Imbalanced Nutrition: more than body requirements

Senin, 22 Juli 2013

Intake of nutrients that exceeds metabolic needs

Defining Characteristics:

  • Triceps skin fold >25 mm in women;
  • triceps skin fold >15 mm in men; 
  • body weight (20% over ideal for height and frame; eating in response to external cues (e.g., time of day, social situation); 
  • eating in response to internal cues other than hunger (e.g., anxiety); 
  • reported or observed dysfunctional eating pattern pairing food with other activities; 
  • sedentary activity level; 
  • weight 10% over ideal for height and frame; 
  • concentrating food intake at the end of the day

Related Factors:
  • Excessive intake in relation to metabolic need; 
  • deficient knowledge related to desirability of nutritional supplements

NOC Outcomes (Nursing Outcomes Classification)

Suggested NOC Labels
  • Weight Control
  • Nutritional Status: Nutrient Intake
  • Nutritional Status: Food and Fluid Intake Management
Client Outcomes
  • States pertinent factors contributing to weight gain
  • Identifies behaviors that remain under client's control
  • Claims ownership for current eating patterns
  • Designs dietary modifications to meet individual long-term goal of weight control, using principles of variety, balance, and moderation
  • Accomplishes desired weight loss in a reasonable period (1 to 2 pounds/week)
  • Incorporates appropriate activities requiring energy expenditure into daily life
  • Uses sound scientific sources to evaluate need for nutritional supplements
NIC Interventions (Nursing Interventions Classification)

Suggested NIC Labels
  • Weight Management
  • Eating Disorders Management
  • Nutrition Management
  • Nutritional Counseling, Weight Reduction Assistance

Nursing Interventions and Rationales

1. Obtain a thorough history. Refer to dietitian if client has a medical condition.
The most appropriate clients for the nursing intervention of Weight Management are adults with no major health problems who require diet therapy. If a patient has a medical condition necessitating diet therapy, the assistance of a dietitian may be required (Crist, 1992).

2. Evaluate client's physiological status in relation to weight control. Refer as appropriate.
Nondieting approaches focus on changing disturbed thoughts, emotions, and body image associated with obesity to help obese persons to accept themselves and resolve issues that may hinder long-term weight maintenance (Foreyt, Walker, Poston II, 1998).

3. Assess dietary intake through 24-hour recall or questions regarding usual intake of food groups.
Information may not be completely accurate. Permits appraisal of client's knowledge about diet also.

4. Determine client's knowledge of a nutritious diet and need for supplements.
This information is useful for developing an individualized teaching plan based on client's current state.

5. Calculate body mass index (BMI) (use this formula: weight in kg divided by height in m2 [kg/(m)2]; or use this alternate formula: weight in lb multiplied by 705, divided by height in inches, divided again by height in inches).
A normal BMI is 20 to 25, 26 to 29 is overweight, and a BMI of greater than or equal to30 is defined as obesity.

6. Compute the waist to hip ratio (WHR).
 A WHR >0.85 in women and >1.0 in men indicates increased risk of problems related to obesity (Lutz, Przytulski, 2001).

7. Define client's healthy body weight with client, considering physiological, experiential, and cultural factors.
Overweight has been viewed as an individual problem, and treatment oriented toward an individual victim-blame model, with little consideration of personal context or the influence of cultural values on behavior (Allan, 1994). Children have been included in weight management programs but their growth factor has not been factored into the equation, potentially risking future growth-related health problems. These potential risks may require the direct attention of dietitians and physicians (Crist, 1992).

8. Determine client's motivation to lose weight, whether for appearance or health benefits.
Female peripheral fat pattern (gynecoid), predominant in most women, is associated with virtually no impairment of health (Allan, 1994). Often a healthier body weight is only a 5% to 10% reduction from initial body weight (Nonas, 1998).

9. Observe for situations that indicate a nutritional intake of more than body requirements.
Such observations help gain a clear picture of the client's dietary habits. Overfeeding of post-trauma patients that was attributed to the lack of an interdisciplinary plan of care has been documented (Klein, Henry, 1999).

10. Suggest client keep a diary of food intake and circumstances surrounding its consumption (methods of preparation, duration of meal, social situation, overall mood, activities accompanying consumption).
Self-monitoring helps the client assess adherence to self-determined performance criteria and progress toward desired goals. Self-monitoring serves an important role in the maintenance of internal standards of behavior (Fleury, 1991).

