NURS 308: UNIT 1 - TOPIC 8: MALNUTRITION AND SPECIALIZED NUTRITIONAL SUPPORT

What is starvation-related (primary) malnutrition?

Malnutrition caused by inadequate intake where nutritional needs are not met, such as in anorexia nervosa.

What causes chronic disease–related (secondary) malnutrition?

Increased or special nutritional needs due to chronic inflammation from long-term diseases.

Which conditions are associated with chronic disease–related malnutrition?

Cancer, obesity, organ failure, and hyperthyroidism.

What is acute disease- or injury-related malnutrition?

Malnutrition caused by increased nutritional needs due to marked acute inflammation.

Which conditions are linked to acute disease- or injury-related malnutrition?

Burns, infections, surgery, and trauma.

How does acute disease- or injury-related malnutrition differ from chronic disease–related malnutrition?

It is not long-term and is related to short-term acute inflammation.

What socioeconomic factors contribute to malnutrition?

Food insecurity caused by limited finances or lack of transportation, leading to inconsistent access to adequate nutrition

How do physical illnesses increase the risk for malnutrition?

Nausea, vomiting, diarrhea, anorexia, malabsorption syndromes, prolonged illness, hospitalization, and immobilization interfere with nutrient intake and absorption

How does an incomplete diet contribute to malnutrition?

Poor dietary habits, alcohol or drug abuse affecting nutrient absorption, and chronic GI illnesses reduce proper nutrient intake

What role do drug–nutrient interactions play in malnutrition?

Certain medications interfere with the absorption or metabolism of essential nutrients

What determines the severity of starvation manifestations?

They range from mild symptoms to emaciation and death and are linked to protein intake and age

What skin changes are seen with starvation?

Dry, scaly skin; brittle nails; rashes; hair loss

What oral changes occur in starvation?

Crusting and ulceration of the mouth and changes in the tongue

What is often the 1st physical manifestation of decreased protein intake?

Loss of muscle strength and muscle mass

What CNS changes can occur with starvation?

Mental changes such as confusion and irritability

What other systemic effects are associated with starvation?

Anemia, decreased white blood cells increasing infection risk, and delayed wound healing

How does the nurse manage malnutrition?

By identifying clients who are malnourished and those who are at risk for becoming malnourished.

What does the Joint Commission require related to nutrition on admission?

A nutritional screening for all patients within 24 hours of admission

What information does a 24-hour diet recall provide?

A clear picture of what the patient ate and drank in the past day

What physical exam findings help identify nutritional problems?

Overall physical appearance, muscle mass and strength, and dental or oral issues affecting chewing or swallowing

Which anthropometric measurements are used to assess nutrition?

Height, weight, BMI, rate of weight change, and amount of weight loss

What amount of weight loss signals a need for further nutritional assessment?

Loss of more than 5% of body weight within 6 months or less

Why is it important to determine whether weight loss was intentional or unintentional?

Unintentional weight loss may indicate serious conditions such as cancer

Which laboratory values are used to evaluate nutritional status?

Glucose, electrolytes, lipid profile, BUN, albumin, prealbumin, and C-reactive protein

What do albumin and prealbumin levels indicate about nutrition?

Low prealbumin reflects acute malnutrition, while low albumin reflects chronic malnutrition

How is functional status assessed when evaluating nutrition?

Ability to perform ADLs and IADLs, handgrip strength, and performance tests such as timed walk tests

What is the primary goal for a patient with malnutrition?

To increase the patient’s weight

What overall weight outcome is expected for a malnourished patient?

Achieve an appropriate, healthy weight

What nutritional intake goal should be established for a malnourished patient?

Consume a specific number of calories per day based on an individualized diet

Who should be involved in planning nutrition for a malnourished patient?

A dietitian should be consulted

What safety outcome should be monitored in a patient with malnutrition?

The patient should have no adverse effects related to malnutrition or nutritional therapies

What health promotion actions support good nutrition?

