Malnutrition: Lab Values, BMI & Diet

Appropriate Lab Values for Malnutrition

• Reduced serum albumin, transferrin, or prealbumin can indicate malnutrition.
• Malnutrition may cause Folate, Iron, and Zinc deficiency.
• Reduced levels of ascorbic acid can indicate malnutrition.

Normal Lab Values

• Glucose: 70-100 mg/dl
• Serum Albumin: 3.4-4.8 g/dl
• Prealbumin: 12-42 mg/dl (primary malnutrition indicator)
• Globulin: 2.3-3.4 g/dl
• Creatinine for Females: 0.5-1 mg/dl
• Creatinine for Males: 0.6-1.2 mg/dl
• Nitrogen (BUN): 8-21 mg/dl
• Hemoglobin for Females: 11.7-15.5 g/dl
• Hemoglobin for Males: 13.2-17.3 g/dl

BMI Ranges

• Underweight: <18.5
• Healthy weight: 18.5-24.9
• Overweight: 25.0-29.9
• Obese: >30
• Obesity Class I: 30-34.9
• Obesity Class II: 35-39.9
• Obesity Class III: >40

Mechanical Soft Diet

• Intended for individuals with chewing difficulties due to missing teeth, jaw issues, or fatigue.
• Appropriate foods include soft vegetables, fruits, chopped, ground, or shredded meats, breads, pastries, and eggs.
• Focus on food that is easy for the patient to chew.

Physical Objective Findings of Malnourishment in a Patient

• Physical signs include Nausea, Vomiting, and Diarrhea
• Other physical signs include weight loss, abdominal enlargement, and poor posture
• Weakness, fatigue, protrusions in bony areas, enlarged area, dry dull eyes may be observed
• Poor dental health, dry scaly skin, dry brittle nails and hair/loss indicate malnutrition
• Spleen/Liver enlargement, mental status changes, and flaccid muscles are also indicators.
• Objective findings through lab values can also be assessed.
• Prealbumin is the best indicator of malnutrition.

Expected Nutritional Status Findings in Older Adults

• Loss of interest in eating might be observed
• Decreased thirst sensation might be observed
• Diets might need to be low in salt, simple sugars, or fat.
• Diminished taste and smell can make certain diets unappealing.
• Vision or hearing loss, limited mobility, and interaction make purchasing or preparing food difficult.
• Tooth loss and gum disease can limit chewing ability.
• Conditions like arthritis can make food preparation or eating difficult.
• Physical problems include gastroesophageal reflux, decreased gastric secretions, decreased intestinal peristalsis, and glucose intolerance.
• Older adults need smaller quantities of foods with fiber and fluids.

Low Cholesterol Diet

• Should include foods that increase HDL (good cholesterol)
• Limit whole milk dairy products, fatty meats, tropical oils, and partially hydrogenated vegetable oils.
• Diets might include a variety of fruits, vegetables, and whole grain products.
• Fish, especially fatty fish, should be eaten at least twice a week.
• Consumption of fat-free and low-fat milk products and legumes is recommended.
• Choose skinless poultry and lean meats.
• Use fats and oils containing 2g or less of saturated fats per tablespoon, such as liquid and tub margarines and canola oil.
• High cholesterol foods to avoid includ meats, eggs, dairy products, and organ meats (heart, liver)
• Avoid too much fish and poultry.

Diabetic Diet

• Reduce simple sugars and increase complex sugar intake.
• Monitor for glucose intolerance.
• Small frequent meals can help with blood sugar control.
• Avoid simple sugars, milk, honey, and fruits.
• Complex sugars from vegetables, breads, pastas, grains, and legumes are good.

Electrolytes and Their Function/Effects

• Magnesium normal range: 1.3-2.1 meq/L
• Phosphorus normal range: 3-4.5 mg/dL
• Potassium normal range: 3.5-5 meq/L
• Calcium normal range: 9-10.5 mg/dl
• Chloride normal range: 98-106 meq/L
• Sodium normal range: 135-145 meq/L

Sodium (Na)

• Functions: Water balance, acid-base balance, muscle action, nerve transmission, and convulsion regulation.
• High amounts increase risk for stroke, high blood pressure, myocardial infarction.
• Deficiency Effects: Dizziness, abdominal cramping, N/V/D, tachycardia, convulsions, coma.