11. Adopt a weight loss plan that incorporates the client's culture and preferences.
Dramatic weight loss was achieved in Hawaii with a culturally appropriate methodology (Shintani et al, 1991).

12. Advise client to measure food periodically.
Measuring food alerts client to normal portion sizes. Estimating amounts can be extremely inaccurate.

13. Review client's current exercise level. With client and primary health care provider, design a long-term exercise program.
A health risk appraisal should be performed on all previously sedentary individuals beginning a program of exercise (Grubbs, 1993). Exercise is important for increased energy expenditure, for maintenance of lean body mass, and as part of a total change in lifestyle (Lutz, Przytulski, 2001). In one study, 80% of the weight lost by exercisers was fat; whereas 40% of of the weight loss by dieters was lean tissue (Pritchard, Nowson, Wark, 1997). Loss of lean tissue is undesirable because muscle tissue is estimated to be as much as 70 times as metabolically active as fat tissue (Rippe, Hess, 1998). Women consuming an energy-restricted diet in addition to performing aerobic and strength training exercise lost more weight than the other study groups and slightly increased their lean muscle tissue (Rippe, Hess, 1998).

14. Establish a reasonable goal for client's body weight and for weight loss (e.g., 1 to 2 pounds/week).
Height and weight tables have been criticized because they are based on middle-class white men (Allan, 1994). Because subjects in one study achieved comparable weight loss on liquid formula diets of 420, 600, or 800 kcal/day, choosing the higher energy diets may minimize adverse side effects (Foster et al, 1992).

15. Initiate a client contract that involves rewarding and reinforcing progressive goal attainment.
Patient contracts provide a unique opportunity for patients to learn to analyze their behavior in relationship to the environment and to choose behavioral strategies that will facilitate learning. A series of written contracts provides a history of progress toward desired behaviors (Boehm, 1992).

16. Weigh client twice a week under the same conditions.
It is important to most clients and their progress to have the tangible reward that the scale shows. Monitoring twice a week keeps the client on the program by not allowing him or her to eat out of control for a couple of days and then fast to lose weight (Crist, 1992).

17. Instruct client regarding adequate nutritional intake. A total plan permits occasional treats.
Permanent lifestyle changes must occur for weight loss to be long lasting. Eliminating all treats is not sustainable. Numerous studies have demonstrated that fewer than 5% of persons who lose weight through energy restriction alone are able to maintain this weight loss for 2 years or more (Rippe, Hess, 1998). During energy restriction, a client should consume 72 to 80 g of high biological value protein per day to minimize risk of ventricular arrhythmias (Nonas, 1998).

18. Familiarize client with the following behavior modification techniques (Lutz, Przytulski, 2001):
Self-monitor
  • Keep a food and exercise diary
  • Graph weight weekly Stimulus control
  • Limit food intake to one site in the home
  • Sit down at the table to eat
  • Plan food intake for each day
  • Rearrange schedule to avoid inappropriate eating
  • Save or reschedule everyday activities for times when you are hungry
  • Avoid boredom; keep a list of activities on the refrigerator
  • At a party: eat before you go, sit away from the snack foods, and substitute lower calorie beverages for alcoholic ones
  • Decide beforehand what to order in a restaurant Slow down eating
  • Drink a glass of water before each meal; take sips of water between bites of food
  • Swallow food before putting more food on the utensil
  • Try to be the last one to finish eating
  • Pause for a minute during your meal, and attempt to increase the number of pauses Reward yourself
  • Chart your progress
  • Make an agreement with yourself or significant other for a meaningful reward
  • Do not reward yourself with food Cognitive strategies
  • View exercise as a means of controlling hunger
  • Practice relaxation techniques
  • Imagine yourself ordering a side salad, diet dressing, low-fat milk, and a small hamburger at a fast-food restaurant
  • Visualize yourself enjoying a fresh apple in preference to apple pie
19. Encourage client to adopt an exercise program that involves 45 minutes of exercise five times/week.
As exercise time increases beyond 30 minutes, there is an increased reliance on fat stores for energy (Grubbs, 1993). Moderately intense physical activity for 30 to 45 minutes 5 to 7 days/week can expend the 1500 to 2000 calories/week that appear to be necessary to maintain weight loss. Cross-sectional and longitudinal studies illustrate that persons who increase their physical activity also increase their resting metabolic rate (Rippe, Hess, 1998).

