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

Linchpins (Key Points):

• Notice
  • Critically Ill & Risk Factors
• Interpret
  • Labs & Swallow
• Respond
  • Enteral Feeding
• Reflect
  • Refeeding Syndrome & Ileus