Care of the patient with malnutrition

• What is marasmus?

• Body fat and proteins are wasted

• Preserved serum proteins

• What is kwashiorkor?

• Adequate calories

• Low serum proteins

• What is marasmic-kwashiorkor?

• Starvation

• Complete lack of nutrients

• What are the physical risk factors for malnutrition?

• Chronic conditions

• Constipation

• Decreased appetite

• Dentition

• Drugs

• Dry mouth

• Failure to thrive

• Impaired eyesight

• Pain that is acute or persistent

• Weight loss

• What are situations linked to malnutrition?

• Poverty

• Lack of education

• Substance abuse

• Decline in functional ability

• Infectious disease

• Medical treatments

• What is the psychosocial assessment for malnutrition?

• Economic status

• Occupation

• Education level

• Gender orientation

• ethnicity/rate

• Living and cooking arrangements

• Mental status

• What labs to look at for malnutrition?

• Hemoglobin

• Hematocrit

• Serum albumin

• Thyroxine-binding prealbumin

• Transferrin

• Cholesterol levels

• What are nasoenteric tubes used for ?

• Short term

• Examples

  • NG tubes

What are enterostomal tubes used for?

• Long term

• Gastrostomy performed

• PEG tubes

• What are enteral tube feedings bag change?

• Every 24 hours

What are the considerations for continuous drip enteral tube feedings?

• Check residuals every 4-6 hours

• Residual less than the previous two hours

• Flush with water every 4 hours

• What are the considerations for intermittent feedings enteral tube feedings?

• Every 4 to 6 hours

• Check residual

• What are the considerations for bolus feeding enteral tube feedings?

• Every 4 to 6 hours

• Check residual

• What is the nursing care for enteral tube feedings?

• Verify feeding tube placement

• Verify presence of bowel sounds

• HOB to at least 30 degrees

• Begin with small volume and increase gradually to desired rate

• Monitor tube insertion site

• Monitor bowel movements

• Oral care

What are the complications of enteral tube feedings?

• Clogged tube is most common problem

• Refeeding syndrome

• Tube misplacement

• Abdominal distention with nausea and vomiting

• Fluid and electrolyte imbalance with diarrhea

• What is overweight?

• 25 to 29

• What is obesity?

• BMI higher of 30

• What causes obesity?

• Dysregulation of adipokines hormones

  • Effect appetite 

  • Fat metabolism

• Environmental

• Genetic

• behavioral

• What are the complications of obesity?

• Hypertension

• Hyperlipidema

• CAD

• Stroke

• Peripheral arterial disease

• Obstructive sleep apnea

• Metabolic syndrome

What is bariatric surgery?

•  surgical procedure used to manage obesity and obesity-related conditions. Long term weight loss with bariatric surgery may be achieved through alteration of gut hormones, physical reduction of stomach size, reduction of nutrient absorption, or a combination of these.

• What is a gastric sleeve?

• Where ¾ of stomach is removed

• What are the considerations after bariatric surgery/

• Airway management

• Patient and staff safety

• Pressure between skinfolds

• Reintroduction of nutrition

What are things to monitor with a client who had bariatric surgery?

• Abdominal binder

• Skin assessment

• Ambulate ASAP

• Position in semi fowlers

• Absorbent padding

• Monitor abdominal girth

• Oxygen monitoring

• Removal of urinary catheter within 24 hours

• 6 small feedings

• Heparin

• Assist client out of bed

• Observe for signs of dumping syndrome

• What is dumping syndrome?

• Rapid emptying of food contents into small intestine

• Shifts fluid into gut causing abdominal distention

• What is early dumping syndrome?

• Occurs within 30 minutes of eating

• Report manifestation to surgeon

• And have client lie down

What are the manifestations of early dumping syndrome?

• Vertigo

• Tachycardia

• Syncope

• Sweating

• Pallor palpitations

• Desire to lie down

• What is late dumping syndrome?

• Occurs 90 minutes to 3 hours after eating

• Caused by release of excessive amount of insulin

• What Are the manifestations of late dumping syndrome?

• Dizziness

• Lightheadedness

• Palpitations

• Diaphoresis

• Confusion

What is the treatment for dumping syndrome?

• Eat small meals

• Avoid drinking with meal

• Increase diet

What are some diet changes for dumping syndrome?

• Eat more protein

  • Meat 

  • Poultry

  • Creamy peanut butter

  • Fish

• Eat more complex carbohydrates

  • Oatmeal

• Limit high sugar foods

  • Candy

  • Table sugar

  • Syrup

  • Sodas

  • Juice