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Illness and surgery can have devastating effects on nutritional status. Fever, nausea, fear, depression, chemotherapy, and radiation can destroy appetite. Vomiting, diarrhea, chemotherapy, radiation, and some medications can reduce or prevent absorption of nutrients. In addition, food is restricted before surgery and some diagnostic tests. Ironically, this reduced nutrient and calo-ries intake occurs just at a time when requirements are increased. Fluid may also be restricted as most clients are NPO (nothing by mouth) for 12 hours prior to surgery.
When the increased needs for energy and protein are not met by food intake, the body must use its stores of glycogen and fat. When they have been used, the body breaks down its own tissues to provide protein for energy. It has no other “stores” of protein. Protein-energy malnutrition, commonly called PEM, can be a problem among hospitalized clients. It can delay wound healing, contribute to anemia, depress the immune system, and increase susceptibility to infections. Symptoms of PEM include weight loss and dry, pale skin. When malnutrition occurs as a result of hospitalization, it is called iatrogenic malnutrition.
The importance of improving a client’s nutritional status is obvious. Formal nutri-tional assessments of clients should be made on a regular basis, but all members of the health care team should be alert to signs of malnutrition every day. The nurse or nursing assistant who sees the client regularly is in the best position to help the client. This person will be most familiar to the client and will hear the client’s complaints about and see the reactions to the food served. She or he can bring problems to the attention of the dietitian responsible for the client’s nutrition:
· The client may need information about nutritional needs
· The client may need a supplement
· The client may want other foods
If not contraindicated by the client’s health condition, it can be helpful to invite friends and relatives to bring the client some of his or her favorite foods.
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