Care of the Malnourished Elderly Patient

tabular array of Contents Page fleshs Abstract 2 Chapter 1 / admittance farm animal of the fuss. 5 Signifi provokece or Importance of the Problem for Nursing6-8 Problem Statement. . 8 Purpose of the Study. . . 9 Hypothesis- Null and research.. . .. .. 9 Definition of Terms.. . 9-10 Assumptions. 10 Summary.. . 10 Chapter II/Review of Literature Review of Literature.. 11-16 Chapter III/ methodology and Research Design Research Design. 17 Variables. 17-18 Selection of Subjects and Research Setting . . 18-19 Data Collection Instruments . .. . 19 Statistical Analysis .. . . . 20 Data Collection Procedure . .. . 20 Limitations .. . 21 APPENDICESA. Request for permit to Survey Participants. . .. . . 22 B. nutritionary Assessment Survey. . 23-26 REFERENCES . 27-28 Chapter I. Introduction Origin of the Problem In our society, malnutrition and under-nutrition is a rising problem for the older heavy(p) population. Approximately 35%-85% of residents living in a long- bourn explosiv e charge facility, 60% of hospitalized older adults, and an estimate of 5%-10% of older adults living in community settings be feed (Maher and Eliadi, n. d. ).These statistics sadly show that hospitalized and long-term economic aid forbearings are more likely to set about under nourished compared to the gray population in the community. According to the Joanna Briggs Institute (JBI, 2007), malnutrition can lead to hearty(p) or adverse health outcomes. Malnutrition has been linked to lengthy hospital remain with higher complications, morbidity, mortality rate, and frequent visits to their general practitioner (JBI, 2007). There are several(prenominal) risk factors (i. e. physical, psychosocial, social, and medical factors) that lead to malnutrition (Maher & Eliadi, n. . ). It is predicted that by 2030, the senior population in the United States testament double in size and exceed 70 million people. In light of these predictions, addressing the nutritionary unavoidably of the older allow for r for apiece one epic proportions and become a complex issue. Based on clinical observation, the signs and symptoms of malnutrition and under nutrition are a lot overlooked. Observing residents in a clinical setting at a local long- term health assist facility precipitated our interest in this problem with malnutrition.The absolute majority of antiquated people living in misgiving homes all break dementia, suffer from some form of physical dis efficiency, or oblige difficultness swallowing, which restricts them from adequately hydrating and nurturing themselves. With dementia, they usually do not remember how to eat or how to chew. With various physical disabilities, such(prenominal) as upper extremity contractures, their ability to feed themselves is often limited. In the event of swallowing difficulties, their nutrition preference is often altered to prevent choking or aspiration.This often discourages them from eating ascribable to the texture of the diet ordered. With the issues fore-stated, the residents often have to rely on the lag to assist them with meals. Caregivers often contribute to the problem of malnutrition because not enough succession is devoted to assisting and supervising the residents to ensure they are eating priggishly. It is our job as shell outgivers to know the signs of malnutrition and risk factors that lead to malnutrition so that it can be sight and reported to the physician or dietitian early, before major problems occur.Various nutritionary screening tools, assessment tools, studies, and research programs are available to dish up keep apart and provide aggressive preventive treatment strategies for those at risk. The Nutritional form for the Elderly (NUFFE), Malnutrition Screening Tool (MST), and the Malnutrition Universal Screening Tool (MUST) are instrumental in detecting and providing interventions to decrease morbidity and mortality. These various studies table service support t he fact that malnutrition is overlooked, unrecognized, and left untreated by comforts and health rush professionals.Other studies sense that even though malnutrition was identified, no interventions were put into place to treat this festering concern. Significance of the Problem for Nursing In a hospital ground setting, there are several different groups and departments that deal with unhurried of care. These departments and groups lie of nutritionists, doctors, social workers and other disciplines. However, the defys are ultimately responsible for the entire care of the affected role throughout their stay.Nurses realize that many patriarchal patients come into the hospital undernourished or malnourished related to their cosmos on a fixed income, having reduced access to nutriment, having poor knowledge of nutrition, or beingness dependent on others for food preparation. These sr. patients sometimes have degenerative illness such as depression, cancer, diabetes, renal failure, and cardiovascular disease that leads to malnutrition or under- nutrition (Briggs 2007). Under-nutrition is a wide spread problem that usually results in the elderly staying in the hospital longer related to a learn in recovery, more complications, and higher mortality rate.That is why it is important for nurses to do a detailed assessment upon admission to prevent these issues or problems. It is the nurses responsibility to gather all the background data some a patient during the assessment period. This result help to diagnose the nutritional place from the beginning of the patients care. Some of the information that is still during this time, such as the patients mental status, allows the nursing squad to identify if the patient is oriented or has problems with dementia.According to Briggs 2007 article, dementia is a earthy cause of under nutrition, as are the adverse effects of medications, such as digoxin and some anti-depressants. Antihistamines, angiotensin- converting enzyme inhibitors, and lithium zinc deficiency can alter a patients taste and smell. For this reason, the nurse needs to collect a medication list that is up-to-date (Briggs 2007). During this process, nurses should ask questions that will reveal information about the patients medical history. This is do to identify possible diseases that have an effect on the patients nutritional status.Nurses should use all resources available to them after collecting data to assist with care of the patient. It is important for the nurse to know the policies and procedures at the current hospital to consult specialists in order to improve patient care. This allows each department access to review the patients medical information and provide patient care as needed. Nurses are the primary caregivers for elderly patients in the hospital. When a malnourished patient is admitted nurses often develop plans of care to assist patients with improving their nutrition.Some of the ways that have been recommended are serving food at the appropriate temperature, providing food that is packed with nutrients, offering food that the patient enjoys eating, and giving viva supplements throughout