Malnutrition

Malnutrition

1. Pathophysiology

   • 1. Body uses up carbohydrate stores from liver and muscle
     • 2. Protein is then converted to glucose for energy, gluconeogenesis occurs
       • 3. In 5-9 days, fat is mobilized to start supplying energy
         • 4. In 4-6 weeks fat stores used up, after that visceral and body proteins of internal organs
           • 5. Liver function impaired, protein synthesis diminished, plasma oncotic pressure decreases, albumin leaks to interstitial space

2. Contributing Factors

   • Socioeconomic factors
     • Food insecurity
   • Physical Illness
     • Injury, Surgery, Hospitalization
       • sepsis
       • draining wounds
       • burns
       • hemorrhage
       • Fractures
       • Immobilization
   • Incomplete diet
     • vitamin deficiency
   • Drug-Nutrient Interactions
     • Change in taste or appetite
     • Nausea
     • Increase/decrease in apsorption of nutrients

3. Clinical Manifestations

   • Dry, scaley skin, brittle nails, rashes, hair loss
   • Mouth crusted and ulcerated
   • Decreased muscle mass, weakness
   • Confusion, irritablilty, fatigue

4. Diagnostic Studies

   • Serum albumin, prealbumin, serum transferrin, CRP, electrolytes, CBC

5. Nursing Diagnoses

   • Imbalanced nutrtion: less than body requirements
   • Feeding self-care deficit
   • Deficient fluid volume
   • Risk for impaired skin integrity
   • Noncompliance related to alteration in perception or lack of motivation

6. Nursing Interventions

   • Monitor: Daily weights, diet history, MDS, medications, lab values, physical exam, anthropometric measurements
   • Educate on nutritional requirements and food choices (high calorie, high protein foods)
     • Refer to dietician
   • Provide small and frequent meals throughout the day
   • Encourage patient to keep a food diary
   • Encourage patient to set small, attainable goals
   • Provide pleasant environment at meal times, proper positioning, good oral hygiene, and necessary eating utensils