Nursing diagnosis – ADULT FAILURE TO THRIVE



Progressive functional deterioration of a physical and cognitive

nature. The individual’s ability to live with multisystem diseases,

cope with ensuing problems, and manage his/her care are remarkably



• Cognitive decline, as evidenced by problems with responding

appropriately to environmental stimuli and decreased

• Consumption of limited to no food at most meals (i.e., consumes

less than 75% of normal replacements); weight loss

• Decreased participation in ADLs that were once enjoyed

• Decreased social skills or social withdrawal

• Difficulty performing simple self-care tasks

• Frequent exacerbations of chronic health problems, such as pneu-

monia or urinary tract problems

• Neglect of home environment or financial responsibilities

• Adequate elimination pattern for age


• Depression

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Knowledge

• Nutrition

• Coping

• Sleep patterns

• Emotional

• Values and beliefs


The patient will

• Express understanding of causes of failure to thrive.

• Express realization that he or she is depressed.

• Consume sufficient amounts of food and nutrients.

• Sleep for ___ hours without interruption.

• Gain weight.

• Verbalize feelings of safety.

• Follow up with psychiatric evaluation/social service assistance.


Nutritional Status: Physical Aging Status; Psychosocial Adjustment:

Life Change; Will to Live


Determine: Assess daily food intake; meal preparation; sleep

patterns; mobility status; education, activity, and exercise;

religious affiliation; involvement in social activities; and access to

transportation. Assessment factors will help identify appropriate


Monitor fluids and electrolytes. Imbalance can be life-threatening.

Perform: Record daily weights at the same time each day to provide

consistent information.

Report abnormal electrolyte levels to ensure that therapy will

reverse and levels will not deteriorate.

Monitor fluid intake and output every 8 hr to ensure that fluids

are balanced. Imbalance can lead to heart failure or dehydration.

Record amount of food consumed and supplements given to

patient to ensure that the patient is getting sufficient nutrition.

Plan activities and exercise consistent with patient’s capabilities. It

is important that the patient be able to enjoy activity. Overexertion

can lead to cardiac problems.

Arrange for social interaction with other patients. Arrange for the

nurse to spend several short periods of uninterrupted time with the

patient each day to instill trust and a sense of caring.

Teach caregiver how to make meals that may be appetizing to the

patient. Encourage caregiver to record food consumed by patient.

Appetizing foods may help motivate the patient to eat when he or

she claims not to be hungry.

Attend: Create a pleasant mealtime environment for patient. Provide

unlimited access to nourishing foods and nutritional supplements.

Attempt to accommodate ethnic food preferences. This will encour-

age patient when he or she is hungry rather than when food is put

in front of him or her.

Encourage family members and caregivers to establish a plan for

addressing patient’s failure to thrive in order to take responsibility

for meeting the patient’s needs to the extent they are able.

Encourage patient to participate in active exercise during the day

to the extent he or she is able. Exercise is essential to a feeling of


Manage: Refer patient and family to appropriate agencies in the

community such a meal programs, senior support/activities groups,

and so forth. This kind of follow-up will ensure that the plan has a

chance of succeeding.

Refer patient and family to social services for appropriate resources.
Refer to clergy person for spiritual help if patient wishes.


Coping Enhancement; Home Maintenance Assistance; Nutritional

Monitoring; Spiritual Support


Lennie, T. A. (2006, March–April). Factors influencing food intake in patients

with heart failure: A comparison with healthy elders. The Journal of Car-
diovascular Nursing, 21(2), 123–129.