10 UNIT 1 Principles of Nutrition Box 1.5 PHYSICAL SYMPTOMS SuGGESTIVE or MALNUTRITION Hair that is dull, brittle, or dry or falls out easily Swollen glands of the neck and cheeks Dry, rough, or spotty skin that may have a sandpaper fee Poor or delayed wound healing or sores Thin appearance with lack of subcutaneous fa Muscle wasting (decreased size and strength) Edema of the lower extremities weakened hand grasp Depressed mood Abnormal heart rate, heart rhythm, or blood pressure Enlarged liver or spleen Loss of balance and coordination Nursing Diagnosis A diagnosis is made after assessment data are interpreted. N ursing diagnoses in hospitals and long-term care facilities provid written documentation of the client's status and serve as a framework for the plan of care that follows. The diagnoses relate directly to nutrition when the pattern of nutrition and metabolism is the problem. other nursing diagnoses, while not specific for nutrition, may involve nutrition as part of the pl an, such as teaching the patient how to increase fiber intake to relieve the nursing diagnosis of constipation Box L6 lists nursing diagnoses with nutritional significance Planning: Client outcomes outcomes, or goals, should be measurable, attainable, specific, and client centered. How do you measure success against a vague goal of "gain weight by eating better"? Is "eating better" achieved by adding butter to foods to increase calones or by substituting 1% milk for whole milk because it is heart healthy? Is a 1-pound weight gain in 1 month acceptable or is 1 pound/week attainable if the client has accelerated prcferable s 1 pound/week metabolism and catabolism caused by third-degree burns? Client-centered outcomes place the focus on the client, not the health-care provider, they specify where the client is heading. Whenever possible, gi the client the opportunity to actively participate in goal setting, even if the client's perception of need differs from yours. In matters that do not involve life or death, it is best to first address the client's con ccrns. Your primary consideration may be the patient's significant weight loss during the ast 6 months of chemotherapy, whereas the patient's major concern may be fatigue. The two issues are doubtedly related, but your effectiveness as a change agent is greater if you approach the problem from the client's perspective. Commitment to achieving the goal is greatly increased when the client "owns" the goa Keep in mind that the goal for all clients is to consume adequate calories, protein, and nutrients using foods they like and tolerate as appropriate. If possible, additional short-term s may be set to alleviate symptoms or side effects of disease or treatments and to preven complications or recurrences if appropriate. After short-term goals are met, attention can expand to promoting healthy eating to reduce the risk of chronic diet-related diseases such as obesity, diabetes, hypertension, and atherosclerosis