20. Assess for use of nonprescription diet aids.
Ingestion of an herbal supplement (containing Ma-huang, the main plant source of ephedrine) for weight loss caused mania in a client with no history of psychiatric illness (Capwell, 1995). Clinicians should be aware that ostensibly harmless herbal remedies may have potent ingredients that are not subjected to the same scrutiny that the FDA devotes to prescription drugs (Woolf, 1994).

21. Observe for overuse of particular nutrients.
Almost all nutrients given in quantities beyond a certain threshold will reduce immune responses (Chandra, 1997). Daily ingestion of 500 ml of tonic water containing 40 mg of quinine hydrochloride caused photosensitivity. Other conditions associated with tonic water are disseminated intravascular coagulation, recurrent dermatitis, fixed drug eruption, and toxic epidermal necrolysis (Wagner et al, 1994). Clients who are consuming excessive amounts of some nutrients may also be consuming less than adequate amounts of others.

Geriatric

1. Assess fluid intake. Recommend routine drinks of water whether thirsty or not.
Thirst sensation becomes dulled in the elderly.

2. Observe for socioeconomic factors that influence food choices (e.g., funds, cooking facilities).
Food choices in today's food markets are greatly enhanced, even for those on a limited budget (Love, Seaton, 1991).

3. Suggest a variety of seasonings.
The ability to taste sweet, bitter, sour, and salty declines in most, but not all, older persons (Morley, 1997).

4. Encourage social involvement in activities other than eating.
Energy needs decrease an estimated 5% per decade after the age of 40.

5. Recommend weight reduction changes judiciously.
Weight reduction should be pursued if it is needed to treat current problems, such as diabetes mellitus or hypertension, but not to prevent new ones (Feldman, 1988).

Multicultural

1. Assess for the influence of cultural beliefs, norms, and values on the client's nutritional knowledge.
What the client considers normal dietary practices may be based on cultural perceptions (Leininger, 1996).

2. Assess for the influence of cultural beliefs, norms, and values on the client's ideal of acceptable body weight and body size.
Ideal body weight and size may be based on cultural perceptions (Leininger, 1996). African-American women report more satisfaction than other women with body size (Miller et al, 2000). Overweight Hispanic women with high levels of binge eating and depression preferred a slimmer body ideal (Fitzgibbon et al, 1998).

3. Discuss with the client those aspects of his or her diet that will remain unchanged, and work with client to adapt cultural core foods.
Aspects of the client's life that are meaningful and valuable to them should be understood and preserved without change (Leininger, 1996). Core foods are those foods which are universal, staple, important, and consistently used in the culture (Sanjur, 1995).

4. Negotiate with the client regarding the aspects of his or her diet that will need to be modified.
Give and take with the client will lead to culturally congruent care (Leininger, 1996).

5. Validate the client's feelings regarding the impact of current lifestyle, finances, and transportation on ability to obtain and prepare nutritious food.
Validation lets the client know that the nurse has heard and understands what was said, and it promotes the nurse-client relationship (Stuart, Laraia, 2001; Giger, Davidhizer, 1995).

Client/Family Teaching

1. Foster client's/family's input into care plan.
Extrinsic motivations (such as pressure from others) may be less effective than intrinsic motivations (such as beliefs) on promoting healthful behaviors (Patterson et al, 1995).

2. Provide the client and family with information regarding the treatment plan options.
Because the purpose is to obtain a permanent change in weight management, the decision regarding treatment plans should be left up to the client and family (Crist, 1992).

3. Inform the client about the health risks associated with obesity.

4. Guide the client toward changes that will make a major impact on health.
Even modest weight loss contributes to diabetes and hypertension control.

5. Inform the client/family of the disadvantages of trying to lose weight by dieting alone.
Resting metabolic rate is decreased as much as 45% with extreme calorie restriction. The decrease persists after the diet period has ended, leading to the "yo-yo effect." With a reduced-calorie diet alone, as much as 25% of the weight lost can be lean body mass rather than fat. Resting energy expenditure is positively related to lean body mass (Grubbs, 1993).

