DNP 810 Choose one disorder of malnutrition that is found in your clinical setting or community
DNP 810 Choose one disorder of malnutrition that is found in your clinical setting or community
Recognized as a developmental disorder, cerebral palsy affects individuals at a very young age. Cerebral palsy can directly impact nutrition because the condition often adversely impacts the muscles necessary for chewing and swallowing (Aydin et al., 2018). Malnutrition in children with CP is usually caused by poor oral-motor function, which impairs the child’s ability to consume calories and nutrients required to support growth (Aydin et al., 2018). Moreover, children need adequate nutrition when concerning the promotion of both development as well as growth. A healthy diet also improves energy levels and body functions, which can positively affect performance during physical therapy (Aydin et al., 2018). Unfortunately, the condition can also require specific medications, making children lose their appetite or interest in food or water.
Individuals falling within the majority that possess Cerebral Palsy, 93%, will experience feeding difficulties. Since CP results in impairment of muscle groups, facial muscles can be affected. The facial muscles are one of the most important muscle groups in the body. Impairment hampers a child’s ability to chew, suck, or swallow, creating a high risk for undernourishment, failure to thrive, malnutrition, growth delay, and digestive difficulties (Aydin et al., 2018). Medical professionals may potentially suggest brain imaging tests, such as x-ray computed tomography (CT scan) or magnetic resonance imaging (MRI) (Morgan et al., 2019). In addition, an electroencephalogram (EEG), genetic testing, metabolic testing, or a combination of these might also undergo enactment (Morgan et al., 2019). Moreover, in a generalized manner, CP undergoes diagnosis during the first or second year after birth. Furthermore, primary treatment options for cerebral palsy are medication, therapy, and surgery (Morgan et al., 2019).
Cerebral palsy treatment aims to manage symptoms, relieve pain, and maximize independence to achieve long, healthy life (Novak et al., 2017). When the life expectancy of those with CP, this specific life expectancy undergoes calculations in which a child’s condition severity is considered. Mobility issues, intellectual disabilities, vision/hearing impairments, etc., all impact the lifespan of those with CP (Novak et al., 2017). Most children with milder forms of cerebral palsy have average survival times similar to those of the general population. However, multiple impairments may also lower cerebral palsy life span. According to Dr. Ananya Mandal, children with mild cerebral palsy possess a heightened likelihood (ninety-nine percent chance) of living to 20 years old (Novak et al., 2017). The two factors that have the most significant impact concerning a child’s lifespan with the inclusion of cerebral palsy are addressed to be intellectual and motor developmental challenges (Novak et al., 2017). As these impairments undergo an increase in severity, a child’s life expectancy can see a decline.
The importance of DNP-prepared nurses recognizing and managing cerebral palsy’s many significant comorbidities is as vital as treating motor disabilities and working with the patient’s families to adjust diet, nutrients, and supplements to contribute significantly to an individual’s overall health. Recent advances in understanding cerebral palsy include new ways of thinking about disability, casual pathway recognition, and improvements rooted in measurement, classification, and prognostication (Novak et al., 2017). Challenges entail family as well as child well-being, tackling the lifelong issues faced by individuals with cerebral palsy, as well as the persisting need for tertiary, secondary, as well as primary prevention of the impact that cerebral palsy contributes regards to the daily livelihoods of others (Novak et al., 2017). With most individuals with CP reporting feeding or digestive difficulties, a dietary counseling program can be highly beneficial.
Aydin, K., Akbas, Y., Unay, B., Arslan, M., Cansu, A., Sahin, S., … & Sarioglu, A. A. (2018). A multicenter cross-sectional study to evaluate the clinical characteristics and nutritional status of children with cerebral palsy. Clinical Nutrition ESPEN, 26, 27-34.
Morgan, C., Romeo, D. M., Chorna, O., Novak, I., Galea, C., Del Secco, S., & Guzzetta, A. (2019). The pooled diagnostic accuracy of neuroimaging, general movements, and neurological examination for diagnosing cerebral palsy early in high-risk infants: a case-control study. Journal of clinical medicine, 8(11), 1879.
Novak, I., Morgan, C., Adde, L., Blackman, J., Boyd, R. N., Brunstrom-Hernandez, J., … & Badawi, N. (2017). Early, accurate diagnosis and early intervention in cerebral palsy: advances in diagnosis and treatment. JAMA pediatrics, 171(9), 897-907.