Calcium (Ca)

• Functions: Bone/teeth formation, blood clotting, nerve conduction, muscle contraction, cellular metabolism, heart action.
• Deficiency Effects: Bone loss, tetany, rickets, osteoporosis.

Potassium (K)

• Functions: Intracellular fluid control, acid-base balance, nerve transmission, muscle contraction, glycogen formation, protein synthesis, energy metabolism, blood pressure regulation.
• Deficiency Effects: can causes heart problems and arrhythmias, muscle weakness, weak pulse, fatigue, abdominal distention.

Magnesium (Mg)

• Functions: Aids thyroid hormone secretions, maintains normal BMR, activates enzymes for carbohydrate and protein metabolism, nerve and muscle function, cardiac function.
• Deficiency Effects: Increased risk of HTN and CAD in women, tremor, spasm, convulsion, weakness, muscle pain, poor cardiac function.

Chloride (Cl)

• Functions: Bone and tooth strength, overall metabolism, formation of enzymes, acid-base balance.
• Deficiency Effects: Bone loss, poor growth.
• If magnesium is high, then phosphorus is low, if magnesium is low, then phosphorus is high

Ambulation

• Cane: A mobility aid.

Proper Cane Usage

• Ensure the cane is the proper size.
• The patient stands erect, cane tip 20cm (4in) to the side of their foot.
• The top of the cane reaching the top of the hip joint, elbow flexed at 30°.
• Cane should be held on the stronger side
• Weight distributed evenly between the feet and the cane.
• Advance the cane and weaker leg together, then bring the stronger leg through.
• Avoid leaning.
• Maintain rubber tip integrity for traction.

Proper Walker Usage

• Ensure the walker is the proper size.
• The patient stand erect, holding onto the walker.
• The walker should extend from the floor to the hip joint (30° elbow flexion).
• Do not stand too far behind the walker.
• Pick up/advance the walker as you step ahead (not too far).
• If one leg is weaker, move it forward as the walker moves forward.
• Pick up, rather than slide, the walker (unless it has wheels).

Complications of immobility

• Includes pressure injury, impaired skin integrity risk, and constipation.
• Other complications: Joint contracture, muscle weakness, balance problems.
• Deep Vein Thrombosis (DVT), pooling of secretions in lower lobes, and orthostatic hypotension.

Patient Positions

• Semi-Fowler's Position: Head of Bed (HOB) 30-45°
• Fowler's Position: General term, elevation varies.
• High Fowler's Position: HOB at 90°
• Orthopneic Position: HOB elevated 90° with an overbed table and pillow for the patient to lean on, helpful for shortness of breath.
• Lateral (Side-Lying) Position:Top hip and knee flexed, lateral recumbent.
• Oblique Position: Lateral position alternative that reduces pressure on the trochanter; top leg is behind the body.
• Prone Position: Patient lies face down. Supine Position: Patient face up.
• Sims' Position: Semi-prone, lower arm behind, upper arm flexed, upper leg more flexed than the lower one, which facilitates drainage and limits pressure points.
• Trandelemburg Position: Entire bed tilted with the head lower than the foot.
• Reverse Trendelenburg Position: Entire bed tilted with the foot lower than the head.

Crutches

• How to Properly teach a pt to use crutches
• 2-point, 3-point, and 4-point gait

Braden Scale Risk Assessment

• Measures risk for developing acquired ulcers or injuries.
• Scale score and what it means
• 19-23 = no risk
• 15-18 = mild risk
• 13-14 = moderate risk
• < 9 = SEVERE RISK
• THE LOWER THE NUMBER, THE HIGHER THE RISK.
• Categories:
• Sensory perception (ability to respond to discomfort)
• Moisture (skin exposure to moisture level)
• Activity (degree of physical activity)
• Mobility (ability to ccontrol body position)
• Nutrition (food intake patterns) related to friction & shear

Iron Deficiency Anemia

• Iron-rich foods: Meats, spinach, seafood, broccoli, peas, bran, enriched breads, fortified cereals.