Teaching and reinforcing healthy eating habits, using MyPlate, and teaching patients how to read nutrition labels

What actions are important for nutrition management in acute care?

Collaborating with the healthcare provider and dietitian, monitoring daily weights, intake and output, and daily calorie counts, providing high-calorie/high-protein supplements and a supportive eating environment, and using appetite stimulants or enteral/parenteral nutrition when indicated

When are appetite stimulants or nutrition support most commonly used?

They are not common and are usually used for patients with cancer or severe nutritional deficits

What nursing actions are important in ambulatory care related to nutrition?

Teaching causes of nutrition problems and how to avoid them, assessing health literacy and ability to follow directions, considering community resources such as Meals on Wheels or meal delivery services, having the patient keep a diet diary, and monitoring weekly weights

What is the number one indicator used to evaluate nutritional outcomes?

Body weight and weight change

What weight trend is expected when nutritional status is improving?

Weight should be stable or slightly increasing, not decreasing

How can a well-balanced diet be evaluated?

By using a food diary, recording the percentage of meals eaten, and performing calorie counts

What clinical signs should be monitored for malnutrition when evaluating outcomes?

Signs and symptoms of malnutrition

Why is physical functioning assessed when evaluating nutritional outcomes?

It reflects the patient’s strength, energy level, and overall nutritional improvement

Which laboratory values are most important when evaluating nutritional status?

CBC, hemoglobin and hematocrit, white blood cell count, and serum protein/albumin

What is a key component of discharge planning?

Patient and caregiver education

What health promotion topics should be included in discharge education?

Diet and nutrition guidance

Which national guideline can be used to teach healthy eating?

Choose My Plate Dietary Guidelines for Americans

What tool helps patients understand food choices and portions?

Nutrition Facts labels

What should be included if a patient has specific nutritional needs?

Special dietary instructions

When should a referral to a dietitian be made?

When the patient needs individualized nutrition counseling

When is a home health referral appropriate?

When the patient needs continued support or monitoring after discharge

What physiologic changes in the oral cavity affect older adults?

Decreased saliva production, dental issues, and reduced taste can affect chewing and intake

How do changes in digestion and motility impact older adults?

Slower digestion and decreased GI motility increase risk for constipation and poor nutrient absorption

How does aging affect the endocrine system in older adults?

Hormonal changes can alter metabolism and glucose regulation

What musculoskeletal changes affect nutrition in older adults?

Loss of muscle mass and strength with decreased caloric needs leads to faster functional decline if intake is inadequate

How do vision and hearing changes affect nutritional status in older adults?

Impaired senses make food preparation and meal enjoyment more difficult

Why are older adults at increased risk for poor health outcomes?

Multiple chronic conditions and physiologic changes increase vulnerability

Why is decreased appetite common in older adults?

Changes in taste, smell, digestion, medications, and depression reduce appetite

How does depression affect nutrition in older adults?

Depression decreases motivation to eat and prepare meals

How does poor oral health impact nutrition in older adults?

Pain, missing teeth, and gum disease impair chewing and intake

Why are medication effects a concern in older adults?

Polypharmacy and altered metabolism increase side effects and appetite changes

How does cognitive impairment affect nutrition in older adults?

Memory and judgment issues lead to missed meals or unsafe eating

How do chewing or swallowing impairments affect older adults?

They increase risk for aspiration and limit food choices

Why do older adults often have inadequate nutrient intake?

Reduced appetite, access issues, and physical limitations decrease intake

How do financial constraints affect nutrition in older adults?

Limited income restricts access to healthy foods

How do functional constraints impact nutrition in older adults?

Mobility issues interfere with shopping, cooking, and feeding

What is enteral nutrition (EN)?

Delivery of food and nutrients directly into the gastrointestinal (GI) tract.

What types of tubes are used for enteral nutrition?

Orogastric, nasogastric, naso-intestinal, gastrostomy, and jejunostomy tubes.

