Chapter 44: Nutrition Problems Nursing Care

The content establishes normal nutritional requirements, emphasizing balanced macronutrient distribution with carbohydrates comprising 45-65% of calories, fats 20-35%, and proteins 10-35%, while addressing potential deficiencies in vegetarian and vegan diets including vitamin B12, iron, and calcium inadequacies. Malnutrition classification encompasses starvation-related primary protein-calorie malnutrition, chronic disease-related secondary malnutrition, and acute disease-related conditions from trauma or sepsis, with contributing factors including socioeconomic barriers, gastrointestinal disorders, and drug-nutrient interactions. The pathophysiology of starvation reveals progressive depletion beginning with glycogen stores within 18 hours, followed by skeletal protein catabolism, fat utilization providing up to 97% of energy during prolonged starvation, and eventual visceral protein loss leading to organ dysfunction. Comprehensive nutrition assessment incorporates anthropometric measurements including body mass index and midarm circumference, laboratory markers such as albumin, prealbumin, and transferrin levels, and screening tools like the Malnutrition Universal Screening Tool. Management strategies focus on high-calorie, high-protein interventions, appetite stimulants including megestrol and dronabinol, and nutrition support through enteral feeding via nasogastric or percutaneous endoscopic gastrostomy tubes for patients with functional gastrointestinal tracts, or parenteral nutrition through central venous access for those requiring intravenous nutrient delivery. Critical nursing considerations include preventing refeeding syndrome through gradual caloric progression and electrolyte monitoring, managing tube feeding complications such as aspiration and infection, and monitoring parenteral nutrition for metabolic disturbances including hyperglycemia and electrolyte imbalances.