Malnutrition

Front 1

What is malnutrition?

Back 1

An excess, deficit, or imbalance in the essential components of a balanced diet.

Front 2

Where is undernutrition mostly seen?

Back 2

In developing countries, however in US it is found in the lower socioeconomic class or illness. it is common in hospitalized patients, and in elderly long term residents.

Front 3

What is the most common form of malnutrition?

Back 3

PCM (Protein Calorie Malnutrition)

Front 4

Primary PCM

Back 4

Present when nutritional needs are not met as a result of poor eating habits. (Ingesting foods deficient in protein, vitamins and minerals),

Front 5

Secondary PCM

Back 5

Result of an alteration or defect in ingestion, digestion, absorption or metabolism. (Due to GI obstruction, surgical procedures, cancer, malabsorption syndrome, drugs, infectious diseases.

Front 6

What is marasmus?

Back 6

Result of deficiencies in both caloric and protein intake leading to generalized loss of body fat and muscle. Patients appear wasted or emaciated, but may have normal serum protein levels.

Front 7

What is kwashiorkor?

Back 7

Deficiency in protein intake that is superimposed on a catabolic stress event, such as GI obstruction, surgical procedure, cancer, malabsorption syndrome or infectious disease. Patients may appear well nourished but have very low serum protein levels. (hypoalbuminemic malnutrition).

Front 8

What are the two phases of starvation process?

Back 8

Early and Prolonged

Front 9

Early phase of the starvation process consists of what?

Back 9

Carb stores are depleted and protein begins to convert to glucose for energy.
Gluconeogenesis occurs. Negative nitrogen balance.
Body fat mobilized to supply energy within 5-9 days.

Front 10

Prolonged phase of starvation process consists of what?

Back 10

Fat stores are used up in 4-6 weeks. Protein in internal organs and plasma are used. Liver function is impaired, synthesis of protein diminishes, plasma osmotic pressure is decreased resulting in a fluid shift. Ions move, cells expand, Sodium and Potassium pump fails.

Front 11

Malnutrition is not an uncommon consequence of

Back 11

Illness, surgery, injury or hospitalization

Front 12

Sick persons have increased __________ needs.

Back 12

nutritional

Front 13

Fever increases basal metabolic rate leading to ______________ ____________.

Back 13

protein depletion.

Front 14

What is malabsorption syndrome?

Back 14

impaired absorption of nutrients from the GI tract.
May result from decreased enzymes, drug side effects, decrease in bowel surface area.

Front 15

Incomplete diets and vitamin deficiencies are usually found in whom?

Back 15

Alcoholics
Drug abusers
Fad diet followers
Poorly planned vegetarian diets

Front 16

Obvious clinical signs of inadequate protein/calorie intake is apparent in what portions of the anatomy?

Back 16

Skin, eyes, mouth, muscles, CNS

Front 17

As protein intake is severely reduced, the muscles become _________ and ________. This leads to weakness, fatigability, and decreased endurance.

Back 17

wasted, flabby

Front 18

Delayed wound healing, susceptibility to infection and anemia are all clinical manifestations of

Back 18

malnutriton

Front 19

Clinical manifestations in the integumentary system are:

Back 19

dry brittle nails and hair with lack of luster
dry scaly lips, fever blisters, cheilosis, decreased tone and elasticity of skin. Cool, rough, dry, scaly skin with brown-gray pigment changes, reddened scaly dermatitis, scrotal dermatitis, slight cyanosis, peripheral edema

Front 20

Clinical manifestations in the respiratory system are

Back 20

decreased respiratory rate, decreased vital capacity, crackles, weak cough

Front 21

Clinical manifestations in the eyes are

Back 21

pale or red conjunctivae, Bitot's spots, dryness and dull appearance of conjunctiva and cornea, soft cornea, blood vessel growth in cornea, redness and fissuring of eyelid corners.

Front 22

Clinical manifestations of the CV system are

Back 22

increase or decrease in heart rate
decrease BP
dysrhythmias

Front 23

Clinical manifestations in GI system are

Back 23

swollen, smooth, raw, beefy tongue; hypertrophic or atrophic papillae, dental cavities, absent or loose teeth, discolored tooth enamel, spongy, pale receded gums with a tendency to bleed easily, periodontal disease, ulcerations, white patches or plaques, redness, swelling of oral mucosa, distended tympanic abdomen, ascites, hepatomegaly, decreased bowel sounds, steatorrhea.

Front 24

Clinical manifestations of the neurologic system are

Back 24

decreased or loss of reflexes
tremor
inattention
irritability, confusion, syncope

Front 25

Clinical manifestations of the MS system are

Back 25

decreased muscle mass with poor tone, wasted appearance, bowlegs, knock-knees, beaded ribs, chest deformity, prominent bony structures.

Front 26

Clinical manifestation of the reproductive system is

Back 26

no menses in girls

Front 27

Diagnostic studies used to determine malnutrition are:

Back 27

serum albumin, prealbumin, serum transferrin, C-reactive protein, electrolyte levels, CBC (esp. RBC, Hb,and lymphocyte counts), liver enzymes, and serum levels of vitamins.

Front 28

Which lab study is the best to use to determine malnutrition?

Back 28

C reactive protein. it is a positive acute phase protein, typically elevated during inflammation.

Front 29

How do you as a nurse assess for malnutrition?

Back 29

Via past health history, physical assessment, anthropometric measurements, medications, surgery or other treatments, psychosocial, lab studies

Front 30

What are anthropometric measurements?

Back 30

height and weight
BMI
Rate of weight change

Front 31

What nursing implementations are needed for acute undernourished malnourishment disorder?

Back 31

high calorie, high protein diet, specialized nutrition support (oral feeding, tube feeding)

Front 32

What other nursing implementations are needed?

Back 32

Daily weights, I/O, Daily caloric count, high protein-high calorie foods, multiple small feedings, supplements, appetite stimulants, diet diary, dietician consult, discharge instructions.

Front 33

What are the gerontologic considerations for malnutrition?

Back 33

Physiologic changes (oral cavity, digestion/motility, endocrine system, MS system, vison and hearing)

Socioeconomic factors

Front 34

In states of increased stress such as surgery, severe trauma, and sepsis, more _________ and ________ are needed.

Back 34

calories
protein

Front 35

Wound healing requires increased ___________ ___________.

Back 35

protein synthesis

Front 36

What are some of the nursing diagnoses for malnutrition?

Back 36

Imbalanced nutrition, self-care deficit (feeding)
Constipation or diarrhea, deficient fluid volume, risk for impaired skin integrity, non-compliance, activity intolerance