of meals that is rich in nutrients (e.g., fruits and vegetables)
  5. Tube feedings. Alternative methods of nutrient intake may be necessary if the patient is unable to consume meals to meet their body’s requirements, such as if they have dysphagia or difficulties with swallowing.

Overall, the most effective treatment options may be contingent on identifying the source of malnutrition.

Prevention of Malnutrition

  • Having a dietary plan that is both nutritious and well-balanced
  • Make eating and exercising a social event.
  • For undernourished individuals, enhance the flavor of food by adding seasonings (if not contraindicated)
  • Consider incorporating vitamins and supplements into the diet.
  • Encourage physical activity for over-nourished individuals.

Nursing Diagnosis for Malnutrition

Malnutrition Nursing Care Plan 1

Nursing Diagnosis: Imbalanced Nutrition: Less than the body requirements related to reluctance to consume meals, secondary to malnutrition as evidenced by an imbalance in electrolytes, ineffective healing of wounds, reductions in the level of protein, transferrin, and serum albumin concentration, loss of muscle tone and a weight decrease of less than 20%. 

Desired Outcome:

  • The patient will maintain a healthy weight, as demonstrated by steady or improved albumin levels.
Malnutrition Nursing InterventionsRationale
Assess the patient’s body weight in relation to his/her age and height.Consult a dietician for an in-depth review of the patient’s nutritional state and available nutritional support. Experts (e.g., nutritionists) can use nitrogen balance to measure the patient’s nutritional state. Protein deficiency may result from a low nitrogen balance, necessitating further intervention. Additionally, the dietician can determine the patient’s daily dietary needs. 
Make a report on the patient’s actual weight and not an approximation.  It is critical that the anthropometric evaluations are exact and correct because this information will be used to calculate all of the patient’s dietary requirements.  
Involve the patient’s close family members and significant others in the process of taking a nutritional history.For patients with impaired perception, family members may be able to provide more accurate information on their food intake.  
Evaluate the patient’s laboratory results.The results of laboratory testing are crucial in establishing the nutritional condition of a patient.
Observe the patient’s eating environment.Most individuals choose quick, low-nutrient meals such as fast food in order to accommodate their busy schedules. As a result of the lower nutritional value of these eat-on-the-go meals, they are unable to achieve their daily dietary requirements.
Check for physical signs of malnutrition.Nutritional deficits can make a patient appear lethargic and exhausted. Other signs and symptoms include decreased concentration, paleness, dry skin, confusion, loss of subcutaneous tissue, dullness and brittle hair, swollen tongue, etc. Patients may have tachycardia and increased blood pressure reading on their vitals. There may also be paresthesias involved.
Establish realistic short- and long-term goals for the patient. When patients have short-term objectives that he/she can achieve, they become more engaged in the process of recovery. 
Assist in creating a relaxing atmosphere for the patient.Having a calm and comfortable environment can assist the patient in de-stressing and make eating a more pleasurable experience.
If not contraindicated, consider seasoning for patients who have an impaired sense of taste.Seasoning may enhance the flavor of meals and make them more appealing to eat.
Recommend adaptive equipment as prescribed by an occupational therapist to patients with physical disabilities.An expert may provide the patient with specialized apparatus to assist him/her in self-feeding. 
In the case of patients who have difficulty swallowing, consult with a speech therapist for evaluation and guidance.The speech therapist can help the patient with their nutritional intake by adjusting meal thickness and consistency.

Malnutrition Nursing Care Plan 2

  • Nursing Diagnosis: Fatigue related to diminished metabolic energy production and state, secondary to malnutrition, as evidenced by a reduced concentration level, expresses an extreme lack of energy, lethargic or sluggish, inability to perform desired activities, and increased rest needs.

