Ch. 63 Malnutrition and Obesity
What should be included an initial nutritional screening?
Measured height & weight
Usual eating habits
Ability to chew and swallow
At recent changes in appetite or food intake
What are anthropometric measurements?
Noninvasive methods of evaluating nutritional status. Measurements includes height and weight and assessment of body fat. Nurse can delegate this activity to UAP under their supervision. For pt who cannot stand use knee height caliper. Weight is the most reliable indicator of fluid gain or loss!!
What are the three forms of protein-energy malnutrtion? (PEM)
Marasmus- calorie malnutrition innwhich body fat and protein is wasted.
Kwashiorkor- lack of protein quantity and quality in the presence of adequate calories. Body weight is more Norma and serum protiens are low.
Marasmic-kwashiorkor- a comb. protein and energy malnutrition that often presents clinically when metabolic stress is imposed on a chronically starved pt.
* older adults > PEM
What lab assessments indicate malnutrition?
Low hemoglobin level- anemia, recent hemorrhage
High hemoglobin- dehydration,
Low hematocrit- anemia, excessive fluid, cirrhosis
High hematocrit- dehydration, hemoconcentration
Serum albumin reflects nutriton status of a pt. a few wks before testing (not most sensitive)
Preablbumin (PAB)- assess improvement in nutritional status w\ refeeding
Serum transferrin- most sensitive inictor of protein status
Cholesterol level below 160-malnutrition
What kind of pts can receive Total Enteral Nutrition (TEN)?
Those who can at but cannot maintain adequate nutrition by oral intake of food alone. (Ex: Elderly, Cancer pts)
Those who had permanent neuromuscular impairment and cannot swallow. (ex: pt w\ permanent swallowing probs due to stroke, severe head trauma, & advanced multiple sclerosis)
Those who don't have permanent neuromuscular impairment but are critically ill and cannot eat because of their condition.(these pts receive Enteral nutrition for as long as their illness lasts and the feeding is discontinued when the pt conditions improve)
What are the methods of administering TEN?
A nasoenteric tube (NET): Keofeed or dobbhoff tube, NG tube, ND Tube
(NDT for short term, less than 4 wks,)
Enterostomal feeding tube: long term Enteral feedings, ex gastrostomies (PEG tube), jejunostomies (for longterm feedings when it is desirabl to bypass the stomach)
Tube feedings are administered by bolus feeding, continuous feeding and cyclic feeding.
How are tube feedings administered?
Bolus feeding: intermittent feeding of a specified amount of Enteral product at set intervals during a 24 hour period typically q 4 hours. This method can be accomplished maualy or byiinfusion through a mechanical pump or controller device.
Continuous feeding: similar to IV therapy in that small amts are continually infused by gravity drip or pump over a specified time.
Cyclic feeding: like continuous infusion but is stopped for a specified time in each 34 hr period (usually 6hrs) for down time.
What is Refeeding syndrome?
A life threatening metabolic complication that can occur when nutrition is restarted for a pt who is in starvation state. The electrolyte shift of refeeding syndrome can cause cardiovascular, respiratory, and neurologic probs primarily as a result of hypophosphatemia.
What clinical manifestations should you observe in Refeeding syndrome?
Electrolyte imbalance including shallow respirations, weakness, acute confusion, seizures, and increased bleeding tendency. Report and document findings inmediately
What are the symptoms of Fat Overload Syndrome?
Fever, increased triglycerides, clottinr problems, and multi-system organ failure. Discontinue the partial parenteral nutrition (IVFE) infusion and report changes inmediate to PCP.