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Understanding Nutrition and Its Impact
Aug 9, 2024
Chapter 52: Care of Patients with Malnutrition, Undernutrition, and Obesity
Key Concepts
Primary Concept:
Nutrition
Secondary Concept:
Fluid and Electrolyte Balance
Guides for Good Nutrition
Dietary Reference Intakes (DRIs):
Based on age, gender, and life stage
Dietary Guidelines for Americans:
Drafted by the U.S. Department of Agriculture and the U.S. Department of Health and Human Services
My Plate:
Pictorial demonstration to build a healthy plate of food
Canada Food Guide:
Provides visual reference
No universal diet; varies based on preferences and sensitivities
Types of Diets and Food Sensitivities
Vegetarian Diets:
Various types (Box 52.2)
Food Sensitivities vs. Allergies:
Allergies:
Immune inflammatory response (e.g., shellfish causing facial edema)
Intolerance:
GI tract unable to break down certain foods (e.g., lactose, some raw vegetables)
Nutrition Assessment
Nutrition History:
Typical intake over a few days (ideal: 7 days, minimum: 72 hours)
Access to Nutrition:
Assess resources and ability to obtain nutritious food
Labs:
Fluid and electrolyte status, iron deficiency (anemia), albumin, prealbumin
Medications:
Check for food-drug interactions
General Health History and Physical Assessment:
Look for signs of nutritional deficits
Anthropometric Measurements:
Use calipers for adipose tissue
Psychosocial Assessment:
Relate to nutritional status
Initial Screening:
Within the first 24 hours of hospital admission
Tools:
Mini Nutritional Assessment, Adult Malnutrition Screening (Box 52.3)
Measurements:
Height, weight, BMI, body surface area (BSA), skin fold
Undernutrition Pathophysiology
Protein Energy Malnutrition (PEM):
Previously called Protein Calorie Malnutrition
Merasmus:
Caloric malnutrition (body fat and protein wasted)
Kwashiorkor:
Lack of protein quantity and quality (normal body weight)
Starvation:
Severe caloric deficiency
Eating Disorders:
Anorexia nervosa, bulimia nervosa, binge eating disorder
Anorexia Nervosa:
Not consuming needed nutrition
Bulimia Nervosa:
Binge eating with purging
Assessing Older Adults
Conditions and Illnesses:
Affecting GI motility, appetite, dentition
Medications:
Impact on motility or appetite
Oral Care:
Dry mouth, oral hygiene
Failure to Thrive:
Failure to gain/maintain weight in older adults
Psychosocial Factors:
Ability to prepare meals, memory issues, depression, loneliness, resources
Health Promotion and Disease Prevention
Statistics:
462 million malnourished worldwide
Hospitalization:
1/3 develop malnutrition
Nutrition Advocacy:
Essential for healing
History and Assessment for Undernutrition
Food Intake:
Usual intake, meal timing, preferences, patterns
Signs and Symptoms:
Hair, eyes, oral cavity, nails, skin, musculoskeletal, neurological function
Anthropometric Measurements:
Subcutaneous fat, lean muscle
Partnership with Dietitian:
For caloric intake assessment
Psychosocial and Economic Factors
Economic Status:
Impact on ability to secure food
Occupation and Education Level:
Understanding of nutrition
Living Arrangements:
Emotional status and resources
Lab Assessments for Undernutrition
Labs:
Hemoglobin, hematocrit, transferrin, prealbumin, albumin, thyroxine-binding prealbumin, cholesterol
Plan for Undernourished Patients
Goals:
Improve nutrition
Meal Management:
Small, frequent meals, dietary supplements
Drug Therapies:
For motility issues, anti-emetics
Enteral Nutrition:
Gastric or enteral ostomy-feeding tubes (NG, OG, NJ, PEG)
Types of Feeding:
Bolus, continuous, cyclic
Complications:
Tube clogging, misplacement, nausea, vomiting, abdominal distention
Fluid and Electrolyte Imbalances:
Monitor labs
Parenteral Nutrition:
PPN via PIC, TPN via central line
Obesity Pathophysiology
Definition:
Overweight (BMI 25-29), Obesity (BMI ≥30)
Factors:
Environmental, genetic, behavioral, physical inactivity, medications
Incidence and Prevalence:
Doubled since 1980, 1/3 of world population
Health Priorities:
Healthy People 2030, weight management, physical activity
Nutritional Assessment for Obesity
History:
Use RESPECT acronym (rapport, privacy, realistic goals, compassion, tact)
Appetite:
Attitudes towards food, chronic diseases, medications
Functional Ability and Physical Activity:
Familial history, past weight loss attempts
Anthropometric Measurements:
Height, weight, skin fold areas
Psychosocial Assessment:
Emotional factors, perception of nutritional status
Management of Obesity
Goals:
Improve nutrition
Non-Surgical:
Diet programs, nutritional therapy, exercise, drug therapy (e.g., GLP-1 agonist, Ozempic)
Surgical:
Bariatric surgery (gastric banding, gastric bypass)
Post-Op Management:
Nutritional supplements, pureed to solid foods, multiple small meals, signs of dumping syndrome
Community Resources:
Registered dietitian, Overeaters Anonymous, American Society for Metabolic and Bariatric Surgery
Evaluation:
Appropriate nutrient intake, maintenance of weight, adequate hydration, infection-free post-surgery
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