 Desired Outcomes: 

  • The patient will be able to identify the source of his/her exhaustion and the areas in which he/she has control.
  • The patient will report feeling less fatigued and more capable of completing his/her tasks.
Malnutrition Nursing InterventionsRationale
Ask the patient about his/her feelings. Note his/her description of the fatigue by providing a scale and additional aids.Scales such as 1 to 10 can assist a patient in determining their level of exhaustion/fatigue. Pictures and descriptive words can also be used to construct additional rating scales.
Ascertain that the patient is receiving enough intake of nutrition to meet his/her metabolic demands.One of the most prevalent symptoms of malnutrition is recurrent fatigue, which can be caused by malnutrition (possibly brought on by protein-calorie malnutrition, vitamin deficiencies, or anemia). Those who do not consume enough calories, protein, and nutrients will not be able to perform at their peak levels.
Assess the patient’s prospects for fatigue alleviation. Evaluate his/her willingness to participate in fatigue-reduction activities and the patient’s level of support they receive from family and friends.These techniques will encourage patients to take an active role in developing, implementing, and evaluating their own treatment plans for fatigue relief. The patient’s social support will be crucial in helping him, or her implement modifications to reduce exhaustion.
Ascertain that the patient is receiving adequate nutrition.In order to maintain enough energy reserves, the patient will require a nutritionally balanced diet. The diet should be rich in nutrients such as carbs, fats, proteins, minerals, and vitamins. 
Ask the patient to keep a journal to record and track his/her level of exhaustion or activity. The energy level in malnourished patients is typically lower than that in a healthy person. Thereby, minimizing the use of energy is essential. In order to help the patient identify energy drains, to establish links between different activities and fatigue levels. Journaling daily can help patients determine the times of day in which they are most rested. This information can assist the patient in making more informed decisions on how to best utilize periods of high energy levels.

Malnutrition Nursing Care Plan 3

  • Nursing Diagnosis: Risk for Deficient Fluid Volume related to restriction on fluids, secondary to malnutrition, as evidenced by inadequate hydration, generalized nerve discomfort in the abdomen and pelvis, nausea, vomiting, diarrhea, and post obstructive diuresis.

Desired Outcomes:

  • The patient will demonstrate normal skin turgor.
  • The patient’s vital signs are within normal range.
  • The patient’s weight is within the normal range.
Malnutrition Nursing InterventionsRationale
Assess the vital signs of the patient. Take note of the following: capillary refill (CRT), mucous membranes, and skin turgor.Assessing the changes in the patient’s vital signs can provide early indications of inadequate circulating fluid. Postural hypotension can occur due to injury and risk of falls after suddenly shifting the body position (e.g., standing, sitting)
Observe the type of food and volume of fluid consumed by the patient. Measure the volume of urine output. Dehydration may be caused by the patient’s behaviors where he/she may regurgitate, eliminate, or abstain from all types of intake. He/she could also substitute fluid in place of calories, which in turn disrupts the fluid balance in the body.
Educate the patient on the use of laxatives and diuretic medications. Assist him/her in employing techniques to prevent vomitingAssisting the patient in his/her routine can alleviate negative feelings that may lead to vomiting and laxative use. This is especially true in cases of disturbed body image and for patients suffering from bulimia. Patients with bulimia tend to view vomiting as a stress-relieving mechanism. By lending the patient a helping hand, dehydration or continuous fluid loss may be prevented.
Assess the patient’s fluid balance and determine the steps necessary to restore or maintain it. Establish a specific schedule for fluid consumption if required. Correcting fluid imbalances is more likely to succeed if the patient is involved in the process of planning. Thus, ensuring that the patient is adequately hydrated minimizes the risk of illness and infection.
Examine the results of renal function and electrolyte testing.Patient recovery and prognosis can be adversely affected by fluid retention, electrolyte changes, and impaired renal function. Evaluating this information may help identify the need for further intervention.

Malnutrition Nursing Care Plan 4

  • Nursing Diagnosis: Risk for Impaired Skin Integrity related to loss of subcutaneous fat, secondary to malnutrition, as evidenced by inadequate dietary intake, anorexia, nausea, vomiting, and difficulty to absorb nutrients.

