Malnutrition

WHAT YOU SHOULD KNOW:

• Malnutrition (mal-noo-TRISH-un) occurs when you do not get enough calories or nutrients to keep you healthy. Nutrients are protein, fat, carbohydrates, vitamins and minerals. Malnutrition may make your body weak. It may cause health problems such as trouble fighting infections and healing. Malnutrition may be caused by not eating enough of the right food or by having certain health conditions.
  
  
• Malnutrition usually develops in stages over a long period of time. Signs and symptoms may not appear until the later stages of malnutrition. Some signs and symptoms of malnutrition are tiredness, weakness and weight loss. Other signs and symptoms are slow or no growth in children, slow wound healing, and hair and skin changes. The treatment for malnutrition depends on the cause. You may need to increase calories in your diet by eating more food. You may also need to eat or drink a nutrition supplement or take vitamins and minerals. Your caregiver may treat you with medicines if you have a health problem that is causing your malnutrition.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

RISKS:

Malnutrition usually develops in stages over time. Malnutrition may make your body weak and cause health problems such as trouble fighting infections and healing. Severe malnutrition may cause heart problems, breathing problems, and kidney problems. It can also cause changes in the level of chemicals in your blood called electrolytes. Severe (very bad) malnutrition can even lead to death if it goes untreated. Malnutrition can be treated if you follow your caregiver's instructions.

WHILE YOU ARE HERE:

Informed consent: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.

Call button: You may use the call button when you need your caregiver. Pain, trouble breathing, or wanting to get out of bed are good reasons to call. The call button should always be close enough for you to reach it.

Tests: Caregivers will do a medical exam and ask you questions about your health. Some tests help caregivers find out what is causing malnutrition and how it is affecting your body. Other tests are used to help caregivers plan your treatment. Some of the tests you may need are:

• Blood tests: You may need blood taken for tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. It is tested to see how your body is doing. It can give your caregivers more information about your health condition. You may need to have blood drawn more than once.
  
  
• Heart monitor: This is also called an ECG, electrocardiogram, or telemetry. Sticky pads are placed on your chest or different parts of your body. Each pad has a wire leading to a small portable box (telemetry unit), or to a TV-type screen. This lets caregivers see a tracing of the electrical activity of your heart. The heart monitor may help caregivers see problems with the way your heart is beating. Do not remove any wires or sticky pads without asking your caregiver first.
  
  
• Intake and output: Your caregivers may need to know the amount of liquid you are getting. They may also need to know how much you are urinating. Men 19 years old and older should drink about 3.0 Liters of liquid each day (close to 13 eight-ounce cups). Women 19 years old and older should drink about 2.2 Liters of liquid each day (close to 9 eight-ounce cups). Certain foods also contain liquid. You may need more or less liquid each day. Ask your caregiver how much liquid you should have each day. Ask caregivers if they need to measure or collect your urine before you dispose of it.
  
  
• Pulse oximeter: A pulse oximeter is a machine that tells how much oxygen is in your blood. A cord with a clip or sticky strip is placed on your ear, finger, or toe. The other end of the cord is hooked to a machine. Caregivers use this machine to see if you need more oxygen.
  
  
• Urine sample: A sample of your urine is collected and sent to a lab for tests. Your caregiver may give you a special wipe and clean cup. Use the wipe to clean the skin around the opening where you pass urine. Urinate into the clean cup. Put the lid on the cup. Do not touch the inside of the cup or the lid. Give the urine sample to your caregiver.
  
  
• Vital signs: This includes taking your temperature, blood pressure, pulse (counting your heartbeat), and respirations (counting your breaths). To take your blood pressure, a cuff is put on your arm and tightened. The cuff is attached to a machine which gives your blood pressure reading. Caregivers may listen to your heart and lungs by using a stethoscope. Your vital signs are taken so caregivers can see how you are doing.
  
  
• Chest x-ray: This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing. Caregivers may use the x-ray to look for signs of infection like pneumonia, or to look for collapsed lungs. Chest x-rays may show tumors, broken ribs, or fluid around the heart and lungs.

Treatment:

• Caregivers: Some of the caregivers who may help to plan your treatment are:
  
  
  • Therapist: This is a caregiver that works closely with you while you are being treated. This person may be a doctor, psychologist, nurse, mental health counselor or social worker.
    
    
  • Psychiatrist: A psychiatrist is a medical doctor who works in the area of mental health. The psychiatrist is in charge of ordering your medicine. You may work closely with this doctor and other caregivers.
    
    
  • Dietitian: This is a caregiver who works in the area of nutrition. A dietitian may ask you questions about your appetite, eating habits and diet. A dietitian works with you to find the right diet plan for you.
  
  
• Diet: You may need to increase the calories in your diet by eating more food. You may need to eat high calorie, high protein snacks between meals to add food to your diet. You may also need to eat or drink a nutrition supplement if you have trouble eating enough food. The type of diet that you will follow depends on your health condition.
  
  
• Nutrition Support: If you are not able to eat food by mouth, you may need to be fed through a feeding tube or a catheter. Some of the ways that you may be fed are:
  
  
  • Nasogastric (NG) tube: A nasogastric tube is put into your nose and down into your stomach. The tube may be attached to suction (vacuum) to keep your stomach empty. You may need a NG tube if your stomach gets too full or if you throw up a lot after surgery. You may also need it if you cannot use your mouth to eat. An NG tube may also be used to help get your bowels working. Food or medicine may be given through your NG tube.
    
    
  • PEG tubes and J-tubes: A percutaneous endoscopic gastrostomy (PEG) tube, and a jejunostomy tube (J-tube) are small, flexible tubes. The tubes are put through a small cut in your abdomen. The end of a PEG tube goes into your stomach. The end of a J-tube goes into your small intestine. You may have a GJ Tube put in. This tube goes into both your stomach and small intestine. These tubes are used to give you liquids, food, and medicine. The tubes may also be used to let air or fluids out of your stomach.
    
    
  • TPN: TPN stands for total parenteral nutrition. It is also called hyperalimentation. It provides your body with nutrition such as protein, sugar, vitamins, minerals, and sometimes fat (lipids). TPN is used when you have problems with eating or digesting food. TPN is usually put into your body through a large IV catheter, such as a central line. You may need TPN for several days or longer.
  
  
• Medicines: Your caregiver may give you the following kinds of medicines or supplements:
  
  
  • Appetite stimulants: These medicines help improve your appetite so you will want to eat more.
    
    
  • Vitamins and Minerals: Caregivers may give you vitamin or mineral supplements to increase the level of vitamins and minerals in your body. Vitamins and minerals may be given in your IV, as a shot, or by mouth.
  
  
• IV: An IV is a tube placed in your vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.
  
  
• Oxygen: You may need extra oxygen to help you breathe easier. It may be given through a plastic mask over your mouth and nose. It may be given through a nasal cannula, or prongs, instead of a mask. A nasal cannula is a pair of short, thin tubes that rest just inside your nose. Tell your caregiver if your nose gets dry or if the mask or prongs bother you. Ask your caregiver before taking off your oxygen. Never smoke or let anyone else smoke in the same room while your oxygen is on. Doing so may cause a fire.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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