Hypocalcemia (Low Calcium)

• Calcium food sources: Dairy products, sardines, green leafy vegetables, broccoli, whole grains, egg yolks, legumes, nuts, fortified products

Fat-Soluble Vitamins and Food Sources

• Vitamin A: Fish liver oil, egg yolk, yellow fruit, cream, green leafy vegetables, fortified milk.
• Vitamin D: Fish liver oil, fish, fortified milk, sunlight exposure.
• Vitamin E: Vegetable oils, green leafy vegetables, milk, nuts, eggs, meats, fish, wheat and rice germ.
• Vitamin K: Green leafy vegetables, liver.

Vitamin Functions

• Vitamin K: Helps with blood clotting, synthesis of clotting factors, deficiency leads to increased bleeding.
• Vitamin A: Night and color vision, cell growth/maturity, healthy skin/mucous membranes, growth of skeletal/soft tissues, reproduction.
• Vitamin D: Calcium levels, deposit/resorption rate in bones, reabsorption of calcium in bones.
• Vitamin E: Antioxidant, protects red blood cells/muscle tissue cells. Different Types of Diets

Different Diets

• Pureed
• For individuals with swallowing problems
• Clear Liquids
• Provides fluids to prevent dehydration and some simple carbohydrates to help meet energy needs
• Mechanical Soft Diet
• For individuals with chewing difficulties due to missing teeth, jaw problems, or extensive fatigue.
• Gl problems
• Low Sodium Diet
• For individuals with hypertension, inner ear or fluid balance issues
• NPO (nothing by mouth)

Suitable Food for Osteoporosis Patients

• Calcium-rich foods can be incorporated: Dairy products, sardines, green leafy vegetables, broccoli, whole grains, egg yolks, legumes, nuts, fortified foods.

Lipids, Carbohydrates, and Fiber Functions

• Lipids (Fats): Supply essential nutrients, energy, flavor and satiety, insulation, organ protection, thermoregulation, nerve impulse, cell metabolism.
• Function: Fats supply the fatty acids and aid in the absorption of fat-soluble vitamins.
• Energy utilization: Body burns fat during light activity, when glycogen is exhausted, and at rest. Lipids give food its creamy taste and the feeling of fullness.
• Flavors and Satiety: Fats are digested more slowly therefore the stomach feels full for longer. Cholesterol is a part of every cell in the body.

Carbohydrates

• The primary energy source.
• They supply energy for muscle and organ function.
• They are digested easily.
• Used for skeleton muscle activity by providing nearly all energy for the brain.
• Humans store glucose in the liver and skeletal muscle tissue as glycogen.
• Glycogen is converted back into glucose to meet energy needs (glycogenolysis)
• Spare Protein: To catabolize stores of protein and lipids when glycogen stores are low
• When proteins are used for energy they are not available for their primary tissue.
• Fats are then converted directly into the alternative fuel called ketones.
• Increase Satiety & Improve absorption of sodium & excretion of calcium.
• Enhance insulin secretion.
• Insulin is a pancreatic hormone that promotes the movement of glucose into the cells for use.

Fiber

• A protective effect from disease and normalizes BM
• Helps maintain BM
• Tissue building
• Nitrogen balance

Protein Foods

• Soy beans are good and not peanut butter. What type of dietary problems could occur (nutritional problems)

Dehydration

• Often caused by inadequate water or fiber.
  • Constipation
    • Is a symptom of excess calcium intake Know what it means when you have

Low or High-Density Lipoproteins

• Low-Density Lipoproteins (Bad Cholesterol):
  • Not enough cholesterol transported into body cells (Low LDL).
  • Cholesterol being deposited rather than transported (High LDL).
    • Causes cardiovascular disease.
• High-Density Lipoproteins (Good Cholesterol):
  • Not enough cholesterol being removed from bloodstream. (Low HDL)
  • Protective against cardiovascular disease. (High HDL)

Foods For Pressure Ulcers

• Adequate Hydration
• Protein rich foods

Dietary Restrictions

• Must follow code laws for any meats and their slaughter

Kosher Foods (Meat, Dairy, Pareve)

