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What is PCM?
protein calorie malnutrion
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primary PCM
nutritional needs are not met
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secondary PCM
result of an alteration or deficit in ingestion, digestion, absorption, or metabolism
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What is PCM generally low in?
protein, vitamin, and minerals
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Marasmus
- characterized by generalized loss of body fat and muscle
- pt's appear wasted or emaciated
- may have normal serum protein
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Kwashiorkor
- caused by a deficieny of protein intake
- associated with edema and low serum protein levels
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Marasmus-kwashirokor
severe tissue wasting, loss of SQ fat, and dehydration
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causes of malnutrition
- socioeconomic class
- physical illness
- incomplete diets
- food-drug interactions
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Clinical manifestations
- dry, scaly skin
- brittle nails
- rashes
- hair loss
- mouth crusting and ulceration
- tongue changes
- decreased muscle mass with weakness
- confusion and irritability
- delayed wound healing
- susceptability to infections
- anemia
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Which body organ losses the most mass during protein deprivation?
liver; it becomes infiltrated with fat
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history/physical exam
- diet hx over the past week
- height
- weight
- vital signs
- physical state
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labs
- prealbumin-best indicator of recent/current nutritional status
- serum transferrin-indicator of protein status
- albumin
- C-reactive protein--used to determine if low levels of viseral proteins are due to an inflammatory process or malnutrition
- K-elevated in malnutrition
- RBC & Hgb-anemia
- total lymphocyte count decreases
- liver enzyme levels increased
- serum levels of fat/water soluble vitamins decreased
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nursing assessment
- screening for all pts w/in 24 hrs of admission:
- hx of weight loss
- prior intake before admission
- nutirion support
- chewing/swallowing issues
- skin bresakdown
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acute intervention
- select high calorie, high protein foods
- bring the pts favorite foods during hospitalization
- between meal supplements
- multiple, small meals
- appetite stimulants-megestrol acetate (Megace) or dronabinol (Marinol)
- EN may be conidered if the pt can't take in enough orally
- PN if EN is not possible
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gerontologic considerations
- little/no appetite
- problems eating/swallowing
- inadequate nutrients
- fewer than 2 meals/day
- chronic illness
- poor oral health: cavities, gum disease, missing teeth, dry mouth
- physiologic changes such as decreased body mass and redistribution of fat around internal organs
- changes in taste
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