What is parenteral nutrition (PN)?

Administration of nutrients directly into the bloodstream.

What are the types of parenteral nutrition?

Peripheral parenteral nutrition (PPN) and central line parenteral nutrition (TPN).

What is another name for enteral nutrition?

Tube feeding.

How is enteral nutrition administered?

Through a tube, catheter, or stoma directly into the GI tract using nutritionally balanced liquefied food or formula.

Which parts of the GI tract can enteral nutrition be delivered to?

Stomach, duodenum, jejunum.

When is enteral nutrition indicated?

When the client has a functioning GI tract but is unable or unsafe to take enough oral nourishment.

What are the contraindications for enteral nutrition?

GI obstruction, prolonged ileus, severe diarrhea or vomiting, enterocutaneous fistula.

What conditions indicate the use of enteral nutrition?

Anorexia, orofacial fractures, head/neck cancer, neurologic or psychiatric conditions, extensive burns, critical illness, chemotherapy, radiation therapy.

What is a major risk associated with enteral nutrition?

Aspiration.

How can aspiration be prevented in a patient receiving enteral nutrition?

Ensure the tube is in the correct position, maintain head-of-bed elevation, and follow agency policy for checking gastric residual volume.

What is the recommended patient position for enteral feeding?

Sitting or semi-Fowler’s position with head-of-bed elevated 30 to 45 degrees.

How long should the head-of-bed remain elevated for intermittent enteral feedings?

30 to 60 minutes.

Why might promotility drugs be ordered for a patient on enteral nutrition?

To speed up peristalsis and prevent aspiration.

What is the purpose of checking gastric residual volume?

To assess digestion before giving a bolus feeding.

What is important to monitor daily for a patient receiving enteral nutrition?

Daily weights.

What should be assessed before each enteral feeding?

Bowel sounds to ensure the GI tract is functional.

Why is a functional GI tract necessary for enteral nutrition?

Enteral nutrition requires a working digestive system to absorb nutrients.

What measurements should be accurately tracked during enteral nutrition?

Intake and output (I&O).

What initial laboratory check is recommended for patients starting enteral nutrition?

Glucose levels.

How should enteral feeding containers be labeled for safety?

With the date and time started.

How often should enteral pump tubing be changed?

Every 24 hours (q24h).

What are common gastrointestinal complications of enteral nutrition?

Vomiting, diarrhea, constipation, dehydration.

What factors can contribute to dehydration in enteral nutrition?

Using more calorically dense formulas with less water and formulas with high protein content.

What is a misconnection in enteral nutrition?

An accidental connection between an enteral feeding system and a nonenteral system, such as an IV line, peritoneal dialysis catheter, or tracheostomy tube cuff.

How can misconnections be prevented?

By carefully checking all lines before connecting feeds.

Who can enteral feeds be delegated to?

Assistive personnel (AP) or LPN/LVN under supervision.

Why is a misconnection dangerous?

It can result in severe patient injury or death.

What fluid and electrolyte considerations are important for older adults receiving enteral nutrition?

They have an increased risk for fluid and electrolyte imbalances.

Why might older adults be at risk for dehydration during enteral nutrition?

They have decreased thirst perception and may have cognitive impairment.

What metabolic risk is increased in older adults on enteral nutrition?

Increased risk for glucose intolerance.

Why is cardiac function a concern for older adults receiving enteral nutrition?

Decreased cardiac function means they cannot handle rapid or sudden shifts in fluid.

What swallowing-related risk is higher in older adults on enteral nutrition?

Increased risk for aspiration.

How can mobility and sensory deficits affect enteral nutrition in older adults?

Decreased mobility and sensory deficits make home management of enteral nutrition more difficult.

What does parenteral nutrition (PN) contain?

Macronutrients and micronutrients in proportions tailored to the individual patient’s needs.

Why can parenteral nutrition damage peripheral veins?

Because it is a hypertonic solution.