Effect of admission nutritional status on length of hospital stay

Malnutrition is a large problem among patients admitted to U.S. hospitals and is an area of increasing concern for GI health care professionals. We conducted a prospective assessment of the admission nutritional status of 500 consecutive patients admitted to the Huntington Veterans Affairs Medical Center. Admission nutritional status was compared to the length of hospital stay (LOS). Nutritional status was calculated based on three equally weighted and easily obtained parameters--serum albumin, total peripheral blood lymphocyte counts and unintentional weight loss over time. A significant difference (p less than 0.01) was noted for the LOS between patients with normal, mildly abnormal and moderately abnormal nutritional status as compared with the patients with severe malnutrition. The length of hospital stay progressively increased with deterioration of nutritional status. The GI practitioner is in a key position to assess nutritional status of hospitalized patients. If malnutrition can be documented on hospital admission, attempts can be made to reverse the malnutrition and hopefully diminish LOS.

Perioperative nutrition problems. Nursing management

Because critically ill surgical patients requiring nutritional support have altered metabolic pathways and are frequently hypermetabolic, catabolic, and hyperglycemic, nurses play an important role in monitoring their care. These metabolic changes place the patient at risk for rapid muscle wasting and nutritional depletion. Enteral and parenteral support provide specialized routes for the delivery of nutrients but have inherent risks and complications. Diarrhea and aspiration pneumonia are consistently reported complications of tube feeding on which nurses have a great impact. Further research is critical to improving nursing practice and patient care. CVC infection continues to plague the delivery of parenteral nutrition. Nurses must remain abreast of current research in this area and apply it in the clinical setting to improve patient care.

Potential for altered nutritional status in the stroke patient

Metabolic events combined with neurological deficits place some stroke patients at risk for malnutrition. Nutritional support in the poststroke patient is an important part of recovery. Basic knowledge of nutritional assessment and interventions for altered nutritional status can help the nurse plan appropriate care.

[Maternal malnutrition. The nursing task]

A retrospective study of 577 patients from urban and periurban areas of Las Tunas municipality is made. These patients were delivered in "Dr. Ernesto Guevara de la Serna" Hospital between January and April 1986, both inclusive; their characteristics included being single pregnancies and not having suffered maternal diseases that influenced fetal growth. The following variables were studied: state of maternal nutrition at implantation, initial weight and weight gain, newborn weight, as well as maternal age and place of residence; these variables were interrelated with the view to know their influence or lack of influence on fetal weight. A survey of 89 of these women is made; they had been classified as malnourished and the purpose of the survey is to analyze their knowledge and views on malnutrition, as well as the instructions received during pregnancy and after delivery. Conclusions are derived and nursing recommendations are made.

Managing nutritional problems in people with AIDS

The complicated clinical picture presented by people with AIDS is often exacerbated by compromised nutritional status. Oral and esophageal pain, diarrhea, malabsorption, and weight loss frustrate efforts to achieve or maintain adequate nutrition. It is, therefore, an important and challenging responsibility for nurses to ascertain and implement appropriate interventions to assist patients with HIV infections to improve their nutritional status, thereby potentially delaying disease progression and significantly contributing to improved quality of life.

Nourishing the HIV-infected adult

Malnutrition of protein, calories, and micronutrients can magnify the immunosuppression of HIV. The goal of nutritional therapy in the HIV-infected population is the maintenance of optimal nutritional status. This may not always be realistic because of the vast number of nutrition-related problems that can occur. In some cases a more appropriate goal is the prevention of further depletion. This is preferably accomplished by intake of a well-balanced diet with the use of a one-a-day type multivitamin if necessary. Tube feedings or parenteral nutrition may be required if oral intake is insufficient. Restricted diets that severely limit food choices may impede adequate intake. Vitamin and mineral megadoses should be avoided because they can impair immunity as well as general biological functioning. The roles of nurses and dietitians are often enmeshed. Nurses are frequently the first to identify nutrition-related problems as part of their daily care of clients. They often augment the nutritional counseling provided by the dietitians. In certain instances, they may be the sole provider of nutrition information. It is therefore important for nurses to have an understanding of the nutritional problems in HIV infection. The responsibility of all health care professionals is the provision of accurate information given in a creative, supportive, and nonjudgmental fashion. This approach can best contribute to patient comfort and health and will foster a trusting and effective relationship.

Nutritional concerns in cancer patients

One of the prime nutritional concerns in cancer patients is cachexia and deteriorating nutritional status. Cachexia can occur as a result of either treatment or the tumor itself. The progressive malnutrition ultimately affects performance status and organ function. Tolerance to treatment may thus be decreased, which, in turn, may adversely affect toxicity and response. In addition, the deleterious effects of malnutrition on the immune system can increase susceptibility to infection. The weakness and fatigue related to muscle wasting and changes in metabolism affect physical appearance, leading to a loss of self-esteem. Thus, the vicious cycle of cachexia severely impacts on every aspect of daily life. Providing nutritional support and effective treatment may reverse the cachexia. Studies involving caloric supplements alone have not been encouraging. Conversely, studies using megestrol acetate have shown that cancer patients gain weight and that their sense of well-being improves. However, the mechanisms of weight gain remain unknown, and further studies are needed to determine the mechanisms by which appetite is stimulated or catabolism is inhibited or both. Nursing interventions to stimulate appetite and promote greater food intake, coupled with the use of agents that alter metabolism, such as megestrol acetate, may reverse the trend of cachexia and thus provide an increased sense of well-being and improved quality of life.

Guidelines for nutrition support in AIDS. Task Force on Nutrition Support in AIDS

The nutritional status of people with AIDS is challenged throughout the progression of the illness by the manifestation of symptoms such as malabsorption, diarrhea, candidiasis, and fever. As yet, there is no widely accepted method for nutritional management of AIDS. Therefore, a Task Force on Nutrition Support in AIDS was formed to develop practical recommendations for those involved in the management of this patient population. The "Guidelines for Nutrition Support in AIDS" are aimed at improving nutritional status, alleviating symptoms, and enhancing quality of life at each stage of the disease. The Task Force concluded that optimizing the nutritional status of people with AIDS, through aggressive nutritional therapy, is essential in overall medical management; nutrition intervention and education is indicated as early in the disease progression as HIV diagnosis; thorough nutritional assessment and regular monitoring is advocated; and enteral feedings should be considered the first line of nutrition support therapy.

Ineffective breathing pattern related to malnutrition

This article has highlighted the problem of malnutrition in the stable COPD patient and the critically ill, hypercatabolic patient, and has reviewed resultant mechanisms which influence the alteration of breathing pattern. These complex patients present a challenge for the nurse. Table 1 briefly summarizes the manifestations of malnutrition, goals, interventions and expected outcomes of the nursing diagnosis, ineffective breathing pattern related to malnutrition. The goal of the interventions is to modify the cause (malnutrition) of the nursing diagnosis (altered breathing pattern). The success of the interventions will lead to the achievement of expected outcome As expected outcomes are achieved, relief of signs and symptoms related to the nursing diagnosis will occur. The nurse caring for the patient with actual or potential malnutrition must be knowledgeable about the physiology of malnutrition and effect on breathing pattern. It is essential that the nurse assess and provide appropriate nutritional support and evaluate progress toward expected outcomes. In the event that expected outcomes are not achieved, reassessment with modification of interventions is necessary. Nurses play a key role in the total health care delivery to these complex patients. Further study will strengthen the research base of nursing interventions.