14.4 Putting It All Together

Patient Scenario

Mr. Curtis is a 47-year-old patient admitted to the hospital with increased weakness, fatigue, and dehydration. His skin appears dry, and tenting occurs when skin turgor is evaluated. He is currently undergoing chemotherapy treatment for multiple myeloma and has experienced weight loss of 10 pounds within the last two weeks. He describes that “nothing tastes good,” and he feels as if there is “metal taste in his mouth.” When he does eat small meals, he reports that he is often nauseous. The patient’s serum protein level is 3.1 g/dL.

Applying the Nursing Process

Assessment: The nurse identifies that the patient is experiencing signs of imbalanced nutrition with the signs of increased weakness, fatigue, and signs of dehydration such as skin tenting and dryness. The patient has demonstrated a significant weight loss over the past two weeks and reports “nothing tastes good” and “a metal taste in the mouth.” The patient also reports nausea after eating. His serum protein level reflects signs of malnutrition.

Based on the assessment information that has been gathered, the following nursing care plan is created for Mr. Curtis:

Nursing Diagnosis: Imbalanced Nutrition: Less Than Body Requirements r/t insufficient dietary intake as manifested by weight loss of 10 pounds in the last two weeks, skin tenting and dryness, reports of “nothing tastes good,” and serum protein of 3.1 g/dL.

Overall Goal: The patient will demonstrate improvement in nutrition intake.

SMART Expected Outcome: Mr. Curtis will eat 50% of offered meals and demonstrate dietary tolerance within 24 hours.

Planning and Implementing Nursing Interventions:

The nurse will validate the patient’s feelings regarding his current symptoms and provide emotional support. The nurse will determine the time of day when the patient’s appetite is highest and offer the highest calorie meal at that time. The nurse will offer high-calorie protein shakes to the patient at frequent intervals. The nurse will assess the patient’s food preferences and ensure that small frequent meals are offered that incorporate those preferences. The nurse will also encourage the use of plastic utensils and encourage the patient to eat mints or chew gum to minimize the metallic taste in the mouth.

Sample Documentation:

Mr. Curtis demonstrates signs of imbalanced nutrition: less than body requirements. He reported a significant weight loss of 10 pounds over the past two weeks associated with chemotherapy. He reports feeling nauseous following small meals. He also reports “nothing tastes good” and having “a metal taste in the mouth.” He demonstrates signs of weakness, fatigue, and dehydration. Interventions have been implemented to increase the patient’s nutritional intake. 

Evaluation:

Twenty-four hours later, the nurse evaluates Mr. Curtis and finds he is able to consume 50% of breakfast with his preferred dietary items. Planned interventions will continue and the nurse plan to reevaluate his progress the following day.