Desired Outcomes:

  • The patient will exhibit intact skin or tissues with absent excoriation.
  • The patient will indicate the absence of pruritus/scratching.
Malnutrition Nursing InterventionsRationale
Monitor the patient’s skin and note any areas that appear excoriated, irritated, scalded, or inflamed.In order to ensure the integrity of the skin, an accurate and comprehensive skin assessment is essential. However, if these symptoms are present, this potentiates the risk of skin breakdown, which may necessitate more intensive treatment. Moreover, early detection of these symptoms is critical in determining whether or not the patient is suffering from another condition.
Use less pressure and massage the skin lightly, especially around the bony prominences.This increases blood flow to the skin, which brightens the complexion. Besides improving the skin’s appearance, massage is considered therapeutic, especially for pediatric patients.
Encourage the application of moisturizers and creams twice daily and immediately after showering.It reduces itchiness by lubricating the skin. Patients who are malnourished tend to have dry, thick skin that is easily bruised; therefore, moisturization is necessary to keep the skin’s integrity and, as a result, limit the likelihood of infection from occurring.
Instead of showering daily, suggest bathing on alternate days.One of the symptoms of malnutrition is having dry, thick skin. In order to prevent skin breakdown from happening, it is important to prevent frequent bathing since it causes the skin to become dry and flaky.
Educate the patient on the importance of regular movements, posture corrections, and changes. Insist on being active.Improves skin circulation and perfusion by reducing long-term strain on the tissues.
Ascertain that the patient consumes a nutritionally balanced diet that includes adequate hydration.Maintaining a healthy balance in dietary and fluid consumption will help to improve the state of the patient’s skin.

Malnutrition Nursing Care Plan 5

  • Nursing Diagnosis: Deficient Knowledge related to unreliable or incomplete information on undernutrition and overnutrition, secondary to malnutrition, as evidenced by frequent requests for information about obesity and dietary factors, verbalized weight loss issues, and insufficient adherence to previous dietary or exercise recommendations. 

Desired Outcomes: 

  • The patient will articulate their knowledge of the necessity of making lifestyle adjustments to maintain or control their weight.
  • The patient will set a personal goal and devise a plan to achieve it.
  • The patient will begin to search for information on overnutrition and undernutrition.
Malnutrition Nursing InterventionsRationale
Evaluate the patient’s nutritional knowledge and comprehension, including his/her perception of the most pressing need.This is critical since it will determine the additional information required. Building trust begins with listening attentively to the patient’s concerns and questions.
Educate the patient on strategies for achieving adequate food intake and a balanced diet when he/she is away from the comfort of their homes.To keep weight under control while having fun socially, using “smart” eating strategies, whether dining out or traveling, is advisable. Refer the patient to additional sources of information (for overnutrition and malnutrition), such as books, audiotapes, community classes, and other organizations.
Identify alternatives to the chosen activity program to meet the patient’s travel and weather conditions, and other concerns. Discuss the application of mechanical aids and equipment to aid in the reduction process. This ensures the continuation of the program. Despite the lack of evidence that spot reduction or mechanical gears can assist people in losing weight, certain activities or equipment may be able to tone certain body areas. Similarly, overnutrition can be combated in large part through regular physical activity.
Promote participation in non-food-related activities such as nature hiking, biking, participating in group sporting, and seeing a musical event.Allows for enjoyment and relaxation without the risk of falling to “temptation.” Calorie-burning activities and exercises can also help over-nourished patients maintain a healthy weight.
Ensure continuous counseling and follow-up care, most notably when reaching a plateau. At some point, the body’s metabolism slows down when it reaches a state known as a “plateau.” This is produced by the body activating a survival mechanism in an attempt to avoid “starvation.” In order to maintain weight loss in the face of these changes, it is necessary to devise a new plan that is both vigorous and consistent.
Create an alternative plan for rewarding the patient and their significant others. This is done to avoid overnutrition. Eating is less likely to be used as a coping method for emotional distress. 

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. (2022). 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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Anna C. RN, BSN, PHN

Anna C. RN, BSN, PHN
Clinical Nurse Instructor

Emergency Room Registered Nurse
Critical Care Transport Nurse
Clinical Nurse Instructor for LVN and BSN students

Anna began writing extra materials to help her BSN and LVN students with their studies. She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process.

Her experience spans almost 30 years in nursing, starting as an LVN in 1993. She received her RN license in 1997. She has worked in Medical-Surgical, Telemetry, ICU and the ER. She found a passion in the ER and has stayed in this department for 30 years.

She is a clinical instructor for LVN and BSN students along with a critical care transport nurse.

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