Chapter 39: Malnutrition Flashcards
Malnutrition
Deficit, excess, or imbalance of essential nutrition
Undernutrition
Occurs when nutritional reserves are depleted, and nutrient and energy intake are not sufficient to meet daily needs or added metabolic stress
Overnutrition
The ingestion of more food than is required for body needs, as in obesity
Explain starvation-related malnutrition and give an example of this.
AKA Primary PCM:
Occurs when nutritional needs are not met. In primary PCM there is chronic starvation without inflammation (eg: anorexia nervosa)
Explain chronic disease-related malnutrition and give an example of this.
AKA Secondary PCM:
Related to conditions that have sustained mild to moderate inflammation. This occurs when dietary intake does not meet tissue needs, although it would under normal conditions. (eg: organ failure, cancer, rheumatoid arthritis, obesity)
Explain acute disease-related malnutrition and give an example of this.
AKA Injury-related malnutrition:
Related to acute disease or injury states with marked inflammatory response (eg: major infection, burns, trauma, surgery)
Relate the levels of inflammation with above categories of malnutrition.
- Marked Inflammatory Response:
*Acute Disease or Injury-Related Malnutrition: Major infection, burns, trauma, closed head injury, SIRS, MODS - Mild to Moderate Degree of Inflammation:
*Chronic Disease-Related Malnutrition: Organ failure, pancreatic cancer, rheumatoid arthritis sarcopenic obesity - None
*Starvation-Related Malnutrition: Pure chronic starvation (anorexia nervosa)
Describe socioeconomic factors that contribute to malnutrition.
*Persons or families with limited financial resources may have food insecurity (inadequate access).
*Those with food insecurity usually choose less expensive “filling” foods, which are more energy dense (high fat) and lack nutritional value. This type of diet increases the risk for nutrient deficiencies.
*The “heat or eat” phenomenon is problematic, as those with limited economic resources struggle to pay household utility bills or put food on the table.
*Older adults on a fixed income have an added burden of deciding on whether to pay for medications or food.
Describe physical illnesses that contribute to malnutrition.
- consequence of illness, surgery, injury, or hospitalization.
*Prolonged illness, major surgery, sepsis, draining wounds, burns, hemorrhage, fractures, and immobilization can all contribute to malnutrition
*Undernutrition can worsen a pathologic condition.
*Anorexia, N/V, diarrhea, abdominal distention, and abdominal cramping may accompany gastrointestinal (GI) disease. Any combo of these symptoms interferes with normal food consumption and metabolism.
Explain malabsorption syndrome and possible causes of this condition.
*The impaired absorption of nutrients from the GI tract. Decreases in digestive enzymes or in bowel surface area can quickly lead to a deficiency state.
*Many drugs have undesirable GI side effects and alter normal digestive and absorptive processes.
*Fever accompanies many illnesses, injuries, and infections, with a concomitant increase in the body’s basal metabolic rate (BMR) and nitrogen loss. Each degree of temperature increase on the Fahrenheit scale raises the BMR by about 7%. WIthout an increase in caloric intake, the body uses protein stores to supply calories and protein depletion develops. After the body temperature returns to normal, the rate of protein breakdown and resynthesis may stay increased for several weeks.
List conditions that could lead to incomplete diets.
*When vitamin imbalances do occur, they usually involve several vitamins, rather than a single one. This may happen with a person with a pattern of alcohol and drug use, those who are chronically ill, and those who follow poor dietary practices. Persons who had surgery on the GI tract may be at risk for vitamin deficiencies.
*Manifestations of vitamin imbalances range from skin conditions to neurologic signs.
Give examples of drug-nutrient interactions.
A drug-nutrient interaction occurs when a drug affects the use of nutrients in the body. Many drug and food or beverage interactions may occur. Potential adverse interactions include incompatibilities, altered drug effectiveness, and impaired nutritional status. Many drugs have side effects. Such as changes in taste, appetite, and nausea. Grapefruit juice can increase the absorption of some drugs, enhancing their effect. Drug-nutrient interactions can also occur with the use of herbs and dietary supplements. Monitor and prevent these potential interactions for patients in the hospital and at home.
Describe how edema could result from the starvation process.
As protein depletion continues, liver function becomes impaired and protein synthesis decreases. The decrease in protein synthesis lowers plasma oncotic pressure. A major function of plasma proteins, primarily albumin, is to maintain the osmotic pressure of blood. When the oncotic pressure decreases, body fluids shift from the vascular space into the interstitial space along with the fluid. Edema becomes observable. Often edema in the patient’s face and legs masks the underlying muscle wasting.
Explain the clinical manifestations of malnutrition
*The manifestations of malnutrition range from mild to emaciation and death.
*The most obvious signs are seen in the skin (dry and scaly skin, brittle nails, rashes, hair loss), mouth (crusting and ulceration, changes in tongue), muscles (decreased mass and weakness), and CNS (mental changes, such as confusion, irritability).
*As protein intake declines, the muscles (the largest store of protein in the body) become wasted and flabby. This leads to weakness and fatigability.
*delayed wound healing
*Anemia
*The diagnosis of malnutrition is best determined by body composition, including a thorough history of weight loss, nutrient intake, and measures of functional status. Obtain vital signs, height, and weight. Assess and document the patient’s physical state and each body system.
Review nursing interventions that could help with patients struggling with malnutrition.
*Protect mealtime from unnecessary interruptions by performing nonurgent care before or after mealtime.
*If the patient is unable to consume enough nutrition with a high-calorie, high–protein diet, consider adding oral liquid nutritional supplements.
*If EN is not possible, consider starting parenteral nutrition (PN).
*Consider the availability and acceptability of community resources that provide meals, such as Meals on Wheels, senior congregate feeding sites, and the Supplemental Nutritional Assistance Program (SNAP).
*Keeping a diet diary for 3 days at a time is one way to analyze and reinforce healthful eating patterns.
- Encourage self-assessment of progress by having the patient weigh himself or herself once or twice a week and keep a weight record.
