Malnutrition

Malnutrition

1. Pathophysiology

   • protein depletion
     • impaired liver function
       • inflammation
   • gluconeogenesis

2. Contributing Factors

   • Physical Illness
     • anorexia
     • diarrhea
     • vomiting
     • nausea
     • malabsorption syndrome
     • dementia
     • depression
   • Incomplete Diets
     • vitamin deficiencies
     • post-gastrectomy
   • Socioeconomic Factors
     • Food Insecurity
   • Drug-Nutrient Interactions
     • Grapefruit juice
     • Dietary Supplements
     • Herbs

3. Nursing Diagnosis

   • Imbalanced nutrition: less than body requrements
     • Ensure
   • Feeding self-care deficit
     • provide quiet, calm environment at mealtimes
   • deficient fluid-volume
     • encourage fluid intake
     • IV bolus
   • Risk for impaired skin integrity
     • Monitor for skin breakdown
   • Noncompliance
     • educate
       • print sources
   • Goals/Expected Outcome
     • Patient will achieve an appropriate weight.
     • Patient will consume adequate number of calories per day as specified by physician.
     • Patient will have no adverse effects related to malnutrition or nutritional therapies.

4. Clinical Manifestations

   • dry, scaly skin
     • rashes
   • brittle nails
   • crusting and ulceration of mouth
   • hair loss
   • changes in tongue
   • decreased muscle mass
     • weakness
   • CNS
     • irritability
     • confusion

5. Diagnostics

   • History & Physical
     • Anthropometric Measurements
   • Labs
     • low albumin
     • low prealbumin
     • elevated CRP
     • elevated potassium
     • elevated liver enzymes
     • decreased RBC's
     • decreased hemoglobin

6. Other Medical Diagnosis

   • Hypertension
     • lisinopril 10 mg daily
     • carvedilol
   • Acid Reflux
     • omeprazole
     • TUMS
     • simethicone
   • Cobalamin Deficiency
     • Vitamin B12 injections monthly
   • Hypercholesterolemia
     • atorvastatin
   • Rheumatoid Arthritis
     • Calcium Carbonate/Vitamin D
     • Vitamin E

7. Collaborative Care

   • PCP
   • Dietician
   • Occupational Health