Exam 4 (Adult Health) Malnutrition

What is Malnutrition?

a deficit, excess, or imbalance in a person’s intake of energy and/or nutrient

Cause of malnutritions? (3)

1. Starvation induced.

2. Chronic diseae induced.

3. Acute disease induced.

Things/ Nursing Management to do for the malnourished pt.

1. Nutrition screening for all patients within 24 hours of admission with a detailed nutrition assessment if a patient is at risk.

What are the common nutrition screening tools?

1. Malnutiotion Universal Screening tool

2. Nutriiton Risk Screening.

What is the next step to do when the pt. is identifed as risk of malnutrition?

1. Anthropometric assessments.

2. Physical Assessments

3. Laboratory Data

4. Functional Status.

What are the things should be considered in the Anthropometric measurements?

• Height and weight

• Body mass index (BMI)

• Rate of weight change

• Amount of weight loss

What are the things falls under physical assessment?

• Physical appearance

• Muscle mass and strength

• Dental and oral health

What are the important laboratory data needed?

• Glucose

• Electrolytes

• Lipid profile

• Blood urea nitrogen (BUN)

• Albumin, prealbumin, C-reactive protein

What are the factors included in Functional Status?

• Ability to perform basic and instrumental activities of daily living

• Handgrip strength

• Performance tests (e.g., timed walk tests)

Ranges from Body Mass Index (BMI)?

less than 18.5 is underweight.

18.5-24.9 is normal weight

25-29.9kg/m2 is overweight

more than 30 is obese.

What are the health teaching can be given to the pt? (8)

1. My plate- evidenced based researched ideas about the nutrition.

2. Talk about good health- balanced wieight.

3. Teach them about the cause of the undernourished state and ways to avoid the problem in the future.

4. Assess their ability to follow the diet instructions considering past eating habits, religious and ethnic preferences, age, income, resources, and state of health.

5. Emphasize the need for continual follow-up care to achieve and maintain rehabilitation.

6. In your assessment, consider the availability and acceptability of community resources that provide meals, such as Meals on Wheels, senior congregate feeding sites, and the Supplemental Nutrition Assistance Program (SNAP).

7. Keeping a diet diary for 3 days at a time is one way to analyze and reinforce healthful eating patterns.

8. Encourage self-assessment of progress by having the patient weigh themselves once or twice a week and keep a weight record.

What are the high calorie, high protien diet?

Breads and Cereals

• Buttermilk biscuits, muffins, banana bread, zucchini bread

• Granola and other cereals with dried fruit

• Hot cereals (oatmeal, cream of wheat) prepared with milk, added fat (butter or margarine), and sugar

• Potatoes prepared with added fat (butter and whole milk)

Vegetables

• Fried vegetables

• Vegetables prepared with added fat (margarine, butter)

Fruits

• Canned fruit in heavy syrup

• Dried fruit

Meat

• Casseroles

• Fried meats

• Meats covered in cream sauces or gravy

• Peanut butter

Milk and Milk Products

• Ice cream

• Milkshakes

• Whipping cream, heavy cream

• Whole milk and milk products (yogurt, ice cream, cheese)

• Whole milk with added nutrition supplements

What is refeedign syndrome?

the body’s response to the switch from starvation to a fed state in the initial phase of nutrition therapy in patients who are severely malnourished.1

What makes pt. to have this syndrome? (5)

chronic alcohol use, cancer, trauma, inflammatory bowel disease, and major surgery.

CM of the refeeding syndorme ? (7)

Hypophosphatemia , hyperglycemia, fluid retention, hypokalemia, and hypomagnesemia. Serious outcomes include dysrhythmias and respiratory arrest.

Management of the refeeding syndrome? (3)

1. start feeding rates at no more than 50% of their usual energy requirements and gradually increase.

2. Monitor electrolyte values and maintain ECG monitoring

3. receive phosphate, potassium, magnesium, and B vitamin supplements.

What are the major situtations that might happen to older adults? (6)

poor wound healing, pressure injuries, infections, decreased muscle strength, postoperative complications, and increased mortality.

What are the risk factors for the older adults in terms of Malnutrition?

little or no appetite, problems with eating or swallowing, inadequate servings of nutrients, and fewer than 2 meals per day, Limited incomes, Social isolation, Functional limitations, lack transportation, Chronic illnesses associated with aging, depression and dysphagia (from a stroke), Poor oral health, Medications, dementia, Changes in smell and taste (from medications, nutrient deficiencies, taste-bud atrophy).

Nursing management for the older adults? (8)

1. older adults may need to increase their protein intake and ingest a moderate amount of high-quality protein at each meal.

2. Daily vitamin D

3. improving oral intake and providing a pleasant, social environment for meals.

4. adaptive devices and proper positioning,

5. adults may need nutrition support therapies until their strength and general health improve.

6. Consult with the social worker and dietitian to ensure there is access to food on discharge.

7. Home-delivered meals or groceries or senior congregate feeding programs are an appropriate referral.

8. Community nutrition programs can make mealtime a pleasant, social event. Improving the social setting of a meal often improves intake.