Alteration in Nurtition: More Than Body Requirements

Alteration in Nurtition: More Than Body Requirements

(_)Actual (_) Potential

Related To:
[Check those that apply]
(_) Altered satiety patterns
(_) Medications (steroids)
(_) Lack of knowledge
(_) Decreased activity
(_) Decreased metabolic needs
(_) Other:_____________________________
____________________________________
____________________________________

As evidenced by:
[Check those that apply]
Major:
(
Must be present)
(_) Overweight (weigh 10% to 20% over ideal for height and frame.
(_) Obese (weigh over 20% of ideal).
Minor:
(
May be present)
(_) Reported undesirable eating patterns.
(_) Intake in excess of metabolic requirements.
(_) Sedentary activity patterns.

Date &
Sign.
Plan and Outcome
[Check those that apply]
Target
Date:
Nursing Interventions
[Check those that apply]
Date
Achieved:
The patient will:

(_) Decrease total calories ingested.

(_) Increase activity level.

(_) Loose weight:
(_____ pounds by discharge).

(_) Other:

(_) Assess and document patient's dietary history, patterns of ingestion, activity patterns.

(_) Discuss with patient potential causative factors for weight gain.

(_) Assess motivation to correct overweight.

(_) Consult with dietician regarding balanced plan for weight loss. Reinforce teaching. Discuss realistic weight loss of not more than 2 pounds per week.

(_) Provide positive reinforcement for weight loss.

(_) Record intake.

(_) Weigh q ___ days at ____ am/pm.

(_) Other:________________
________________________
________________________
________________________

__________________________
Patient/Significant other signature

__________________________
RN signature

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