6. Teach the importance of exercise in a weight control program.
A physically conditioned person uses more fat for energy at rest and with exercise than a sedentary person does (Grubbs, 1993). The majority of patients will benefit from establishing walking as a cornerstone of their physical activity program (Rippe, Crossley, Ringer, 1998).

7. Teach stress reduction techniques as alternatives to eating.
The client needs to substitute healthy for unhealthy behaviors.

12 komentar:

Anonim mengatakan...

You have really selected the suitable topic; this is one of my favorite blogs. CNA Practice Test

Anonim mengatakan...

I would unquestionably provide ten out of ten for such incredible content. CNA Practice Test

Unknown mengatakan...

The program has attracted attention elsewhere with other public hospitals, private hospitals and insurers, and overseas groups interested in it. Chio’s Healing

King mengatakan...

There's no Skin Care and no other Botox treatment is involved. I beg you, reconsider. Let's be honest. Botox treatment has a face only a mother could love. It was an enormous help. I figured out that I'm used to speaking to typical people who shared an interest Botox treatment. There not many of us who believe this. I might previously know the things that you know. What should you do with your old Joyelle Derma Cream? It still looks to me that Skin Care has missed its chance. I don't want you to reckon I have a choice about Anti Aging. >>https://www.healthstrikes.com/joyelle-derma-cream

Nerotenze Testosterone

Unknown mengatakan...

Nevi-Skin is an all-natural product which will make you look bright and beautiful because it helps you get rid of moles, warts and skin tags. It is a natural—safe and fast—way to treat a host of skin-related problems. This Neviskin reviews will help you understand why this skin cream is regarded as one of the best mole removal product preferred by millions all over the world. Kindly Visit on Nevi Skin Mole Removal

Richard William mengatakan...

Am Richard, I am here to testify about a great herbalist  man who cured my wife of breast cancer. His name is Dr Imoloa. My wife went through this pain for 3 years, i almost spent all i had, until i saw some testimonies online on how Dr. Imoloa cure them from their diseases, immediately i contacted him through. then he told me the necessary things to do before he will send  the herbal medicine. Wish he did through DHL courier service, And he instructed us on how to apply or drink the medicine for good two weeks. and to greatest surprise before the upper third week my wife was relief from all the pains, Believe me, that was how my wife was cured from breast cancer by this great man. He also have powerful herbal medicine to cure diseases like: Alzheimer's disease, parkinson's disease, vaginal cancer, epilepsy Anxiety Disorders, Autoimmune Disease, Back Pain, Back Sprain, Bipolar Disorder, Brain Tumor, Malignant, Bruxism, Bulimia, Cervical Disc Disease, Cardiovascular Disease, Neoplasms , chronic respiratory disease, mental and behavioral disorder, Cystic Fibrosis, Hypertension, Diabetes, Asthma, Autoimmune inflammatory media arthritis ed. chronic kidney disease, inflammatory joint disease, impotence, alcohol spectrum feta, dysthymic disorder, eczema, tuberculosis, chronic fatigue syndrome, constipation, inflammatory bowel disease, lupus disease, mouth ulcer, mouth cancer, body pain, fever, hepatitis ABC, syphilis, diarrhea, HIV / AIDS, Huntington's disease, back acne, chronic kidney failure, addison's disease, chronic pain, Crohn's pain, cystic fibrosis, fibromyalgia, inflammatory Bowel disease, fungal nail disease, Lyme disease, Celia disease, Lymphoma, Major depression, Malignant melanoma, Mania, Melorheostosis, Meniere's disease, Mucopolysaccharidosis, Multiple sclerosis, Muscular dystrophy, Rheumatoid arthritis. You can reach him Email Via drimolaherbalmademedicine@gmail.com / whatsapp +2347081986098

Oscar mengatakan...



I would like to thank Ultimate Health Home for reversing my father's Amyotrophic Lateral Sclerosis (ALS). My father’s ALS condition was fast deteriorating before he started on the ALS Herbal medicine treatment from Ultimate Health Home. He was on the treatment for just 6 months and we never thought my father will recover so soon. He has gained some weight in the past months and he is able to walk with no support. You can contact them at ultimatehealthhome@gmail.com

Moin khan chouhan mengatakan...


