Malnutrition (Failure to Thrive, Malabsorption Disorders) for Progressive Care Certified Nurse (PCCN)
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Outline
Malnutrition (Failure to Thrive, Malabsorption Disorders)
Definition/Etiology:
- Definition
- Failure to thrive (weight loss & frailty) is a another word for malnutrition.
- Term usually used for pediatric patients but highly prevalent for elderly.
- Nutritional support in critical care patient is frequently missed.
- Etiology
- Older Age
- Pain
- Nausea & Vomiting
- Swallowing problems
- Stroke
- Strictures of throat
- Trauma/burns
- Sepsis
- GI Cancer
- Psychologic disorders
- alcohol and medication abuse
Pathophysiology:
- Pathophysiology
- It results from the body’s physiologic adaptive response to starvation in response to severe deprivation of energy and all nutrients, and is characterized by wasting of body tissues, particularly muscles and subcutaneous fat.
- This leads to coma then death.
Noticing: Assessment & Recognizing Cues:
- Subjective Cues
- Loss of appetite
- Depression
- Weak
- “Trouble swallowing”
- Objective Cues
- Poor intake (less than 50% meals)
- weight loss
- Skin
- Ulcers, Edema, Infection
- Steatorrhea – fat in stool
Interpreting: Analyzing & Planning:
- Labs
- Pre-Albumin
- Albumin
- Electrolytes
- Vitamin levels
- Diagnostics
- Braden Score
- Swallow Screen
- Underlying cause
Responding: Patient Interventions & Taking Action:
- First Goal is always nutritional support within 24 to 48 hours.
- Pharmacological Interventions
- Treat underlying cause
- Replace fluids/electrolytes
- Enteral Feedings (in the mouth)
- NG tube – short term
- Peg Tube – more than 4 weeks
- Preferred over parenteral
- Minimal needs
- Calories 25 kcal/kg/day
- Protein 1 gram/kg/day
- Non-Pharmacological Interventions
- Nutritional screenings with 24 hours of admission
- Strict skin care
- Invasive studies are related to primary diagnosis
Reflecting: Evaluating Patient Outcomes:
- Manage the delivery device
- Assess for complications: Sinusitis, dysphasia, migration, , tube occlusion, pulmonary aspiration, esopharyngeal discomfort, erosion of the nasal septum
- Monitor for Refeeding Syndrome vs Underfeeding
- Refeeding Syndrome -potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial refeeding
- Hallmark = hypophosphatemia
- Seizures, irregular heartbeat
- Underfeeding
- Minimize NPO for diagnostics
- End result is ileus
- Refeeding Syndrome -potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial refeeding
Linchpins (Key Points):
- Notice
- Critically Ill & Risk Factors
- Interpret
- Labs & Swallow
- Respond
- Enteral Feeding
- Reflect
- Refeeding Syndrome & Ileus
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Transcript
References
- AACN, & Hartjes, T. (2023). AACN Core Curriculum for Progressive and Critical Care Nursing (8th ed.). Elsevier Health Sciences (US).
- Dennison, R. D., & Farrell, K. (2015]). Pass PCCN!. Elsevier Health Sciences (US).
- Kupchik, N. (2017). Ace The Pccn®!: You can do it!: Practice question review book. Nicole Kupchik Consulting, Inc.
- Stone, L. M. (2018). Certification and Core Review for High Acuity, Progressive, and Critical Care Nursing (7th ed.). Elsevier Health Sciences (US).
- Trivium Test Prep. (2019). Pccn review book 2019-2020: Pccn Study Guide and Practice Test Questions for the Progressive Care Certified Nurse Exam.
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Progressive Care Certified Nurse (PCCN)
Course Lessons
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Cardiac Surgery (Post-ICU Care) for Progressive Care Certified Nurse (PCCN)
Cardiac Tamponade for Progressive Care Certified Nurse (PCCN)
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AV Blocks Dysrhythmias for Progressive Care Certified Nurse (PCCN)
Heart Failure (Acute Exacerbations, Chronic) for Progressive Care Certified Nurse (PCCN)
Hypertension (Uncontrolled) and Hypertensive Crisis for Progressive Care Certified Nurse (PCCN)
Minimally-Invasive Cardiac Surgery (Non-Sternal Approach) for Progressive Care Certified Nurse (PCCN)
Valvular Heart Disease for Progressive Care Certified Nurse (PCCN)
Vascular Disease for Progressive Care Certified Nurse (PCCN)
Pulmonary
Acute Respiratory Distress Syndrome (ARDS) for Progressive Care Certified Nurse (PCCN)
Asthma (Severe) for Progressive Care Certified Nurse (PCCN)
COPD Exacerbation for Progressive Care Certified Nurse (PCCN)
Minimally-Invasive Thoracic Surgery (VATS) for Progressive Care Certified Nurse (PCCN)
Obstructive Sleep Apnea for Progressive Care Certified Nurse (PCCN)
