Malnutrition

complications of malnutrition

wound healing delayed/impaired

immune status impairment

impaired organ function

increased mortality, healthcare resource use

vitamin b1

thiamin

malnutrition definition

inadequacy of nutrients to maintain persons health

malnutrition causes

insufficient intake, impaired absorption, nutrient requirements altered, transport and utilization altered

what triggers the inflammatory response

pathogens/trauma, cause the production of cytokines which are released to fight the infection/trauma

cytokines role

signal to the liver to stop making negative acute phase proteins to conserve AA to produce more positive acute phase proteins (fight off offender)

anorexia

inflammatory cytokines cause this bc when they have high levels of inflammatory cytokines they might not have an appetite

positive acute phase proteins

will increase in response to stress, body makes them to fight off infection

CRP

positive acute phase protein that binds to microorganisms and triggers innate immune response and targets the bad proteins, also elevates in arthritis and CVD

serum amyloid

pos acute phase protein that stimulates leukocytes to secrete cytokines

haptaglobin

pos acute phase protein that binds to hemoglobin (oxidizing agent causing tissue damage) and dead RBCs

also regulates lymphocytes

C3

positive acute phase protein, complement system that attacks foreign invaders

negative acute phase proteins

body is deprioritizing and making less of so the AA can be used for what it needs to survive

albumin

negative acute phase protein, inflammation and hydration status change these, only good marker of inflammation, slow half life

transferrin

negative acute phase protein, binds to iron and transports it. higher iron leads to ^ infection, transferring decreases so you have less circulating iron and less infection

indirect calorimetry

best to see energy needs for pts through gas exchange, serum CRP most variance in predicting energy expenditure, predictive eqns can be innacurate

orbital region

stand in front of pt, touch above cheekbone, to palpate for FAT LOSS

upper arm- tricep/bicep

arm bent at 90 degrees, roll skin through fingers, don’t include muscle in pinch to test for FAT LOSS

thoracic and lumbar region

ribs and iliac crest (waist), have pt push against object, check for ribs, run fingers down back to examine depressions. Check for FAT LOSS

shoulder acromium

run hands down neck and across shoulders

collarbone- clavicle

press tips of fingers under clavicular portion of the pec, check for MUSCLE LOSS

make sure pt isn’t hunched over

arms at side, cup shoulder to feel muscle

shoulder blade

hold arms out straight in front of body

scapular bone

ask pt to extend hands straight out, push against wall, your hand. palpate above/below scapula

upper body

this will typically show muscle wasting before lower body does

temple region

palpate in scoop forward motion/back/diagonal, pt can engage by chewing motion MUSCLE LOSS

dorsal hand

look at thumb side of hand, pads of thumbs when tip is touching forefinger like an okay sign MUSCLE LOSS

patellar/thigh region

ask pt to sit, prop leg on low furniture if able. Grasp quads to differentiate amount of muscle tissue from fat tissue for MUSCLE LOSS

posterior calf region

can hold/support pts ankle, ask them to bend leg while grasping calf, engage toes, MUSCLE LOSS

blood pressure

hypotension occurs with dehydration and reduced cardiac function

heart rate

reduced cardiac and vascular mass due to malnutrition, abnormal heart rate

respiratory rate

reduced intercostal muscle mass, diaphram muscle mass, infections, lung function lower

arrhythmia

insufficient mg, potassium, inadequate protein

bradycardia

insufficient energy-protein intake

decreased BP

insufficient thiamin, energy-protein intake

palpatation

insufficient thiamin

rapid pulse

insufficient potassium

refeeding syndrome

metabolic and electrolyte abnormalities when kcal are reintroduced or ^ after period of absent/low calorie intake

refeeding syndrome how it works

after low intake, calories, energy, vitamins, electrolytes deplete

when refed, glucose ^ in bloodstream and insulin is secreted

catabolic → anabolic state

insulin drives phosphorous and potassium into the cells switching to anabolic

signs of refeeding syndrome

hypophosphatemia, hypokalemia, thiamin deficiency, sodium retention

malnutrition screening

joint commission requires nutrition screening at acute and long term care facilities for those at nutritional risk, screen within 24 hours

cellular level refeeding syndrome

starved cells take up nutrients, potassium and phosphorous shift into intracellular compartments

the joint commision

requires that nutrition screening occurs at acute care and long term care facilities