Malnutrition

Malnutrition

1. Cause: deficit, excess, or imbalance of essential nutrients

   • Contributing factors: socioeconomic factors, physical illnesses, incomplete diets, drug-nutrient interactions
     • Risk factors: Dementia, depression, chronic alcoholism, excessive dieting, swallowing disorders, decreased mobility, nutrient losses, no oral intake and/IV solutions for 10 days, food insecurity
   • Clinical Manifestations: dry, scaly skin, brittle nails, hair loss, crusty mouth, ulcerations on tongue, decreased muscle mass and weakness, mental changes

2. Nursing Diagnosis: Imbalanced Nutrition: Less than body requirements r/t decreased access to food

   • Nursing Interventions: Offer community resources, meet with dietician to plan out meals, keep food and weight diary, apply for SNAP, seek meals on wheels

3. Nursing Diagnosis: Feeding self-care deficit r/t decreased strength, fatigue

   • Nursing interventions: Make sure room is quiet, offer oral hygiene, assist patient to comfortable position, assist with eating
   • Collaborative care: PT/OT scheduled

4. Nursing Diagnosis: Deficit fluid volume r/t factors affecting access to or absorption of foods

   • Nursing Interventions: Offer foods preferred by the patient, assist family in selecting high-protein/high-calorie foods, offer nutritional supplements, Use MyPlate visual guide, download food plans to electronic device

5. Nursing Diagnosis: Noncompliance r/t alteration of perception, lack of motivation

   • Nursing Interventions: Assess learning, Assess pts nutritional state with HCP, offer inbetween meal supplements, offer appetite stimulant, offer community resources

6. Expected Outcomes: Pt will achieve appropriate weight, pt will consume a specified number of calories per day, pt will have no adverse consequences r/t malnutrition or nutritional therapies, pt will maintain optimal physical functioning.

7. Labs: Prealbumin and albumin decreased, CRP elevated, Potassium elevated, total lymphocyte decreased, RBC/Hgb decreased, liver enzymes increased, low fat-soluable vitamins, glucose decreased.

8. Medications: Appetite stimulants

   • Marinol
     • Megace

9. Psychosocial aspects: Depression, fear

   • Nursing Interventions: Address concerns, therapeutic listening, offer any resources available

10. Diagnostic studies: History and physical examination, laboratory studies, anthropometric and functional measurements.