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Malnutrition is a debilitating disorder that is widespread in acute hospitals. Malnutrition is associated with many undesirable effects including depression of the immune system, alteration of wound healing, muscle atrophy, longer hospital stays, higher processing costs, and a rise in mortality. Nutritional risk screening using a validated tool is a simple way to quickly identify patients at risk of malnutrition and provides a basis for rapid dietary recommendations. Non-identified malnutrition not only increases the risk of undesirable complications for patients (Prell & Perner, 2018). It is highly recommended that mandatory nutrition screening be widely adopted according to published best practices to effectively target and reduce the incidence of malnutrition in hospitals.
Like other geriatric syndromes, malnutrition is also a multifactor genesis syndrome. In most cases, malnutrition depends on insufficient food intake and less frequently on a higher nutrient requirement or malassimilation problem. As we get older, a series of physiological changes occur that promote malnutrition. These changes are usually summarized under the term anorexia of aging, defined as the loss of appetite and decreased food intake in late life (Landi et al., 2016). Therefore, the course of acute illness is more challenging in geriatric patients. The doctoral-prepared nurse can apply this information to identify motor and sensory and cognitive impairments such as stroke, Parkinson’s disease or dementia are common among neuro-geriatric patients.
Landi, F., Calvani, R., Tosato, M., Martone, A., Ortolani, E., Savera, G., Sisto, A., & Marzetti, E. (2016). Anorexia of Aging: Risk Factors, Consequences, and Potential Treatments. Nutrients, 8(2), 69. https://doi.org/10.3390/nu8020069
Prell, T., & Perner, C. (2018). Disease Specific Aspects of Malnutrition in Neurogeriatric Patients. Frontiers in Aging Neuroscience, 10. https://doi.org/10.3389/fnagi.2018.00080
Chronic kidney disease (CKD), a rising health problem can be a progressive condition accompanied by multiple co-morbidities. Protein-energy wasting (PEW) is a disorder in patients with renal disease and has a high mortality rate. (Aggarwal, et al., 2018)PEW is defined as multiple nutritional and catabolic alterations, including hormonal problems, inflammation, and uremic toxicity. Although there is a lack of a single reliable method to diagnose nutritional status among CKD patients, use of clinical, nutritional, and biochemical markers are used. Malnutrition and inflammation markers are indicative of poor clinical outcomes for renal patients. (Aggarwal, et al., 2018) During all assessments of renal patients, nutritional status and labs should be taken into account. One assessment the Malnutrition-Inflammation Score (MIS) uses a combination of data such as anemia, inflammation, and nutrition. (Aggarwal, et al., 2018). Studies show that patients diagnosed with malnutrition have higher BUN and Creatinine and CRP.
It’s important for patients with renal disease to receive nutritional education. provided nutrition education courses to patients that discussed protein and energy intake, content of phosphorus and potassium in foods, cooking procedures, and a fourth issue chosen according to the patient’s specific needs; for example, fat content , cholesterol, or sugar in foods. (Perez, et al., 2021)
Recent studies indicate the need for considering r patient sex so as to individualize the care during CKD when providing nutritional education. Based on results from Perez, et al., 2021. ,; women worse with nutritional interventions, and the effects. One possible factor in this relationship could be the higher incidence of sarcopenic obesity in female . Obesity can make the nutritional intervention more difficult because it can mask the malnutrition, and there is a lack of clinical guidelines for this condition. Gender/sex and BMI/weight are other factors to consider in part of the educational planning to provide to patients. (Perez, et al., 2021).
Aggarwal, H.K., Jain, D., Chauda, R., et al., (2018). Assessment of malnutrition inflammation score in different stages of chronic kidney disease. http://manu.edu.mk/prilozi/39_2_3/6.pdf
Pérez-Torres A, González García ME, Ossorio-González M, Álvarez García L, Bajo MA, del Peso G, Castillo Plaza A, Selgas R. The Effect of Nutritional Interventions on Long-Term Patient Survival in Advanced Chronic Kidney Disease. Nutrients. 2021; 13(2):621. https://doi.org/10.3390/nu13020621
I am glad you discussed chronic kidney disease as this disorder is often seen in the emergency room. Patient with CKD arrive for numerous concerns and are very likely to be admitted. Patient with CKD require a dietary consult to assist in developing a meal plan. A CKD diet entails a low sodium diet to assist in maintaining blood pressure, consuming less protein or in smaller amounts in order to avoid overloading he kidneys, and consuming heart healthy foods. Electrolytes that require additional attention on a CKD diet are restricting foods that are high in potassium and phosphorus (U.S Department of Health and Human Services, n.d.). I believe one of the main factors contributing to the lack nutrition in CKD patients is education and non-compliance. My father recently was diagnosed with Acute Kidney Injury (AKI) and was placed on the proper diet while hospitalized however once discharged he did not receive diet education and continues to consume products high in sodium.
