Malnutrition

Malnutrition

1. Pathophysiology

   • deficit, excess or imbalance of essential nutrients.
   • Starvation process and malnutrition go hand in hand. body will begin to be selectively use carbs rather than fat and protein to meet metabolic needs. The carb stores are minimal at this point and may be gone within 18 hours. Once the carb stores are gone the body will convert skeletal protein to glucose for energy.Eventually protein depletion occurs, the decrease in protein syntheis will decrease the oncotic pressure which will lead to a fluid shift. Edema will be visible often in face and legs

2. Clinical Manifestations

   • Skin: dry and scaly, brittle nails, and hair loss.
   • Mouth: Crsusts and ulcerations and changes in the tongue.
   • Muscles: decresed mass and weakness.
   • CNS: mental changes suchas confusion and irritability
   • Other: delayed wound healing, suseptible to infection, leukocyte decrease, and anemia.

3. Diagnostic Studies

   • Physical exam: physical appearance, muscle mass and strength, and dental and oral health.
   • Lab studies: Glucose, electrolytes, lipid profile, BUN, albumin, prealbumin, and CRP
   • Anthropometreic measurements: height, weight, BMI, rate of weight change, and amount of weight loss.
   • Functional Status: ability to perform basic and instrumental ADLs, handgrip strength, performance tests.
   • Diet History: chewing and swallowing, changes in appetite or taste, food and nutrition intake, availability of food.
   • Health History: personal and family history, acute or chronic illnesses, current meds,herbs or supplements, depression and cognitive status.

4. Potential Nursing Diagnosis

   • Imbalanced nutrition: less than body requirements related to... anorexia, malabsorption, digestion, decreased access, or increased metabolic needs.
   • Feeding self-care deficit related to... decrease strength, endurance, and fatigue
   • Deficit fluid volume related to ...factors affecting access or absorption of fluids
   • Risk for impaired skin integrity related to ...poor nutritional state.
   • Noncompliance related to...alteration in perception, lack of motivation, incompatibility of regimen with lifestyle or resources.

5. Contributing Factors

   • Socioenomical factors, physical illness, incomplete diets, and drug nutrient interactions
   • Conditons that increase risk: dementia, depression, alcoholism, excessive dieting, swallowing disorder, decreased mobility, nutrition losses from malabsorption, dialysis, diarrhea, or wounds, medication , extreme need for nutrients, no oral intake

6. Nursing Interventions

   • Teach and reinforce healthy eating habits
   • MyPlate education and resources
   • Using and app or software to tracking eating and exercising
   • Daily weights, height, BMI, intake, output, calorie count
   • Provide environment conductive to eating
   • Oral and hand hygiene