Malnutrition

Nutrition is the process by which nutrients are taken in and used by the body to support overall health and essential functions, such as metabolism, growth, and maintaining and repairing body tissues.

When nutrition is imbalanced, it's called malnutrition. Now, malnutrition can be overnutrition, or the ingestion of more nutrients and energy than the body needs; or undernutrition, where nutrient and energy intake is insufficient to meet the body’s daily needs.

Okay, let’s review the different types and causes of malnutrition. First, starvation-related malnutrition, also called primary protein-calorie malnutrition, occurs when nutritional needs aren’t met due to starvation, like with anorexia nervosa.

Then, there’s chronic disease–related malnutrition, also known as secondary protein-calorie malnutrition, where dietary intake is insufficient to meet the increased metabolic demands related to chronic inflammatory conditions, like rheumatoid arthritis.

Lastly, there’s acute disease–related or injury-related malnutrition, where there is significant inflammation, like with major infections, burns, and trauma, and dietary intake is unable to supply enough calories for energy or protein for tissue repair.

So, there are several risk factors for malnutrition, including socioeconomic factors, like food insecurity; health conditions, like prolonged physical illness, surgery, trauma, or prolonged immobility; incomplete diets, like with fad diets or poorly planned veganism; and malabsorption, like with vitamin B12 deficiency that occurs when intrinsic factor is lost after a gastrectomy.

Now, as protein stores are depleted, synthesis of plasma proteins, like albumin, decreases. This lowers oncotic pressure in the intravascular space, which causes a shift of fluids out into the interstitial tissues, leading to edema, as well as drying of the skin and mucous membranes.

Protein deficits can also result in brittle nails and hair loss, as well as decreased muscle mass. Finally, other clinical manifestations include weight loss, decreased muscle strength, easy fatigability, and decreased ability to perform activities of daily living.

Diagnosing nutritional problems begins with the patient’s history and physical assessment. Additionally, laboratory tests that reflect malnutrition include decreased serum albumin and prealbumin, and decreased hemoglobin, hematocrit, and RBC count related to anemia.

Electrolyte levels can be altered as they shift between the intracellular and extracellular space. Liver enzymes will often increase as liver mass decreases; and C-reactive protein, or CRP, will increase in the presence of inflammation and systemic disease.

So, treatment for nutritional problems involves restoring nutritional status by promoting intake orally or through other routes, like the enteral route, which delivers nutrition through a tube inserted into the GI tract; or the parenteral route, which delivers nutrients to the bloodstream through a vascular access device.

Alright, when caring for your patient with nutritional problems, begin by completing a nutritional screening using your facility-approved screening tool to identify the risk for, or the presence of, malnutrition.

Then, collaborate with the dietician to perform a comprehensive nutritional assessment, including their most recent laboratory test results; height, weight, and body mass index; as well as measurements of muscle mass and strength.

Also note their physical appearance including their skin, hair, and nails; integrity of their oral mucosa, and signs of poor dentition.

Next, assess their functional status, including their ability to chew and swallow, as well as their ability to perform basic and instrumental activities of daily living, or IADLs, like housekeeping and grocery shopping.

Based on the results of the assessment, provide the prescribed enteral or parenteral diet; monitor their fluid balance and weight; and institute a strict calorie count.

Lastly, evaluate the expected outcomes of treatment, such as achieving and maintaining the desired body weight and having no adverse effects related to malnutrition.

When your patient is ready for discharge, promote a well-balanced diet by explaining how eating appropriate nutrients in the right amount is essential for providing those necessary nutrients and calories for their body’s optimal functioning.

Then, assist them to identify nutritionally dense foods they enjoy; teach them how to read food labels to avoid excess sodium and sugars; and teach them how to count calories.

Also remind them to keep a daily food diary and monitor their weight so they can track their progress. Finally, encourage your patient to follow-up with their health care provider and nutritionist for ongoing monitoring and support.

Alright, as a quick recap. .

. Nutrition is the process of how nutrients are taken in and used by the body to support overall health and essential bodily functions.

Malnutrition refers to an imbalance of nutrition, including overnutrition and undernutrition, and can be related to socioeconomic factors, illness, incomplete diets, and malabsorption.

Nursing considerations include performing a comprehensive nutritional assessment, providing the prescribed enteral or parenteral nutrition, providing patient education to promote balanced nutrition, and evaluating outcomes of care.