NURSING MANAGEMENT OF MALNUTRITION

 

MALNUTRITION:

This is a life threatening situation that occurs when the body lacks both essential and non essential nutrients (chemical of the body).

CAUSES:

1.Inadequate or imbalanced diet e.g protein energy malnutrition(PEM) or vitamin deficiency.

2.Malabsorption or indigestion problems.

3.Certain medical conditions  e.g inflammatory bowel syndrome.

4.Starvation for along period of time.

SYMPTOMS:

-Fatigue

-Dizziness

-Weight loss.

NUTRITIONAL ASSESEMENT METHODS:

1.Anthropometric including checking weight and height for body mass index calculation

2.Biochemical method which involve lab work e.g serum electrolyte levels, mineral levels.

3.Clinical method where a quick outlook is given by a health worker depending on the status of the patient which may be visible on quick examination.

4.Dietary approach where the patient is questioned on the diet he/ she has been for the last two days to evaluate on balanced diet.

5.Economical method where a patient is evaluated according to his/her financial status and ability to purchase food essential for balanced diet.

FORMS OF MALNUTRITION:

a)Kwashiorkor

-This is a form of malnutrition that occurs as a result of lack f proteins in the diet .

Symptoms:

-Changes in hair and skin texture and pigment

-Decreased muscle mass 

-Diarrhea

-Consistent weight loss

-Reduced immunity

-Fatigue and lethargy

-Protruding belly.

b) Beriberi.

This is where the diet taken lacks thiamime (vitamin B1)

There are two forms of beriberi: 1.Wet beriberi affecting cardiovascular system.

2. Dry beriberi affecting central nervous system also known as warnecke karsokof syndrome.

Symptoms of wet beriberi: 

*Tachycardia

*Shortness of breathe during activities.

*Oedema of the lower limbs ..

*Awakening at night with shortness of breathe.

Symptoms of dry beriberi:

*Difficulty in walking.

*Peripheral neuropathy

*Paralysis of extremities

*Mental confusion.

*Strange eye movement (nystagmus)

*Tingling

*vomiting

Complications of beriberi: 

√Coma

√Congestive cardiac failure

√Psychosis

c)Rickets.

It's a disorder caused by lack of vitamin D, calcium  and phosphate ions.

It may lead to softening and weakening of bones 

Symptoms: 

-Bone pain

-Dental deformity

-Impaired growth

-Increased bone fractures

-Muscle cramps.

-Bowlegs

-Spine deformities.

Complications:

√Chronic skeletal pain.

√Skeletal fractures

√Skeletal deformities.

d)Scurvy: 

This is a disorder that occurs when one has savere lack of vitamin c (Ascorbic Acid ) 

It may cause ; 

#Anaemia

#Hemorrhage 

#Gum disease.

Laboratory tests and examination for  patients with malnutrition:

-Arterial blood gas

-Serum electrolyte levels

-Bone x- ray

-Serum alkaline phosphate..

-Parathyroid hormone level.

Definitive management of malnutrition:

*Stabalize the patient by correcting dehydration through iv fluid infusion.

*Correct micronutrients deficiency deficiency by providing: 

a)Food rich in vitamin A e.g fruits and vegetables

b)Multivitamin or supplements such as ready to use therapeutic food RUTF).

c)Folic acid tabs 2.5 mg OD 

d)Iron containing foods .

Correct electrolyte imbalance by infusing mineral mix and potassium orally added to feeds

*Correct hypoglycemia by proper feeding with balanced diet.

*Treat any underlying medical condition if possible replace the missing nutrients needed and treat any symptoms showing out.

By Jones H.M- MBA/DMS