Individualized Body Nutrition Products


Welcome to Go Builz Health Products Store, Get the personalized nutrition and health products. We offer customizable nutrition products to your body.


<a href="https://gobuilz.com/</a>

MATINA mengatakan...

I was diagnosed as HEPATITIS B carrier in 2013 with fibrosis of the
liver already present. I started on antiviral medications which
reduced the viral load initially. After a couple of years the virus
became resistant. I started on HEPATITIS B Herbal treatment from
ULTIMATE LIFE CLINIC (www.ultimatelifeclinic.com) in March, 2020. Their
treatment totally reversed the virus. I did another blood test after
the 6 months long treatment and tested negative to the virus. Amazing
treatment! This treatment is a breakthrough for all HBV carriers.

Tom Neil mengatakan...

Hi, there. I am Tom Neil and I wish to describe how life had been for my younger brother living with schizophrenia and how he had been permanently able to overcome this debilitating disease via a naturopathic, herbal treatment.

Maicon - my kid brother was twenty years old when he was brought to the emergency room by the campus law of the college from which he had been suspended several months ago. A professor had called and reported that he had walked into his classroom, accused him of taking his tuition money, and refused to leave.

Although he had much academic success as a teenager, his behavior had become increasingly odd during the past year. He quit seeing his friends and no longer seemed to care about his appearance or social pursuits. He began wearing the same clothes each day and seldom bathed. He lived with several family members but rarely spoke to any of them. When he did talk to them, he said he had found clues that his college was just a front for an organized crime operation. He had been suspended from college because of missing many classes. My sister said that she had often seen him mumbling quietly to himself and at times he seemed to be talking to people who were not there. He would emerge from my room and ask my family to be quiet even when they were not making any noise.

My father and sister told the staff that Maicon's great-grandmother had had a serious illness and had lived for 30 years in a state hospital, which they believed was a mental hospital. Our mother left the family when Maicon was very young. She has been out of touch with us, and they thought she might have been treated for mental health problems.

Maicon agreed to sign himself into the psychiatric unit for treatment. The whole family except I had agreed to have Maicon transferred to a mental asylum. I knew inwardly there was still some plausible means by which my kid brother could overcome this condition. I knew botanical means of treatment will be more favorable than any other type of treatment, and as such, I had taken a keen interest in the research of naturopathic alternative measures suitable for the treatment of schizophrenia. I had pleaded for some little patience from the family in the delay of the transfer, I was looking forward to proving a point to the entire family, of a positive botanical remedy for this condition.

It was during my ceaseless search on the internet I had been fortunate enough to come across Dr. Utu Herbal Cure: an African herbalist and witch doctor whose professional works had majored on the eradication of certain viral conditions, especially schizophrenia, ( improving the memory capacity positively), via a traditional, naturopathic process and distinguished diet plan. It was by the administration of this herbal specialist that my brother had been able to improve his condition for better.

Before the naturopathic remedy - Maicon's story had reflected a common case, in which a high-functioning young adult goes through a major decline in day-to-day skills. Although family and friends may feel this is a loss of the person they knew, the illness can be treated and a good outcome is possible.

My brother Maicon is just like many other patients out there suffering from this disease. Although he was able to overcome this condition via a naturopathic herbal remedy administered by this African herbal physician and saved completely thus, rekindling the lost joy which had been experienced by the family members.

I wish to use this opportunity to reach across to anyone who may happen to be diagnosed with this disastrous condition to spread the hope of an everlasting herbal remedy that is capable of imposing a permanent end to this disease.

For more information concerning this naturopathic herbal remedy, feel free to contact this African herbal practitioner via email:
drutuherbalcure@gmail.com

faryabachelder mengatakan...

Harrah's Resort Southern California - Mapyro
Harrah's Resort Southern California 구리 출장샵 · Southern California Casino · Harrah's Resort Southern California Casino 화성 출장샵 · 진주 출장마사지 Harrah's Rincon Casino 포항 출장샵 Resort · Harrah's Resort 충청북도 출장샵 Southern

Tino Best mengatakan...

Massage furthermore will help to remove lactic acid which gathers inside the muscles and it helps the lymphatic system that is responsible for removing toxins from the body. 구리 출장안마

Posting Komentar