• Kosher Foods (Meat, Dairy, and Pareve)
• Meat and milk products are not mixed together
• Any meat from kosher animals is slaughtered using the correct procedure
• Certain parts of the animal may not be eaten
• All blood must be drained out of it before it is eaten
• CAN EAT: Animals with 2 hooves
• Cows, sheep, goats, lambs, oxen, and deer
• Fruits, vegetables, grains, pasta, nuts, beans, and legumes
• CANNOT EAT: Animal products from non-kosher animals are not included
• Pig, shellfish, reptiles

Interventions to Prevent Pressure Ulcers

• Avoid skin trauma
• Reposition client in bed every 2 hours
• Reposition client in chair every 1 hour
• Keep skin clean, dry, and intact
• Provide wrinkle-free linen
• Keep HOB elevated at or below 30 degrees
• Raise heels off the bed to prevent pressure
• Provide supportive devices
• Maintain skin hygiene
• Inspect skin frequently
• Clean skin gently
• Wash with tepid water (not hot) and avoid scrubbing
• Do not massage bony prominences
• Encourage proper nutrition
• Adequate hydration
• Protein diet

Low-Sodium Diet

• Sodium dietary restrictions:
• Avoid foods
• Table salt - salt alternatives may be used
• Milk
• Meat
• Eggs
• Baking soda and baking powder
• Celery, spinach, carrots, beets

Nasogastric Tubes

• Measure from tip of nose to earlobe, and from earlobe to the xiphoid process to figure out the length needed.

• The lumen (inside diameter) of a feeding tube is measured using the French(Fr) scale

  • • The larger the lumen, the larger the diameter
  • -Most feeding tubes for adults are 8-12 Fr and 90-108 cm(36-42in) long -E Each Fr unit is about 0.33 mm, so a 12Fr tube is about 4mm in diameter. How to select appropriate size( different types of NG tubes)

• Small-bore NG tube

• Inserted one nairs through the nasopharynx into the esophagus, and finally into stomach

• NE tube : Used for pts at risk for aspiration with decreased level of consciousness, absent or diminished gag reflux, severe gastroesophageal reflex reflux

• Longer than NG

• Extending into Junenum

• Large bore NG

• Salem sump

• Greater than 12Fr

• Verifying -X ray

• Most Reliable

• Aspriate Stomach

• 1-5.5 pH

• Intestinal content will have a Yellow green tinge due to bile

NG Tubes

• PH should be between 1-5.5
• Check the length of the tube that extends from the body
  • When the tube was placed, it should have been marked, check the mark to see that the tube has not moved
• Proper maintenance of an NG tube
• Periodically assess placement of the tube
• Check pH
• Listen over stomach with a stethoscope while injecting air into the tube
• Review x-rays
• Examine the skin and mucous membranes around the insertion site (nares, abdomen)
• Assess for swelling, redness, drainage, or tenderness
• Irrigate with 10-30 mL of normal saline every 3 to 4 hours

Use For NG Tube

• -A patient that requires short term (less than 6 weeks) enteral feedings
• Patient recovering from surgery and can't eat food for a short time
• A patient who is undernourished
• Proper order in how to start a tube feeding
• Aseptic technique & Lable Equipment
• -Elevate head of bed
• -Right Pt right formula and check lines

Procedures for Wheelchair transfer

• To transfer a patient using a wheelchair in the hospital:
• Position wheelchair directly next to bed.
• Lock wheelchair brakes and move footrests out of the way.
• Lower bed rail on the side you will be transferring.
• Use gait/transfer belt.
• Move patients bottom to the front of the wheelchair seat so that their feet are in contact with the floor.
• To complete the transfer, the person should lean forward over their feet, use their hands to push from the surface they are sitting on, swing their bottom around to the adjacent surface and slowly sit back down

Movement

• Use your body.

PROM

• Maintain for joint mobilty
• Definition is the movement of the joints through their full range of motion by another person

Proper use with Antiembolic Stockings

• Definition is.
  • Used Assess skin circulation and present on edema
  • Then Measure calf and thigh
  • After that use Tape
    1. -perform hand hygiene
    2. -assess skin and what's the circumference 3 -- inside out Then use stockings 4-) Remove very 8 hr for test

High and Low

Knee and use stocking below. Help prevent falls. Do not catch the pt. Ranges of Movements

• Flexion --Reduces a joint angle
• Extension--- Increase
• Abduction---- awayfrom body

Foods rich in patissum

• Unproccesed Foods and Fruits