the day to increase caloric intake. A good tip that nurses could use would be to always offer food or drinks when entering the patients room. From this research we know that indigence is one reason for malnutrition. When developing a plan of care for this patient the nurses can solicit the help of a social worker to help find resources to save money and provide food (Mayo Clinic, 2011).Malnutrition is a probatory problem in nursing because it alters the type of care a nurse can provide. For instance, if a harm already exists, malnourished patients are at a higher risk for decreased wound healing. The nurse will then have to improve the nutritional status before proper wound healing can occur. The malnourished individual can become very weak and is thereby prone to falls. The impoveris hed elderly patient may not only be malnourished but have insufficient funds to purchase needed supplies, such as diabetic test strips and glucose monitoring systems.This could also lead to weakness and the development of go on complications. Nurses need to ensure that daily weights and labs are obtained to track the progress of each patient. Malnutrition may seem secondary in nature, but it can set up into a monumental problem. Problem Statement Do registered nurses use evidence-based standards in the care of elderly hospitalized patients who are undernourished? Purpose of Study The advise of this culture is to examine registered nurses usage of evidence-based standards in the care of undernourished elderly hospitalized patients.Hypothesis Research Hypothesis Registered nurses use evidence-based standards in the care of undernourished elderly hospitalized patients. Null Hypothesis Registered nurses do not use evidence-based standards in the care of undernourished elderly hospit alized patients. Definition of Terms For the purpose of this study, the following hurt have been defined 1. Undernourished- defined as an imbalance of nutrients caused by either an excess intake of nutrients or a nutritional deficit. (Maher & Eliadi, n. d. ) 2. Older Adults- while 64 or older. Maher & Eliadi, n. d. ) 3. Associate Degree Registered Nurse- Registered nurses (RNs) provide and coordinate patient care, educate patients and the public about various health conditions, and provide advice and mad support to patients and their family members. Registered nurses must also become licensed by departure a national licensing examination. An associate degree is an academic degree awarded on satisfactory completion of a 2-year course of study, usually at a junior college. (Bureau of Labor Statistics, 2012) (Elsevier, 2009) 4.Evidence-Based Practice- the use of scientific evidence, integrated with clinical grow and incorporating patient values and preferences in the institutiona lise of professional nursing care. (Houser, 2012, p. 12) 5. infirmary Setting- a health care facility that provides inpatient beds, continuous nursing services, and an organized medical staff. (Elsevier, 2009) Assumptions 1. If caregivers feed elderly patients, then the proper kernel of the meal will be consumed. 2. Registered nurses help to prevent malnutrition in elderly patients. 3. The adequate amount of protein consumed in an elderly patients diet prevents malnourishment. . Registered nurses provide help with dietary interventions of the undernourished. 5. If the proper screening tools are performed on admission, the elderly patients weight will improve. Summary stack in this nation are living longer. As recognized throughout this research, malnutrition in the elderly patient is at an extremely high level. It is not only the nursing home patients experiencing undernourishment but the hospitalized elderly patients also. Malnutrition is everyday throughout the elderly communit y. Through using evidence based practice tandards, malnutrition tools, and education strategies this dilemma can be improved. CHAPTER II. Review of the Literature undernourishment has long been a prevalent problem among the elderly, especially in an acute-care setting. It has been a long-standing challenge for health-care providers to determine the most effective process for identifying those that are undernourished, at-risk for undernourishment, as sanitary as intervening promptly and appropriately. A review of literary works was done to examine registered nurses usage of evidence-based standards in the care of undernourished elderly hospitalized patients.Much of the literature supports the use of nutritional screenings to identify undernourished patients and reduce the number of those patients in the hospital setting. Undernourishment is often referred to as malnutrition. The effects of malnutrition, which is the understaffed consumption of essential nutrients, are very devasta ting to the health of an individual. As well-known among healthcare providers, inadequate nutrition can prolong wound healing, suppress the immune system, lead to increased length-of-stay, and increase the risk of mortality from comorbidities.The article entitled, How well do nurses recognize malnutrition in elderly patients, describes how well nurses are able to recognize the problem of undernourished patients and if care is being provided to these patients. There are numerous methods that can be used in determining if a patient is malnourished. In this study Mini Nutritional Assessment (MNA), Body Mass Index (BMI), and a detailed questionnaire was used. The MNA is a simple, reliable, and well-validated tool used to determine a patients nutritional status.MNA gives a maximum of 30 points. A score of less than 17 indicates the patient is undernourished, while a MNA of 17-23. 5 shows a patient is at risk for malnutrition. BMI is another tool used in determining the status of a patien ts nutritional state. In this study a BMI of less than 20 is considered to be high risk for malnutrition. A questionnaire was attached to nurses to determine daily routines related to nutritional care such as amount of food consumed at each meal, snacks between meals, and any oral nutritional supplements given.The study examined elderly patients in a long-term care unit in Helsinki City hospitals in Finland to determine if nurses are able to recognize undernourished patients and if adequate care was provided (Suominen, Sandelin, Soini, & Pitkala, 2009). The above study included 1,043 elderly hospitalized patients for a two-week period. The nurses measured the BMI of patients as well as their MNA, but the nurses were not aware of the values to determine an undernourished state. In addition, the nurses were asked if they believed the patients were malnourished by simply marking yes or no.The nurses that performed the study participated in a 3-hour course to learn how to organize the study, assess the patients, and to complete the questionnaire (Suominen et al,. 2009). The results of the study, How well do nurses recognize malnutrition in elderly patients, revealed that malnutrition is not recognized by nurses and therefore results in the inability to provide evidence-based care to the patients. The results showed that 56. 7% were malnourished with an MNA