NUTRITIONAL PROBLEMS
Prioritization question:
A client had a 1000mL bag of 5% dextrose in 0.9% NS hung at 1500. The nurse making rounds at 1545 finds that the client is
complaining of a pounding headache and is dyspneic, is experiencing chills, and is apprehensive with an increased pulse
rate. The IV bag has 400mL remaining, the nurse should take which action FIRST?
a. Sit the client up in bed
b. Remove the IV catheter
c. Call the health care provider
d. Slow the infusion
Malnutrition:
• Deficit, excess, or imbalance in essential components of balanced diet
o Undernutrition: nutrient and energy intake are not sufficient to meet daily needs or added metabolic stress
o Overnutrition: ingestion of more food than required, as in obesity
• Etiology:
o Starvation-related malnutrition or primary PCM (protein-calorie malnutrition)
§ Dietary intake is not met
• Example: caused by anorexia nervosa
o Chronic disease-related malnutrition or secondary PCM
§ Intake can't meet needs
• Example: caused by rheumatoid arthritis or obesity
o Acute disease-related or injury-related malnutrition
• Causes of malnutrition:
o Inadequate oral intake
o Drug interaction à cholesterol
o Physical illness
o Depression/anxiety
o Incomplete diets à could be due to GI surgeries
• Pathophysiology:
o Carbohydrate stores are found in liver and muscles à depletes in 18 hrs
o Carbohydrate stores are depleted, body converts the protein found in muscles into glucose à uses for energy
o Within 5-9 days, body fat is fully mobilized to supply much of the energy
§ Body then begins to use protein and organ proteins for energy
o As protein depletion continues, liver function becomes impaired, and synthesis of proteins diminishes
o Plasma oncotic pressure is lower because of decreased protein
o Major function of plasma proteins is maintenance of osmotic pressure of the blood
o Decreased osmotic pressure, causes shift of body fluids from vascular à interstitial space
o Edema becomes clinically observable
, • Clinical manifestations:
o Weight loss
o Dry scaly skin
o Confusion, irritability
o Weakness
o Decreased perfusion
o Increased risk of infection, leukopenia
o Hair loss
o Intolerance to cold
o Anemia
• Diagnostic studies:
o Laboratory studies
§ Decreased serum albumin
§ Decreased prealbumin
§ Decreased serum transferrin
• Binds and transfers iron à main iron carrier in the blood
§ Electrolyte levels (K+ increases)
§ Decreased CBC
§ Liver enzymes
• Impacted by starvation
§ C-reactive protein: levels of inflammation in the body
• Nursing management:
o Joint commission requires screening within 24 hrs à what to look for…
§ Hx of weight loss
• 5% = significant loss, especially in older adults
§ What was intake before admission
§ Use of nutritional support and/or supplements
§ Chewing or swallowing abnormalities
§ Skin breakdown
• need to do a more detailed assessment if yes to any of these questions
• Nursing diagnoses:
o Imbalanced nutrition: less than body requirements
o Self-care deficit (feeding)
o Constipation of diarrhea
o Deficient fluid volume
o Risk for impaired skin integrity
o Noncompliance
o Activity intolerance
• Planning:
o Overall goal for a pt with malnutrition is:
§ Achieve weight gain (muscle mass)
§ Consume a specified # of calories per day
§ Have no adverse consequences related to malnutrition or nutrition therapies
• Ex. inserting a feeding tube into the lungs
Prioritization question:
A client had a 1000mL bag of 5% dextrose in 0.9% NS hung at 1500. The nurse making rounds at 1545 finds that the client is
complaining of a pounding headache and is dyspneic, is experiencing chills, and is apprehensive with an increased pulse
rate. The IV bag has 400mL remaining, the nurse should take which action FIRST?
a. Sit the client up in bed
b. Remove the IV catheter
c. Call the health care provider
d. Slow the infusion
Malnutrition:
• Deficit, excess, or imbalance in essential components of balanced diet
o Undernutrition: nutrient and energy intake are not sufficient to meet daily needs or added metabolic stress
o Overnutrition: ingestion of more food than required, as in obesity
• Etiology:
o Starvation-related malnutrition or primary PCM (protein-calorie malnutrition)
§ Dietary intake is not met
• Example: caused by anorexia nervosa
o Chronic disease-related malnutrition or secondary PCM
§ Intake can't meet needs
• Example: caused by rheumatoid arthritis or obesity
o Acute disease-related or injury-related malnutrition
• Causes of malnutrition:
o Inadequate oral intake
o Drug interaction à cholesterol
o Physical illness
o Depression/anxiety
o Incomplete diets à could be due to GI surgeries
• Pathophysiology:
o Carbohydrate stores are found in liver and muscles à depletes in 18 hrs
o Carbohydrate stores are depleted, body converts the protein found in muscles into glucose à uses for energy
o Within 5-9 days, body fat is fully mobilized to supply much of the energy
§ Body then begins to use protein and organ proteins for energy
o As protein depletion continues, liver function becomes impaired, and synthesis of proteins diminishes
o Plasma oncotic pressure is lower because of decreased protein
o Major function of plasma proteins is maintenance of osmotic pressure of the blood
o Decreased osmotic pressure, causes shift of body fluids from vascular à interstitial space
o Edema becomes clinically observable
, • Clinical manifestations:
o Weight loss
o Dry scaly skin
o Confusion, irritability
o Weakness
o Decreased perfusion
o Increased risk of infection, leukopenia
o Hair loss
o Intolerance to cold
o Anemia
• Diagnostic studies:
o Laboratory studies
§ Decreased serum albumin
§ Decreased prealbumin
§ Decreased serum transferrin
• Binds and transfers iron à main iron carrier in the blood
§ Electrolyte levels (K+ increases)
§ Decreased CBC
§ Liver enzymes
• Impacted by starvation
§ C-reactive protein: levels of inflammation in the body
• Nursing management:
o Joint commission requires screening within 24 hrs à what to look for…
§ Hx of weight loss
• 5% = significant loss, especially in older adults
§ What was intake before admission
§ Use of nutritional support and/or supplements
§ Chewing or swallowing abnormalities
§ Skin breakdown
• need to do a more detailed assessment if yes to any of these questions
• Nursing diagnoses:
o Imbalanced nutrition: less than body requirements
o Self-care deficit (feeding)
o Constipation of diarrhea
o Deficient fluid volume
o Risk for impaired skin integrity
o Noncompliance
o Activity intolerance
• Planning:
o Overall goal for a pt with malnutrition is:
§ Achieve weight gain (muscle mass)
§ Consume a specified # of calories per day
§ Have no adverse consequences related to malnutrition or nutrition therapies
• Ex. inserting a feeding tube into the lungs