U.S. Department of Health and Human Services. (n.d.). Eating right for chronic kidney disease. National Institute of Diabetes and Digestive and Kidney Diseases. Retrieved July 11, 2022, from https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/eating-nutrition
Patients with CKD (Acute or chronic) is so common. In my current role, reviewing and retrieving data from medical records (EMR) from multiple health care facilities, I come across CKD in at least 80 percent of my chart reviews. As you stated from your experience, “proper diet while hospitalized and no diet education at discharge”. It is very unfortunate that the nurses and discharge planners did not go over basic diet instructions for someone admitted with Acute Kidney Injury. As a DNP prepared nurse doing education for patients. Basic guidelines to follow re: AKI, CKD
If at high risk or diabetic, test urine/blood annually and as needed, Regular checkups, take medication as prescribed, monitor blood pressure, avoid high sodium food, increase fruit and vegetables. Also, important to discuss, what fruit and vegetables. Suggest fruit and vegetables that are not high in potassium. A good pdf of information: https://www.cdc.gov/kidneydisease/pdf/CKD_TakeCare.pdf
Avoiding progression of AKI to CKD requires collaboration of the patient, case manager, nutritionist, caregivers, and other health care providers in the patients’ network. Unfortunately, your fathers experience was a missed opportunity for the staff to educate the patient. Fortunately, he has a personal advocate in you.
As advanced practice nurses it is our responsibility to provide holistic care. It will and is important to education the patients in how nutrition affects diagnosis such as renal disease, diabetes, hypertension, congested heart failure, etc.
Centers for Disease Control and Prevention (CDC). 2020
Malnutrition among hospitalized patients remains a serious issue affecting more than 30 percent of hospitalized patients in the United States. Malnutrition is associated with high mortality and morbidity, functional decline, prolonged hospital stays, and increased health care costs. Post discharge, malnourished patients are also at risk for more frequent readmissions. Early identification and treatment of malnutrition are critical to prevent poor outcomes in hospitalized adult patients. The Joint Commission also now requires that hospitals screen for risk of malnutrition as part of the general admission process.
Iron deficiency causes anemia is one disorder of malnutrition that is found in our clinical setting or community.
Genetic and environmental influences: Iron deficiency anemia is more common in certain age groups.
Infants between 6 and 12 months, if only breast milk fed or are fed formula that is not fortified with iron. Children between ages 1 and 2, especially if they drink a lot of cow’s milk. Cow’s milk is low in iron. Teens, during growth spurts and Older adults, especially those over age 65.
Unhealthy environments- Low socioeconomic status and postpartum status, exposure to lead in the environment or water interferes with the body’s ability to make hemoglobin and can result in anemia.
Family history and genetics-Von Willebrand disease is an inherited bleeding disorder that affects the blood’s ability to clot.
Lifestyle habits: Vegetarian or vegan eating patterns, Frequent blood donation, Endurance activities and athletes.
The prevalence of iron deficiency anemia is 2 percent in adult men, 9 to 12 percent in non-Hispanic white women, and nearly 20 percent in black and Mexican-American women. Nine percent of patients older than 65 years with iron deficiency anemia have gastrointestinal cancer when evaluated.
The most accurate initial diagnostic test for IDA is the serum ferritin measurement. Serum ferritin values greater than 100 ng per mL (100 mcg per L) indicate adequate iron stores and a low likelihood of IDA. Additional tests may be ordered to evaluate the levels of Complete Blood Count, iron, total iron-binding capacity, and/or transferrin.
Treatment includes, oral iron therapy, eating iron-rich foods, iron supplements, intravenous iron therapy for mild to moderate iron-deficiency anemia, or red blood cell transfusion for severe iron-deficiency anemia.
The DNP nurse can be more prepared to offer preventive solutions for the causal agents or factors such as eating habits to avoid any complications. Effective therapeutic approaches can be implemented for these at risk patients.
AHRQ. (2020). Malnutrition in hospitalized adults. Retrieved from https://effectivehealthcare.ahrq.gov/products/malnutrition-hospitalized-adults/protocol
Iron deficiency anemia. (2007, March 1). Retrieved from https://www.aafp.org/pubs/afp/issues/2007/0301/p671.html#:~:text=The%20prevalence%20of%20iron%20deficiency,a%20gastrointestinal%20