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Nursing Diagnosis: Nutrition: altered, less than body requirements
May be related to
- Hypermetabolic state associated with cancer
- Consequences of chemotherapy, radiation, surgery, e.g., anorexia, gastric irritation, taste distortions, nausea
- Emotional distress, fatigue, poorly controlled pain
Possibly evidenced by
- Reported inadequate food intake, altered taste sensation, loss of interest in food, perceived/actual inability to ingest food
- Body weight 20% or more under ideal for height and frame, decreased subcutaneous fat/muscle mass
- Sore, inflamed buccal cavity
- Diarrhea and/or constipation, abdominal cramping
Desired Outcomes
- Demonstrate stable weight/progressive weight gain toward goal with normalization of laboratory values and be free of signs of malnutrition.
- Verbalize understanding of individual interferences to adequate intake.
- Participate in specific interventions to stimulate appetite/increase dietary intake.
13 Cancer Nursing Care Plan (NCP)
- Anticipatory Grieving — Cancer Nursing Care Plan (NCP)
- Situational Low Self-Esteem — Cancer Nursing Care Plan (NCP)
- Acute Pain — Cancer Nursing Care Plan (NCP)
- Altered Nutrition: Less Than Body Requirements — Cancer Nursing Care Plan (NCP)
- Risk for Fluid Volume Deficit — Cancer Nursing Care Plan (NCP)
- Fatigue — Cancer Nursing Care Plan (NCP)
- Risk for Infection — Cancer Nursing Care Plan (NCP)
- Risk for Altered Oral Mucous Membranes — Cancer Nursing Care Plan (NCP)
- Risk for Impaired Skin Integrity — Cancer Nursing Care Plan (NCP)
- Risk for Constipation/Diarrhea — Cancer Nursing Care Plan (NCP)
- Risk for Altered Sexuality Patterns — Cancer Nursing Care Plan (NCP)
- Risk for Altered Family Process — Cancer Nursing Care Plan (NCP)
- Fear/Anxiety — Cancer Nursing Care Plan (NCP)
Altered Nutrition: Less Than Body Requirements — Cancer Nursing Care Plan (NCP)
| Nursing Interventions | Rationale |
| Monitor daily food intake; have patient keep food diary as indicated. | Identifies nutritional strengths/deficiencies. |
| Measure height, weight, and tricep skinfold thickness (or other anthropometric measurements as appropriate). Ascertain amount of recent weight loss. Weigh daily or as indicated. | If these measurements fall below minimum standards, patient’s chief source of stored energy (fat tissue) is depleted. |
| Assess skin/mucous membranes for pallor, delayed wound healing, enlarged parotid glands. | Helps in identification of protein-calorie malnutrition, especially when weight and anthropometric measurements are less than normal. |
| Encourage patient to eat high-calorie, nutrient-rich diet, with adequate fluid intake. Encourage use of supplements and frequent/smaller meals spaced throughout the day. | Metabolic tissue needs are increased as well as fluids (to eliminate waste products). Supplements can play an important role in maintaining adequate caloric and protein intake. |
| Create pleasant dining atmosphere; encourage patient to share meals with family/friends. | Makes mealtime more enjoyable, which may enhance intake. |
| Encourage open communication regarding anorexia. | Often a source of emotional distress, especially for SO who wants to feed patient frequently. When patient refuses, SO may feel rejected/frustrated. |
| Adjust diet before and immediately after treatment, e.g., clear, cool liquids, light/bland foods, candied ginger, dry crackers, toast, carbonated drinks. Give liquids 1 hr before or 1 hr after meals. | The effectiveness of diet adjustment is very individualized in relief of posttherapy nausea. Patients must experiment to find best solution/combination. Avoiding fluids during meals minimizes becoming “full” too quickly. |
| Control environmental factors (e.g., strong/noxious odors or noise). Avoid overly sweet, fatty, or spicy foods. | Can trigger nausea/vomiting response. |
| Encourage use of relaxation techniques, visualization, guided imagery, moderate exercise before meals. | May prevent onset or reduce severity of nausea, decrease anorexia, and enable patient to increase oral intake. |
| Identify the patient who experiences anticipatory nausea/vomiting and take appropriate measures. | Psychogenic nausea/vomiting occurring before chemotherapy generally does not respond to antiemetic drugs. Change of treatment environment or patient routine on treatment day may be effective. |
| Administer antiemetic on a regular schedule before/ during and after administration of antineoplastic agent as appropriate. | Nausea/vomiting are frequently the most disabling and psychologically stressful side effects of chemotherapy. |
| Evaluate effectiveness of antiemetic. | Individuals respond differently to all medications. First-line antiemetics may not work, requiring alteration in or use of combination drug therapy. |
| Hematest stools, gastric secretions. | Certain therapies (e.g., antimetabolites) inhibit renewal of epithelial cells lining the GI tract, which may cause changes ranging from mild erythema to severe ulceration with bleeding. |
| Review laboratory studies as indicated, e.g., total lymphocyte count, serum transferrin, and albumin/ prealbumin. | Helps identify the degree of biochemical imbalance/ malnutrition and influences choice of dietary interventions. Note: Anticancer treatments can also alter nutrition studies, so all results must be correlated with the patient’s clinical status. |
| Refer to dietitian/nutritional support team. | Provides for specific dietary plan to meet individual needs and reduce problems associated with protein/ calorie malnutrition and micronutrient deficiencies. |
| Insert/maintain NG or feeding tube for enteric feedings, or central line for total parenteral nutrition (TPN) if indicated. | In the presence of severe malnutrition (e.g., loss of 25%–30% body weight in 2 mo) or if patient has been NPO for 5 days and is unlikely to be able to eat for another week, tube feeding or TPN may be necessary to meet nutritional needs. |
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