Obesity

528 UNIT V / Responses to Altered Nutrition
CHART 20–1 NANDA, NIC, AND NOC LINKAGES

Obese Clients
NURSING DIAGNOSES NURSING INTERVENTIONS NURSING OUTCOMES
• Imbalanced Nutrition: More than • Nutrition Management • Nutritional Status

Body Requirements • Weight Reduction Assistance • Nutrient Intake
• Behavior Modification • Weight Control
• Disturbed Body Image • Body Image Enhancement • Body Image
• Chronic Low Self-Esteem • Self-Esteem Enhancement • Self-Esteem
Note. Data from Nursing Outcomes Classification (NOC) by M. Johnson & M. Maas (Eds.), 1997, St. Louis: Mosby; Nursing Diagnoses: Definitions & Classification 2001–2002 by
North American Nursing Diagnosis Association, 2001, Philadelphia: NANDA; Nursing Interventions Classification (NIC) by J.C. McCloskey & G. M. Bulechek (Eds.), 2000, St. Louis:
Mosby. Reprinted by permission.
Using NANDA, NIC, and NOC Home Care

Chart 20–1 shows links between NANDA nursing diagnoses, Weight reduction usually occurs in community-based settings.
NIC, and NOC for obese clients. Weight loss and maintenance requires a long-term commitment
Nursing Care Plan

A Client with Obesity
Sam Elliott,age 57,has gained 30 pounds since PLANNING AND IMPLEMENTATION
his retirement 2 years ago. The most active thing • Assess weight and blood pressure once or twice each week.
he does each day is “puttering around” and “walking to the end of • Discuss current eating habits and strategies to reduce fat and
the driveway to get the mail.”His diet includes juice, oatmeal, muf- calorie intake.
fin, and coffee with cream for breakfast; donuts and coffee with • Discuss cues that promote eating. Identify strategies to elimi-
friends midmorning; a bologna-and-cheese sandwich with chips nate or reduce eating cues.
and a root beer for lunch; and cheese, crackers, and wine before a • Teach to keep a food diary to examine and change eating habits.
dinner of meat, potatoes, vegetables, and dessert. He tells the • Discuss the role of regular exercise in weight loss and weight
nurse,“I have never had to diet. I just don’t know how to get this control. Instruct to maintain an exercise record to track the in-
weight off.” tensity and duration of activity.
• Discuss lifestyle and behavior modification strategies to pro-
ASSESSMENT mote successful weight loss and control.
Mr. Elliott is 5 8 (173 cm) tall and weighs 201 lb (91.2 kg). His BMI
is 30.1 kg/m2. His cholesterol is 240 mg/dL (normal 150 to 200 EVALUATION
mg/dL) with an HDL of 37 mg/dL (normal male value > 45 mg/dL) Two weeks after changing his diet and beginning to exercise, Mr.
and an LDL of 180 mg/dL (normal <130 mg/dL). His BP is 138/90. Elliott has lost 2 pounds. He has maintained a food diary. He has
His fasting blood glucose is normal at 103 mg/dL. His ECG shows identified boredom as a cue to eating. In light of that fact, he has
normal sinus rhythm. He reports fatigue and shortness of breath started volunteering at the local hospital, where he is working
with activity. His health care provider has advised a weight loss of with children. He is walking for 30 minutes 5 days a week. He plans
30 pounds and a regular exercise program. to increase his activity periods to 45 minutes. He verbalizes com-
DIAGNOSES mitment to a lifelong plan of exercising and eating a low-fat diet.
• Imbalanced nutrition: More than body requirements, related to His BP has ranged from 132/76 to 136/84. He plans to have the
food intake in excess of energy expenditure employee health nurse at the hospital check his weight and BP
• Risk for ineffective therapeutic regimen management, related to each week and to join Weight Watchers for ongoing support.
knowledge deficit
Critical Thinking in the Nursing Process
• Activity intolerance, related to sedentary lifestyle
1. What are some possible pathophysiologic bases for Mr.
EXPECTED OUTCOMES Elliott’s abnormal cholesterol, HDL, and LDL levels?
• Lose 1 pound each week. 2. Develop a teaching plan for a group of overweight men and
• Walk 30 minutes 5 days each week. women.
• Verbalize an understanding of the relationship between weight 3. Identify potential barriers to losing weight and strategies to
loss, weight control, and exercise. reduce or eliminate these barriers.
• Identify behavior modification strategies to avoid overeating.
• Identify support systems for behavior modification. See Evaluating Your Response in Appendix C.

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528 UNIT V / Responses to Altered Nutrition

CHART 20–1 NANDA, NIC, AND NOC LINKAGES

• Imbalanced Nutrition: More than • Nutrition Management • Nutritional Status

Using NANDA, NIC, and NOC Home Care

Nursing Care Plan

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