Flashcards in Nutritional Disorders Deck (25)
-clinical & lab findings
def- protein calorie starvation caused by protein and energy deficiency, typically results from chronic diseases (COPD, CHF, cancer)
-lack of food d/t lack of access (SES, education, parental neglect)
-physical disability (cant take in food)
-hx of weight loss
-absence of sub Q fat
-decreased BP, HR, and temp
-dry thin dull hair
- mild anemia
-mildly reduced serum proteins
-CBC indicates anemia
-clinical & lab findings
def- severe protein deficiency in the presence of adequate energy, results from hypermetabolic acute illness (burns, trauma, sepsis)
-increased requirement (fever, neoplasms, surgery)
-normal fat and muscle
-decreased BP, bradycardia, hypothermia
-hepatomegaly w/ ascities
-low serum albumin
-decreased glucose and lipids
Overall PEM is characterized by...
-loss of body weight, adipose stores, & muscle mass
* proten mass is lost from liver, GI tract, kidneys, & heart
What lab could we order to help evaluate protein status?
What labs could we order to see how the liver is functioning?
Bilirubin- if build up of bilirubin from catabolized RBC in blood liver is not functioning well by filtering this out.
Prothrombin time- checks clotting time, liver makes clotting factors(fibrinogen), if liver isnt functioning well clotting time will be greater.
Albumin- produced in the liver
Proteins are important in maintenance of fluid balance. Explain.
if proteins are not being produced by the liver there will be a decrease in the oncotic pressure leading to movement of fluids from the vasculature to the interstitial tissue causing swelling.
Effects of Protein Energy Malnutrition (PEM): MUSCLE MASS
-fat and muscle stores are used for fuel
-muscle loss results in weakness and lost protein
Effects of Protein Energy Malnutrition (PEM): CARDIAC
-decrease in mass and stroke volume---> decreased cardiac output
Effects of Protein Energy Malnutrition (PEM): RESPIRATORY FUNCTION
-weakness and atrophy of respiratory muscles
-decrease in vital capacity, tidal volume, minute volume, and breathing capacity
-mucocilliary clearance is abnormal
Effects of Protein Energy Malnutrition (PEM): IMMUNE FUNCTION
-all components are adversely affected
-t cells depressed
-specific aby responses depressed
-neutropenia (decreased # of neutrophils)
* cannot trust CBC in elderly manlnourished pt, if they cant mount an immune response, labs wont change
***MOST IMPORTANT CHANGE W/ PEM
Effects of Protein Energy Malnutrition (PEM): GI TRACT
-gastric motility slows
-gastric acid secretion decreases
-lack of absorption d/t decrease in small bowel mass
Effects of Protein Energy Malnutrition (PEM): BONES
-calcium not absorbed so you take from bones leading to brittle bones
Effects of Protein Energy Malnutrition (PEM): MENSTRUAL CYCLE
Effects of Protein Energy Malnutrition (PEM): TESTICULAR FUNCTION
-decreased sperm production
Effects of Protein Energy Malnutrition (PEM): WOUND HEALING
-neovascularization, collagen synthesis, fibroblast proliferation, wound remodeling all delayed
Causes of Malnutrition in Hospitalized patients
- decreased oral intake (nausea, pain, old age, depression)
-increased nutrient loss (malabsoprtion, diarrhea, bleeding, nephrosis, glycosuria)
-increased nutrient requirements (fever, burn, trauma, surgery, infection, neoplasm, medication)
What is the most common abx that causes C-Diff and what medication is used to treat it?
3 phases of metabolic responses to critical illness
1.) ebb phase: occurs immediately following injury (12-24hrs)
goal: prevent organ failure
2.) Flow phase:
-fat used as fuel source
3.) Anabolic Phase
-begins onset of recovery
-things start to normalize
-improved appetite & diuresis
Explain how Inflammatory Bowel Disease affect nutritional status
Decreased nutritional intake
-association of food w/ Diarrhea and/or pain
Increased Energy expenditure:
-when Chrohns active, resting energy expenditure increases
Enteral Protein Loss:
-capillary leak of proteins through inflammed tissues
-results in decreased concentration of plasma proteins in blood
-cellular proteins continue to get broken down to feed the pool.
2 Types of IBD:
Chrohns & Ulcerative Colitis
explain each disease.
Chrohns- autoimmune disease all throughout the bowel. Bowel becomes inflammed and does not absorb well, ulcerations in the lining intestines.
Ulcerative Colitis: autoimmune disease of rectum and colon. Bowel becomes inflammed so its not absorbing well, lots of blood in stool, fissures, skin tags. Much higher risk of colon cancer, usually end up with some sort of bowel resection.
Explain how Cancers affect nutritional status
-loss of appetite
-inability to ingest or absorb adequate calories
-in catabolic state b/c of neoplasm
-treatments (surgery) can worsen problem
Explain how Lactose Intolerance affect nutritional status
- a lot of fluid loss
- abd pain
-mucousal injury (IBD)
Explain how Mental Status affect nutritional status
- forgot to eat
-nauseous from meds
-lack of interest in food d/t diminished taste and smell
-poor dental health
How do you work up malnourished patients?
Check labs- CBC, CMP ABG (pH), sed rate, electrolytes