# Nursing Study Guide/Nutritional Issues

Nursing care of Clients with Nutritional Disorders
Nutritional Standards to Promote Health include dietary recommendations, food guide pyramids for adequate nutrition. Nutritional assessment includes diet history, Anthropometric measurements (measurement of height and weight, assessment of body fat [body mass index]).

## Obesity

Overweight means increased body weight for height compared to standard. Obesity is one of the most preventable health problems; it means at least 20% above upper limit of normal range for ideal body weight, due to excess adipose tissue. Obesity is adequately described by the amount of body fat. Morbid obesity has severe negative effects on health. Complications of Obesity
Complications related to obesity include diabetes mellitus, hypertension, hyperlipidemia, coronary artery disease (CAD), Obstructive sleep apnea, depression and other mental health/behavioral health problems, urinary incontinence, cholelithiasis, chronic back pain, early osteoarthritis, delayeded wound healing, and increased susceptibility to infection.

## Pathophysiology of Obesity

Pathophysiology of obesity includes excess calories stored as fat, which can result from excess energy intake, deficient energy expenditure, or a combination of both. The appetite is controlled by the central nervous system (CNS) and by emotional factors. Other factors contributing to the pathophysiology of obesity include hormones (thyroid, insulin, leptin). Two types of obesity are upper body (central) obesity with waist-hip ratio greater than 0.8, and lower body (peripheral) obesity.

## Risk Factors of Obesity

Risk Factors for obesity include genetic, physiologic, physical activity, psychologic, environmental (fast foods, vending machines), sociocultural (family meals, rewards).

## Obesity and Health Promotion

Include health promotion/illness prevention. Teach the potential consequences and complications. Teach the importance of eating a healthy diet, and that foods eaten away from home tend to be higher in fat, cholesterol, and salt, and lower in calcium. Reinforce need for regular moderate activity for at least 30 minutes per day, five or six days a week. Educate regarding diet and activity for children and adolescents, and continuing throughout adulthood.

## Collaborative Care of Obesity

Collaborative Care includes diagnostics; BMI (20-2), anthropometry, underwater weighing, thyroid profile, serum glucose, lipid profile, cholesterol, ECG, treatment, and medications. Nonsurgical Management of obesity may include fasting, very low-calorie diets of 400 to 800 calories per day, novelty diets, diet therapy, exercise programs, drug therapy, OTC medications such as Meridia or Xenical, complementary and alternative therapies and treatments, behavioral therapy, food records which may help identify/eliminate cues that precipitate eating.
Surgical Management of Obesity may include liposuction, bariatric surgery, preoperative care, operative procedures, vertical banded gastroplasty, circumgastric banding, Roux-en-Y gastric bypass.
Postoperative Care of Obesity includes analgesia, skin care, nasogastric tube placement, diet, prevention of postoperative complications. Observe for dumping syndrome signs such as tachycardia, nausea, diarrhea, and abdominal cramping.

## Nursing Care of Obesity

Nursing Care includes health promotion. Start early. Nursing diagnosis (ND) and interventions include possibilities such as the following:
Imbalanced nutrition: more than body requirements; identify factors contributing to food excess, establish realistic goals, assess knowledge and provide patient teaching, discuss how patient can implement behavior modification.
Activity intolerance; assess current activity level, after medical clearance plan an individualized program.
Ineffective therapeutic regimen management; discuss ability to incorporate change, help identify behavior modification strategies, plan ways to deal with stress and interruptions in regimen.
Chronic low self-esteem; encourage patient to verbalize feelings, set small goals, refer to counseling if appropriate.

## Home care of Obesity

Home care includes lifestyle changes; recruit the whole family, establish realistic goals with non food rewards, identify an exercise buddy, expect failures and learn to deal with them, use community resources.

## Malnutrition

Malnutrition may result from inadequate intake of nutrients, or may be caused by inadequate nutrition intake, impaired absorption or increased metabolic need.

## Pathophysiology of malnutrition

Pathophysiology of malnutrition includes starvation (inadequate dietary intake; as it continues the body breaks down fats into fatty acids and ketones), acute stress which produces a state of hypermetabolism and catabolism (cells and tissue breakdown; increased energy expenditure and nutrients needs) protein and calorie malnutrition (PCM): both proteins and calories are deficient.

## Risk Factors of malnutrition

Risk Factors of malnutrition include age, poverty and homelessness, functional health problems, oral or GI problems affecting food intake, chronic pain or disease, medications or treatment, acute problems (infection, surgery, trauma). Manifestations and Complications of malnutrition Manifestations and Complications of malnutrition include weight loss, wasted appearance, dry and brittle hair, pale mucous membranes.

## Collaborative Care of malnutrition

The goal of collaborative Care of malnutrition is torestore ideal body weight, to replace and restore depleted nutrients. Laboratory Assessment of malnutrition includes BMI less than 20, hematology (iron, Hgb, protein studies, albumin below 3 mg/dl, serum cholesterol 160-200, other laboratory tests, total lymphocyte count reduced, serum electrolytes. Collaborative Care of malnutrition
Collaborative Care of malnutrition includes medications, fluid and dietary management, correct imbalances, enteral nutrition, parenteral nutrition.

## Enteral Nutrition for malnutrition

There are different types of enteral products for nutrients, methods of administration of total enteral nutrition, and types of tubes (nasoenteric tube, enterostomal tube), types of feedings. Complications of total enteral nutrition include clogged tube, dislodgement, aspiration, fluid excess, increased osmolarity, dehydration, electrolyte imbalances.

## Parenteral Nutrition for malnutrition

Parenteral Nutrition for malnutrition includes partial parenteral nutrition and total parenteral nutrition (TPN). Complications include fluid imbalances, electrolyte imbalances, glucose imbalances, and infection.

## Nursing diagnoses and Interventions for malnutrition

Nursing diagnosis (ND) and interventions include possibilities such as the following: Imbalanced Nutrition: less than body requirements; assess client, provide rest, assess knowledge and provide teaching.
Risk for infection; monitor for infection, maintain medical asepsis, teach signs of infection and hand washing techniques.
Risk for deficient fluid volume; monitor for dehydration, measure input and output, daily weight, allow frequent, preferred fluids.
Risk for impaired skin integrity; assess skin, turn every two hours, keep skin dry and clean.