Malnutrition- Ashley Melick

Malnutrition- Ashley Melick

1. Pathophysiology

   • Within the first 18 hours, the body uses carbs from liver and muscles as energy. Once depleted, it uses skeletal protein to make glucose for energy. Within 5-9 days, the body uses fat supply for energy. When starvation is prolonged, fat provides up to 97% of calories so that protein in conserved. After 4-6 weeks when the fat stores are depleted, the body uses visceral and body proteins. With continued protein depletion, liver function becomes impaired and protein synthesis decreases. This causes albumin issues and causes edema. This causes many electrolyte imbalances.

2. Contributing Factors

   • -Socioeconomic
   • Physical Illnesses
   • Incomplete Diets
   • Drug-Nutrient Interactions

3. Clinical Manifestations

   • dry, scaly skin
   • Brittle nails
   • Rashes
   • HairLoss
   • Crusting and ulceration in mouth
   • decreased muscle mass and weakness
   • Tongue Changes
   • Irritability
   • Confusion

4. Diagnostic Studies

   • History & Physical Exam
   • Laboratory Studies: Albumin, prealbumin, CRP, serum electrolytes,RBC, WBC, Hemoglobin, lymphocytes, liver enzymes, fa-soluble and water-soluble vitamin levels
   • Anthropometric Measurements: skinfold measurements and mid-arm muscle circumferences
   • Functional measurements: Katz index and Lawton Scale

5. Potential Nursing Dx

   • Imbalanced Nutrition:less than body requirements
   • Feeding self-care deficit
   • Deficient fluid volume
   • Risk for impaired skin integrity
   • Noncompliance

6. Nursing Interventions

   • Health Promotion: provide written and visual resources
   • Identify and address risk factors
   • Collaborate with HCP and dietician
   • Provide high calorie and high protein foods
   • Offer patient preferred foods
   • Provide environment conducive to eating
   • Assist with EN or PN if neccessary
   • provide patient education on malnutrition and healthy diet