Care of Patients with Malnutrition and Obesity

Dietary Guidelines for AmericansFood Guide PyramidVegetarian Food Guide PyramidCultural awarenessGeriatric considerations

Initial nutritional screeningAnthropometric measurementsBody mass indexSkin-fold measurements

Protein-calorie malnutritionMarasmus calorie malnutrition, in

which body fat and protein are wasted, serum proteins are often preserved

KwashiorkorMarasmic-kwashiorkor

Anorexia nervosaBulimia nervosa

Patient historyClinical manifestationsPsychosocial assessment

HemoglobinHematocritSerum albumin, thyroxine-binding

prealbumin and transferrinCholesterolTotal lymphocyte count

Drugs to stimulate appetite—Periactin, Megace

Those patients who can eat but cannot maintain adequate nutrition by oral intake of food alone

Those patients who have permanent neuromuscular impairment and cannot swallow

Those patients who do not have permanent neuromuscular impairment but are critically ill and cannot eat because of their condition

Nasoenteric tube (NET)Nasogastric tube (NG)Nasoduodenal tube (NDT)

GastrostomyPercutaneous endoscopic

gastrostomy (PEG)Low-profile gastrostomy device

(LPGD) Jejunostomy

Bolus feedingContinuous feedingCyclic feeding

Refeeding syndromeTube misplacement and

dislodgementAbdominal distention and nausea

and vomitingFluid and electrolyte imbalances

Partial parenteral nutritionTotal parenteral nutrition

Fluid imbalancesElectrolyte imbalances

Home care managementHealth teachingHealth care resources

Overweight—increase in body weight for height compared with standard, or up to 10% greater than ideal body weight

Obesity—excess amount of body fat when compared with lean body mass, at least 20% above upper limit of normal range for ideal body weight

Morbid obesity—severe negative effect on health, usually more than 100% above ideal body weight

More than half of adults in the United States are estimated to be overweight or obese.

The proportion of adolescents from poor households who are overweight or obese is twice that of adolescents from middle- and high-income households.

Obesity is especially prevalent among women with lower incomes and is more common among African American and Mexican American women than among white women.

Among African Americans, the proportion of women who are obese is 80 percent higher than the proportion of men who are obese.

This gender difference also is seen among Mexican American women and men, but the percentage of white, non-Hispanic women and men who are obese is about the same.

Accessed www.healthypeople.gov 14june10

HypertensionHyperlipidemiaCADStrokePeripheral arterial diseaseMetabolic syndromeObstructive sleep apneaObesity hypoventilation syndrome

Depression and other mental health problems

Urinary incontinenceCholelithiasisGoutChronic back painEarly osteoarthritisDecreased wound healing

DietPhysical inactivityDrug treatmentFamiliar and genetic factors

Patient historyClinical manifestationsPsychosocial assessment

Diet programs Nutrition therapy Exercise program Drug therapy—Meridia, Tenuate,

Bontril, Xenical Behavioral management Complementary and alternative

therapies—acupuncture, acupressure, ayurvedic therapy hypnosis

LiposuctionBariatrics—branch of medicine that

manages obesity and its related diseases: Gastric restrictive Malabsorption Both

Preoperative care

Gastric restriction

Malabsorption surgeryGastric bypass

Airway managementPain managementPatient and staff safetyCare of NG tubeAssess for anastomotic leaks

Abdominal binderPosition Monitor SaO2

Sequential compression hose and/or heparin

Assess skinAbsorbent paddingRemove urinary catheter within 24

hours

Assist patient out of bedAmbulation as soon as possibleMonitor abdominal girth6 small feedings and prevent

dehydrationObserve for signs of dumping

syndrome