Pleural Space Complications (Pneumothorax, Hemothorax, Pleural Effusion, Empyema, Chylothorax) for Progressive Care Certified Nurse (PCCN)
Pulmonary Embolism for Progressive Care Certified Nurse (PCCN)
Pulmonary Hypertension for Progressive Care Certified Nurse (PCCN)
Respiratory Depression (Medication-Induced, Decreased-LOC-Induced) for Progressive Care Certified Nurse (PCCN)
Respiratory Failure (Acute, Chronic, Failure to Wean) for Progressive Care Certified Nurse (PCCN)
Respiratory Infections (Pneumonia) for Progressive Care Certified Nurse (PCCN)
Thoracic Surgery (Lobectomy, Pneumonectomy) for Progressive Care Certified Nurse (PCCN)
Endocrine/Hematology/Neurology/Gastrointestinal/Renal
Diabetes Mellitus for Progressive Care Certified Nurse (PCCN)
Diabetic Ketoacidosis for Progressive Care Certified Nurse (PCCN)
Hyperglycemia for Progressive Care Certified Nurse (PCCN)
Hypoglycemia for Progressive Care Certified Nurse (PCCN)
Anemia for Progressive Care Certified Nurse (PCCN)
Coagulopathies, Medication-Induced (Coumadin, Platelet Inhibitors, Heparin, HIT) for Progressive Care Certified Nurse (PCCN)
Encephalopathy (Hypoxic-ischemic, Metabolic, Infectious, Hepatic) for Progressive Care Certified Nurse (PCCN)
Seizure Disorder for Progressive Care Certified Nurse (PCCN)
Stroke for Progressive Care Certified Nurse (PCCN)
Functional GI Disorders (Obstruction, Ileus, Diabetic Gastroparesis, Gastroesophageal Reflux, Irritable Bowel Syndrome) for Progressive Care Certified Nurse (PCCN)
GI Bleed (Upper, Lower) for Progressive Care Certified Nurse (PCCN)
GI Infections (C. difficile) for Progressive Care Certified Nurse (PCCN)
GI Surgeries (Resections, Esophagogastrectomy, Bariatric) for Progressive Care Certified Nurse (PCCN)
Hepatic Disorders (Cirrhosis, Hepatitis, Portal Hypertension) for Progressive Care Certified Nurse (PCCN)
Ischemic Bowel for Progressive Care Certified Nurse (PCCN)
Malnutrition (Failure to Thrive, Malabsorption Disorders) for Progressive Care Certified Nurse (PCCN)
Pancreatitis For PCCN for Progressive Care Certified Nurse (PCCN)
Renal Failure- Acute Kidney Injury (AKI), Chronic Kidney Disease (CKD) for Progressive Care Certified Nurse (PCCN)
Electrolyte Imbalances for Progressive Care Certified Nurse (PCCN)
End-Stage Renal Disease (ESRD) for Progressive Care Certified Nurse (PCCN)
Musculoskeletal/Multisystem/Psychosocial
Functional Issues (Immobility, Falls, Gait Disorders) for Progressive Care Certified Nurse (PCCN)
End of Life for Progressive Care Certified Nurse (PCCN)
Healthcare-Acquired Infections: Catheter-Associated Bloodstream Infections (CAUTI) for Progressive Care Certified Nurse (PCCN)
Healthcare-Acquired Infections: Central-Line-Associated Infections (CLABSI) for Progressive Care Certified Nurse (PCCN)
Healthcare-Acquired Infections: Surgical Site Infections (SSI) for Progressive Care Certified Nurse (PCCN)
Infectious Diseases: Influenza for Progressive Care Certified Nurse (PCCN)
Infectious Diseases: Multidrug-Resistant Organisms (MRSA, VRE, CRE, ESBL) for Progressive Care Certified Nurse (PCCN)
Pain (Acute, Chronic) for Progressive Care Certified Nurse (PCCN)
Palliative Care for Progressive Care Certified Nurse (PCCN)
Pressure Injuries (Ulcers) for Progressive Care Certified Nurse (PCCN)
Rhabdomyolysis for Progressive Care Certified Nurse (PCCN)
Sepsis for Progressive Care Certified Nurse (PCCN)
Shock States (Anaphylactic, Hypovolemic) For PCCN for Progressive Care Certified Nurse (PCCN)
Toxic Ingestion, Inhalation, Overdose for Progressive Care Certified Nurse (PCCN)
Wounds (Infectious, Surgical, Trauma) for Progressive Care Certified Nurse (PCCN)
Altered Mental Status- Delirium and Dementia for Progressive Care Certified Nurse (PCCN)
Disruptive Behaviors, Aggression, Violence for Progressive Care Certified Nurse (PCCN)
Psychological Disorders (Anxiety, Depression) for Progressive Care Certified Nurse (PCCN)
Substance Abuse (Alcohol, Drug Withdrawal) for Progressive Care Certified Nurse (PCCN)
Substance Abuse (Chronic Alcohol Abuse, Chronic Drug Abuse) for Progressive Care Certified Nurse (PCCN)
Substance Abuse (Drug-Seeking Behavior) for Progressive Care Certified Nurse (PCCN)
Professional Caring and Ethical Practice
Advocacy & Moral Judgement for Progressive Care Certified Nurse (PCCN)
Caring Practices for Progressive Care Certified Nurse (PCCN)
Response to Diversity for Progressive Care Certified Nurse (PCCN)
Facilitation of Learning for Progressive Care Certified Nurse (PCCN)
Collaboration for Progressive Care Certified Nurse (PCCN)
Systems Thinking for Progressive Care Certified Nurse (PCCN)
Clinical Inquiry for Progressive Care Certified Nurse (PCCN)
