Plan Nutritional Strategies to Impact Musculoskeletal and Integumentary Wellness

Core Concepts

Turning Findings into Goals

Planning starts with the problems identified in the diagnosis phase. Each problem is converted into a goal stated in terms of what the person will achieve, paired with a measurable outcome that includes a timeframe — for example, "The person will eat at least half of each meal by day three" or "The person's skin will remain intact throughout the hospitalization" (illustrative examples; outcomes must be individualized). Outcomes should be realistic, meaningful to the person, and written in language the whole team can verify. Nutrition outcomes often involve intake (portion of meals eaten, number of snacks), status (weight trend, skin condition, wound size), function (ability to walk to the bathroom, grip strength), and the person's own report (appetite, pain with eating).

Prioritizing Nutrition Problems

Not every nutrition concern has equal urgency. General frameworks used in nursing — ABC (airway, breathing, circulation) and Maslow's hierarchy — guide priorities, and for these systems the nurse also weighs threats to skin and tissue integrity, swallowing safety, and severe intake deficits as high-priority concerns. A person who cannot chew, has lost significant weight, or has an open wound needs a plan that addresses those immediate issues before broader diet-quality education. Priority also accounts for what the person is ready to work on: a plan the person rejects will not succeed no matter how sound it is.

Choosing Interventions

Interventions chosen during planning fall into the same categories used in the implement phase: independent (within the nurse's authority — mealtime assistance, positioning, basic nutrition education), dependent (requiring a provider's order — a prescribed therapeutic diet, oral nutrition supplements, enteral or parenteral nutrition), and collaborative/interdependent (shared with other disciplines — an RD consult, speech-language evaluation for swallowing, physical therapy for strength). A food-first approach — using regular foods the person enjoys — is generally preferred as a starting point, with specialized products or medical nutrition therapy added only under the guidance of the RD and provider. Planning should never invent dietary restrictions, supplements, or feeding changes beyond scope; those belong to the RD and provider.

Building the Team

Musculoskeletal and integumentary nutrition problems are multidisciplinary by nature. The RD completes the nutrition assessment and designs the individualized nutrition care plan; the provider orders diets, supplements, and treatments; the nurse coordinates, educates, and monitors; speech-language pathologists assess swallowing if aspiration is a concern; physical and occupational therapists address strength and self-feeding. The nurse's planning role is to recognize when each specialty is needed and to initiate referrals through the appropriate channels and facility protocols.

Writing the Plan

The care plan documents the problems, goals, outcomes, and interventions, plus who is responsible and when reevaluation will occur. Good documentation is specific enough that a nurse coming on the next shift knows exactly what to do, what to watch for, and when to escalate. It also records the person's preferences and any barriers (dental problems, difficulty chewing, religious or cultural food practices) so the plan is genuinely person-centered.

Common Confusions