NURS 6501 Week 1 Discussion; Alterations in Cellular Processes - An 83-year-old Resident

Week 1 DB: Main Post Protein Malnutrition In the scenario, an 83-year-old skilled nursing facility (SNF) resident is diagnosed with protein malnutrition. Malnutrition involves impaired absorption and altered nutrition utilization along with an imbalance between nutrient requirements and deficits (McCance & Huether, 2019). Protein-energy malnutrition (PEM), “is the involuntary loss of lean tissues such as muscle, viscera, and blood and immune cells, with or without loss of subcutaneous fat, as a result of inadequate energy, protein and other nutrients over time” (Marshall et al., 2018, p.1903). Genetic Role It is noted that the patient has a history of malabsorption syndrome. According to McCance and Huether (2019) malabsorption refers to the failure of the intestinal mucosa to absorb digested nutrients. The number one cause for malabsorption in The United States is the inherited disease of Cystic Fibrosis (CF) (John Hopkins Medicine, n.d.). In the case of CF, malabsorption is seen due to the thickened secretions from the pancreas causing clogged ducts and a decrease in enzyme secretion from the pancreas. There is not enough information presented in the scenario to identify if this patient has a history of CF but it could explain a genetic component to the history of malabsorption. Patient Presentation The patient is presenting with the symptom of generalized edema of extremities and abdomen (anasarca). This type of PEM is classified as Kwashiorkor, or PEM with edema (Marshall et al., 2018). Albumin, the main plasma protein responsible for regulating the oncotic pressure of attraction in the capillaries is deficient. PEM results in low plasma protein, causing Additional considerations may include the physiological and social challenges that arise with aging. These challenges may include social isolation, financial strain, multi-morbidities, polypharmacy, and decreased appetite (Marshall et al., 2018). Information on familial history of malabsorption, family medical history, and female gender, specifically osteoporosis, would also change my responses to the scenario at hand. Additionally, during the COVID-19 pandemic we are seeing that elderly people are having a harder time adapting. Some are afraid to leave their houses, while others are unfamiliar with the current use of technology to order groceries or food online to be delivered or picked up. I would also inquire about the SNF that this patient resides in. How are the staffing conditions? Is there access to pureed foods? Is there enough staff to help with supervised feeding? Reference Johns Hopkins Medicine. (n.d.) Malabsorption. https://www.hopkinsmedicine.org/health/conditions-and-diseases/malabsorption Marshall, S., Craven, D., Kelly, J., & Isenring, E. (2018). A systematic review and meta-analysis of the criterion validity of nutrition assessment tools for diagnosing protein-energy malnutrition in the older community setting (the MACRo study). Clinical Nutrition, 37(6), 1902-1912. https:// doi-org.ezp.waldenulibrary.org/10.1016/j.clnu.2017.09.022 McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Mosby/Elsevier. Nutritional status of hospitalized elderly. Clinical interventions in aging, 12, 1615–1625. https://doi.org/10.2147/CIA.S140859 Arnarson, A. (2017, October 31). Sign and symptoms of protein deficiency. Retrieved from Healthline: https://www.healthline.com/nutrition/protein-deficiency-symptoms Bhutia, Y. D., & Ganapathy, V. (2018). Physiology of the gatrointestinal tract (Sixth ed.).