Malnutrition

Malnutrition

1. Pathophysiology

   • The body selectively uses carbohydrate stores until they are depleted. Skeletal protein is converted to glucose for energy, using amino acids for gluconeogensis to allow metabolic processes to continue. Within 1 week the body mobilizes fat to supply energy. Once fat stores are gone, the body begins to utilize visceral and body proteins. As protein depletion continues, liver function is decreased, and protein synthesis is impaired. The decrease in protein synthesis lowers plasma oncotic pressure. The decrease in oncotic pressure moves body fluids from vascular space into the interstitial compartment. Edema is often present masking muscle wasting. The sodium-potassium pump fails. Decreasing total blood volume changes the appearance of skin to dry and wrinkled.

2. Clinical Manifestations

   • Dry and Scaly Skin, brittle nails, rashes, hair loss
   • Decreased muscle mass and weakness
   • Mouth and tongue: dry and crusting, may have ulcerations
   • Mental changes: confusion, irritability

3. Diagnostic Studies

   • History and physical examination
   • Lab Studies: albumin, pre albumin, CRP, Serum electrolyte levels, CBC, liver enzymes, serum levels of fat-soluble and water-soluble vitamins
   • Anthropometric measurements

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

   • Daily Calorie count
     • High-protein ,high-calorie foods
       • Multiple, small feedings
     • Diet diary
   • Supplements
     • Appetite stimulants
   • Dietitian consult