Malnutrition

Malnutrition

1. Pathophysiology

   • Starvation-Related Malnutrition
   • Chronic Disease-Related Malnutrition
   • Acute Disease- or Injury-Related Malnutrition

2. Contributing Factors

   • Food Insecurity
   • Fixed Income
   • Illness
     • Eating Disorders
     • GI Disease
   • Injury
     • Wounds
     • Hemorrhage
     • Burns
   • Surgery
   • Hospitalizations
   • Incomplete Diet
   • Drug-Nutrient Interactions

3. Diagnostic Studies

   • History & Physical Exam
   • Laboratory Studies
     • Serum Albumin
     • Prealbumin
     • CRP
     • Serum Electrolytes
     • RBC
     • HGB/HCT
     • WBC
     • Serum vitamin levles
   • Measurement of Fat & Muscle Content
   • Functional Assessment of ADLs

4. Nursing Diagnoses

   • Imbalance 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 incompatibility of regimen with lifestyle or resources

5. Nursing Interventions

   • Determine healthy body weight for age and height. Refer to dietitian.
   • Assess patient's ability to obtain and use essential nutrients.
   • Observe patient's ability to eat.
   • Be alert for food-nutrient-drug interactions
   • Assess for recent changes in physiological status that may interfere with nutrition.
   • Observe patient's relationship to food. Attempt to separate physical from psychological causes for eating difficulty.
   • Weigh weekly under the same conditions.
   • Determine time of day when patient's appetite is greatest and offer highest calorie meal at that time.

6. Clinical Manifestations

   • Dry, scaly skin
   • Brittle Nails
   • Rash
   • Hair Loss
   • Ulcerations in mouth
   • Decreased muscle mass and weakness
   • Fatigue
   • Delayed Wound Healing
   • Increased susceptibility to infection