Malnutrition

Malnutrition

1. Pathophysiology

   • The body uses up carb stores in the liver and muscles (18 hours), once carb stores are depleted, the body converts skeletal protein to glucose for energy. In 5-9 days, the body mobilizes fat to supply energy (4-6 wks), once these are depleted, the body uses visceral and body proteins, which rapidly decrease.

2. Clinical Manifestations

   • Poor skin Turgor
     • Dry Mucous Membranes
       • Weight loss
         • weakness/fatigue
           • decreased muscle mass

3. Contributing Factors

   • Socioeconomic Factors
     • physical illnesses
       • incomplete diets
         • drug-nutrient interactions

4. Diagnostic studies

   • H & P, including diet hx
     • labs, CBC, LFT's and chemistry
       • serum albumin-half life of 20-22 days, long, so pre albumin studies better.  CRP can determine if inflammation present.  A high CRP and low albumin or prealbumin suggests inflammation is driving albumin changes. Electrolyte changes-serum K+ usually elevated, LFT's elevated, RBC and hg may indicate anemia
       • fat measurements
         • functional measurements, Katz

5. Nursing Diagnoses

   • Imbalanced nutrition <body requirements
     • Risk for impaired skin integrity
       • deficient fluid volume
         • feeding self-care deficit r/t decreased strength
           • Noncompliance r/t alteration in perception, lack of motivation

6. Nursing interventions

   • Health Promotion
     • Teach and reinforce healthy eating habits, implement MyPlate for visual guide
     • Acute care
       • identify risk factors, record daily weights, intake and output, daily calorie count.&nbsp; Make environment conducive to eating, encourage family to bring in favorite foods
       • Ambulatory care
         • encourage patient and caregiver to utilize high protein foods to prevent malnourishment, assess ability of patient to follow diet, encourage to keep diet diary, provide ideas on protein rich foods and snacks.&nbsp;