Nursing Care of Patient with Nutritional Disorders

• The Patient with Obesity can have body fat distribution as Android (Apple shaped) with excessive fat located in the central abdominal area, or as Gynoid (pear shaped) with the fat distributed in the lower extremities around the hip or femoral region.
• Bariatrics is a healthcare science focusing on patients who are extremely obese.
• Body mass index (BMI) is used to determine if a person is overweight or obese.
• More than 30% of adults in the United States are obese, and nearly 2/3 of adults in the United States are overweight.
• 3 out of 10 Filipinos are overweight and obese, with 37.2 percent in 2018 based on National Nutrition Survey.
• Risk factors for obesity include genetic, physiologic (physical inactivity), psychologic (low self-esteem), environmental (access to inexpensive and appealing obesogenic foods), sociocultural (overeating at family meals).
• Nutrients provide energy and are building blocks for growth and tissue repair.
• Basal metabolic rate (BMR) is the rate at which the body burns calories when at rest.
• Triglycerides are formed from dietary fats and carbohydrates.
• Obesity occurs when excess calories are stored as fat and/or decreased energy expenditure.
• Appetite is regulated by the central nervous system and by emotional factors.
• Hormones involved in regulating obesity include Thyroid hormone, Insulin, and Leptin.
• Treatment of obesity is ongoing and individualized, with most individuals setting unrealistic goals related to ideal weight.
• Other disorders that can be associated with reproductive functions include polycystic ovarian syndrome (PCOS) and menstrual irregularity in women, and reduction of androgen in men.
• Surgical interventions for obesity include categories of bariatric surgery such as restrictive procedures (vertical gastroplasty (VGB) and adjustable gastric banding (AGB)), and malabsorptive procedures with a restrictive component (Roux-en-Y gastric bypass (RYGB), vertical sleeve gastrectomy (VSG), and biliopancreatic diversion with duodenal switch ( BPD-DS )).
• Nursing care of the patient with malnutrition involves assessment of health history, usual daily dietary pattern, usual weight and recent changes, appetite and food tolerance, specific food likes and dislikes, difficulty swallowing, problems such as anorexia, nausea and diarrhea, or constipation, history of surgery and/or chronic diseases and medications, physical assessment, and laboratory studies.
• Behavioral modification strategies for the obese person include controlling the environment, controlling physiologic responses to food, controlling psychologic responses to food, and social support, group programs.
• Medications to treat obesity include orlistat (Xenical), lorcaserin (Belviq), Qsymia, and appetite suppressants such as amphetamines and nonamphetamines, and antidepressants.
• Impaired mobility, increased risk for pressure ulcers, abdominal edema, diarrhea, impaired nutrient absorption, and general symptoms of frailty, weakness, slow walking speed, low physical activity level, unintentional weight loss and exhaustion are symptoms of malnutrition.
• Exercise for obesity should be spread throughout the week, with at least 10 minutes at a time.
• Fluid, electrolyte imbalances are corrected in nutrition/treatments, along with gradual refeeding, nutritional supplements, enteral nutrition, and parenteral nutrition (PN).
• Diagnosis of obesity can be done through body mass index (BMI), anthropometry, underwater weighing (hydrodensitometry), bioelectrical impedance, waist circumference, and tests to identify physiologic cause and complications of obesity such as thyroid profile, serum glucose, serum cholesterol, lipid profile, and electrocardiogram (ECG).
• Nutrition screening tool, same standard measurements as obesity, serum albumin is reduced in PCM, prealbumin level of less than 10 milligram/deciliter, total lymphocyte count, serum electrolytes, and procedures to evaluate the extent of malnutrition such as bioelectric impedance analysis and total daily energy expenditure are used in the diagnosis of malnutrition.
• Supplemental vitamins, minerals, and therapy tailored to correct specific deficiencies are treatments for malnutrition.
• Parenteral nutrition (PN) involves the intravenous administration of amino acids, often with added carbohydrates, fats, electrolytes, vitamins and minerals, and is administered through a subclavian vein.
• Types of obesity include upper body obesity (central obesity) with a waist-to-hip ratio of greater than 1 in men, 0.8 in women, and health-related problems such as hypertension, heart disease, and stroke, lower body obesity (peripheral obesity) with a waist-to-hip ratio less than 0.8, and sarcopenic obesity due to age-related loss of muscle mass.
• Nursing diagnoses for malnutrition include Imbalanced Nutrition: Less than Body Requirements, Risk for Infection, Risk for Defficient Fluid Volume, and Risk for Impaired Skin Integrity.
• Anorexia Nervosa typically begins during mid to late adolescence, is associated with body image and irrational fear of gaining weight, and is characterized by restricted calorie intake often accompanied by excessive exercise.
• Rest periods before and after meals, knowledge and appropriate teaching, and specialized nutritional support are necessary when a patient cannot, should not, or will not eat adequately and if the benefits of nutrition outweigh the associated risks.
• Nursing care continuity for malnutrition includes periodic nutritional status assessment, teaching diet recommendations and nutritional supplements, and where to obtain foods, supplements.
• Priorities of care in nutritional disorders include obtaining and documenting baseline indicators of nutritional status, creating an interprofessional treatment plan to correct acute fluid and electrolyte imbalances, and ensuring the patient is receiving supplemental nutritional support when appropriate.
• Severely disturbed eating behavior and weight management are characteristic of an eating disorder.
• Bulimia Nervosa is characterized by binge-purge behavior, with patients usually maintaining a normal weight.
• Outcome and intervention for malnutrition include promoting weight gain and well-being, providing an environment and nursing measures that encourage eating, eliminating foul odors, providing oral hygiene before and after meals, making meals appetizing, and offering frequent, small meals including preferred foods.
• Reducing risk for infection in malnutrition includes monitoring temperature and assessing for manifestations of infection every 4 hours, maintaining medical asepsis when providing care and surgical asepsis when carrying out procedures, teaching the patient in the signs and symptoms of infection, hand hygiene, and factors that increase the risk for infection, and monitoring oral mucous membranes, urine-specific gravity, level of consciousness, and laboratory findings every 4 to 8 hours.
• Consultation with the nutrition support team is necessary to provide adequate protein, calories, minerals and vitamins.
• Complications of obesity include cardiovascular disease, respiratory disorders, diabetes mellitus, and other health-related problems.
• Nursing diagnoses for a patient with an eating disorder may include Imbalanced Nutrition: Less than Body Requirements, Imbalanced Nutrition: More than Body Requirements, Ineffective Therapeutic Regimen Management, Chronic Low Self-Esteem, Disturbed Body Image, Dysfunctional Family Processes, and Powerlessness.
• Treatment of eating disorders requires extended treatment, which may include hospitalization, and involves family therapy and social support.
• Patients with eating disorders often induce vomiting or take excessive quantities of laxatives or diuretics to control their weight.