Nutritional Disorders Lecture - Part 1: Malnutrition

Overview

• Lecture Structure: The lecture is part of a series about nutritional disorders, starting with malnutrition.
• Future Topics: Upcoming videos will cover Enteral and Parenteral nutrition, Obesity, Bariatric surgery, and Metabolic syndrome.

Malnutrition

• Definition: Malnutrition can involve deficits, excesses, or imbalances of nutrients. It isn't always associated with being underweight; overweight individuals can also be malnourished.

Risk Factors for Malnutrition

• Economic and Environmental: Lack of resources to obtain nutritious food.
• Medical Conditions: Illnesses, surgery, infections (e.g., sepsis), wounds, burns, immobilization, GI disorders (e.g., Crohn's disease, gastric bypass), substance abuse.

Indicators of Malnutrition

• Hemoglobin (Hb) of 8.1: Indicates lack of nutrients necessary for blood cell production.
• Hemoglobin A1c of 12: Suggests poor glucose control, which can signal malnutrition.
• Potassium Levels: Not a direct indicator; low potassium is more an electrolyte issue.
• Hair Loss: Common physical sign of malnutrition.
• Moodiness and Irritability: Can indicate lack of essential nutrients, akin to symptoms of hypoglycemia.
• BMI of 17: Indicates underweight status.

Assessment of Malnutrition

• Symptoms to Assess: Eating patterns, BMI, skin and hair condition, muscle strength, mental status.
• Indicators: Cachexia (severe muscle wasting), poor muscle strength, mental status changes.

Diagnostic Tests

• CBC: Check hemoglobin and hematocrit (H&H).
• Protein Levels: Especially albumin and pre-albumin; pre-albumin is a better indicator of nutritional status.
• Serum Electrolytes and Liver Function Tests: Check for imbalances and liver health.
• Body Mass Index (BMI): Used widely, though not perfect.

Consequences of Malnutrition

• Healing Complications: Delayed healing, increased risk of pressure ulcers and infections.
• Increased Fall Risk: Due to weakness.
• Mental Health Effects: Risk of depression and dementia.

Medical Treatments

• Cause Identification: Treat the underlying issue leading to malnutrition.
• Nutritional Support: Includes enteral and parenteral feeding.
• Supplements: Vitamins and nutrients, hydration.
• Appetite Stimulants: Medications like Megace and Marinol.

Nursing Interventions

• Priority Goals: Ensure good nutrition and fluid/electrolyte balance.
• Assessment Focus: Skin, hair, nails, mental status, labs.
• Calorie Counts and Daily Weights: Monitor nutritional intake.
• Encouragement and Environment: Create a positive eating environment to promote intake.

Nutritional Focus

• Key Nutrients: Increase protein and calories.

Concluding Notes

• Continued Learning: Future topics will include deeper dives into specific types of nutritional support (Enteral and Parenteral).