Malnutrition

Malnutrition

1. Pathophysiology

   • Deficit, excess or imbalance of essential nutrients
   • Starvation related malnutrition- nutritional needs are not being met.
   • Chronic-disease related malnutrition-in conditions with inflammation, dietary needs do not meet tissue needs, although it would under normal conditions
   • Acute disease or injury related malnutrition is related to a marked inflammatory response (major infection, burn, trauma or surgery)

2. Contributing Factors

   • Socioeconomic factors, physical illness, incomplete diets, and drug-drug interactions.
   • limited finances, cannot afford food. Does not have access to food
   • Illness, surgery, injury or hospitalization
   • Malabsorption Syndrome
   • Vitamin Deficiencies: alcohol and drug abuse, chronic illness, poor dietary practice, GI surgery
   • drug-drug interactions: incompatabilities, altered drug effectiveness, impaired nutritional status.

3. Clinical Manifestations

   • Range from mild to emaciation and death
   • most obvious signs: dry, scaly skin, brittle nails, rashes, hair loss, crusting and ulceration around the mouth, changes in tongue, decreased muscle mass and weakness, confusion, irritability

4. Diagnostic Studies

   • History and physical: body composition, history on weight loss, nutrient intake and measure of functional status. Dietary history, height, weight, vitals and physical state of each body system
   • Lab Studies: serum albumin, Prealbumin is better, CRP, serum electrolytes, RBC count, Hemoglobin, lymphocytic count, WBC count, liver enzymes, serum levels of both fat soluble and water soluble vitamins
   • anthropometric measurements and functional measurements

5. Potential Nursing Diagnosis

   • imbalanced nutrition: less than body requirements related to: decreased access, ingestion, digestion or absorption of food; or related to anorexia, dysphagia, or increased metabolic needs
   • feeding self-care deficit related to decreased strength and endurance, fatigue and apathy
   • Deficient fluid volume related to factors affecting access to or absorption of fluids
   • Risk for impaired skin integrity related to poor nutritional state
   • Noncompliance related to alteration in perception, lack of motivation, or incompatability of regimen with lifestyle or resources

6. Nursing Interventions

   • teach and reinforce healthy eating habits
   • achieve and maintain appropriate weight.
   • make sure patient consumes a specified number of calories per day
   • speak with PCP and dietician to identify malnutrition and implement interventions
   • Identify risk factors for malnutrition and why they exist
   • With increased stress on the body, more calories and protein are needed
   • measure weight and height routinely
   • measure intake and output
   • obtain a daily calorie count and diet diary
   • offer foods that the patient likes and encourage family members to bring food
   • conducive eating environment
   • provide oral and hand hygiene
   • Administer appetite stimulants as ordered: Megace or Marinol