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1. Undernutrition

   • Pathophysiology
     • Undernutrition is sebsequent to insufficient intake, altered digestion, or absorption of protein, energy or both (calories). It is called protein-energy malnutrition (PEM) or Protein-Calorie Malnutrition (PCM).  Characteristics include: weightless, fat loss, muscle wasting and weakness, impaired immune function poor wound healing and reduction of protein synthesis. 
     • Contributing Factors
       • Diagnostic Studies
         • H&P
           • body composition, hx of weight loss, nutrient intake, measures of functional status. 
         • Labs
           • Serum Albumen Prealbumen CRP CBC CMP Liver Enzymes
         • Anthropometric Measurements
           • Gross measurements of fat and muscle contents
         • Functional Measurements
           • assessment focuses on performance of ADLs  Katz index and Lawton Scale 
       • Socioeconomic status, physical illness, incomplete diets, and drug-nutrient interaction
   • Nursing Diagnosis
     • risk for impaired skin integrity related to poor nutritional state.  
     • Intervention
       • Monitor patient for skin breakdown,  Utilize pressure reduction mattresses and turning protocols.  Ensure that patient is receiving adequate amounts of protein or supplemental arginine to prevent or heal current wounds. 
   • Nursing Diagnosis
     • Imbalanced Nutrition, less than body requirements 
     • Intervention
       • Reinforce healthy eating habits, utilizing choosemyplate.gov
   • Nursing Diagnosis
     • Deficient fluid volume 
     • Intervention
       • Encourage fluids to be consumed by mouth, may use flavor enhancers to encourage consumption.  Patient may need to receive fluids by PIV for adequate hydration.  
   • Nursing Diagnosis
     • Feeding self care deficit related to decreased strength and or absorption of fluids. 
     • Intervention
       • Choose high calorie soft foods that will be easy to consume with little effort.  If patient is unable to grip utensils ensure that patient has staff to assist with feeding during meals and snacks. 
   • Health Risk

2. Overnutrition

   • Over 2/3s of Americans are considered overweight or obese naming these the most common forms of overnutrition,  
   • Pathophysiology
     • Overweight=BMI >25-29.9 Obese=BMI >30 Extreme obesity=BMI >40 Obesity is excessively high amounts of body fat or adipose tissue.  Obesity is a major health problem because it increases the risk of many other diseases. Obesity is an increase in body weight beyond the body physical requirements which results in an abnormal increase accumulation of fat cells. There are an increase in the number of adipocytes and an increase in their size.   
     • Contributing Factors
       • Genetic link-estimates of obesity as an inherited problem are more than 50%.  Physiologic regulatory mechanisms: hypothalamus, gut, and adipose tissue synthesize hormones and peptides that stimulate or inhibit appetitie.  Environmental factors Psychosocial factors
       • Diagnostic Studies
   • Nursing Diagnosis
     • Intervention
   • Nursing Diagnosis
     • Intervention
   • Nursing Diagnosis
     • Intervention
   • Nursing Diagnosis
     • Intervention

3. Clinical Manifestaions

   • Range from mild to emaciation and death.  The most obvious signs are dry and scaly skin, brittle nails, rashes,  and hair loss. Dry mouth, crusting and ulcerations with changes in the tongue.  Decreased muscle mass and weakness.  Mental changes such as confusion and irritability.  The speed at which malnutrition develops depends on the quantity and quality of the protein intake, caloric value, illness and the persons age. 

4. Clinical manifestations