MALNUTRITIONSlide 2Tufts Guide for Older AdultsSlide 4Malnutrition & DiseaseMalnutritionSlide 7UndernutritionProtein-Calorie Malnutrition (PCM)Patient with MalnutritionSlide 11Protein Energy Malnutrition (PEM)MarasmusKwashiorkorMalabsorption SyndromeIncomplete DietsClinical ManifestationsSlide 18Slide 19History/Physical ExaminationDiagnostic Laboratory StudiesDiagnostic StudiesNursing AssessmentNursing DiagnosesPlanningNursing ImplementationEvaluationGerontologic ConsiderationsParenteral (TPN) NutritionNursing Interventions & TPNCopyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.1MALNUTRITIONMALNUTRITIONNSG 326 AH INSG 326 AH ICopyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.33Tufts Guide for Older AdultsTufts Guide for Older AdultsTufts University offers a modified food Tufts University offers a modified food pyramid for older adults. The Modified pyramid for older adults. The Modified MyPyramid for Older Adults continues to MyPyramid for Older Adults continues to emphasize nutrient-dense food choices and emphasize nutrient-dense food choices and the importance of fluid balance, but has the importance of fluid balance, but has added additional guidance about forms of added additional guidance about forms of foods that could best meet the unique needs foods that could best meet the unique needs of older adults and about the importance of of older adults and about the importance of regular physical activity.regular physical activity.Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.55Malnutrition & DiseaseMalnutrition & DiseaseCopyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.66MalnutritionMalnutritionDeficit, excess, or imbalance in essential Deficit, excess, or imbalance in essential components of balanced dietcomponents of balanced dietOther terms—undernutrition and overnutritionOther terms—undernutrition and overnutritionUndernutritionUndernutritionPoor nourishment due to inadequate diet or diseasePoor nourishment due to inadequate diet or diseaseOvernutritionOvernutritionIngestion of more food than requiredIngestion of more food than requiredCopyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.77MalnutritionMalnutritionSick persons Sick persons have increased nutritional have increased nutritional needsneedsNot an uncommon consequence ofNot an uncommon consequence ofIllnessIllnessSurgerySurgeryInjury Injury HospitalizationHospitalizationFever Fever increases basal metabolic rate—increases basal metabolic rate—leading to protein depletionleading to protein depletionCopyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.88UndernutritionUndernutritionMost prevalent in countries lacking Most prevalent in countries lacking adequate food sources and educationadequate food sources and educationDoes exist in United StatesDoes exist in United StatesUsually found in lower socioeconomic class or Usually found in lower socioeconomic class or those with chronic or acute illnessthose with chronic or acute illnessCommon in hospitalized patient Common in hospitalized patient (30% to 55%)(30% to 55%)23% to 85% prevalence in elderly long-23% to 85% prevalence in elderly long-term care residentsterm care residentsCopyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.99Protein-Calorie Malnutrition Protein-Calorie Malnutrition (PCM)(PCM)Most common form of undernutritionMost common form of undernutritionPrimary versus secondaryPrimary versus secondaryPrimary—poor eating habitsPrimary—poor eating habitsIngesting food deficient in protein, vitamins, Ingesting food deficient in protein, vitamins, mineralsmineralsSecondary—alteration or defect in ingestion, Secondary—alteration or defect in ingestion, digestion, absorption, or metabolismdigestion, absorption, or metabolismDue to GI obstruction, surgical procedures, cancer, Due to GI obstruction, surgical procedures, cancer, malabsorption syndromes, drugs, infectious diseasesmalabsorption syndromes, drugs, infectious diseasesCopyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.1010Patient with MalnutritionPatient with MalnutritionFig. 40-2Fig. 40-2Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.1111Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.1212Protein Energy Malnutrition Protein Energy Malnutrition (PEM)(PEM)Deficiency of protein is known as Deficiency of protein is known as kwashiokar, while protein combined with kwashiokar, while protein combined with calorie deficiency is called marasmus.calorie deficiency is called marasmus.Together they are known as Protein Energy Together they are known as Protein Energy Malnutrition (PEM). Malnutrition (PEM). Unfortunately 150 million children below 5 Unfortunately 150 million children below 5 years of age suffer from PEM.years of age suffer from PEM.Copyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.1313MarasmusMarasmusResults from concomitant deficiency in Results from concomitant deficiency in caloric and protein intakecaloric and protein intakeGeneralized loss of muscle and body fatGeneralized loss of muscle and body fatAppear emaciated but have normal Appear emaciated but have normal serum protein levelsserum protein levelsCopyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.1414KwashiorkorKwashiorkorDeficiency of protein intake superimposed Deficiency of protein intake superimposed by catabolic stress event such asby catabolic stress event such asGI obstructionGI obstructionSurgerySurgeryCancerCancerMalabsorption syndromeMalabsorption syndromeInfectious diseaseInfectious diseaseMay appear well nourished, have low May appear well nourished, have low protein levelsprotein levelsCopyright © 2007, 2004, 2000, Mosby, Inc., an affiliate of Elsevier Inc. All Rights Reserved.1515Malabsorption SyndromeMalabsorption SyndromeImpaired absorption of nutrients from Impaired absorption of nutrients from the GI tractthe GI tractMay result fromMay result from↓↓