Problems with eating and nutrition: geriatric self-learning module

MedSurg Nursing, Dec, 2004 by Virginia K. Lee

* Kyphosis is often a sign of osteoporosis and vertebral compression fractures indicative of inadequate amounts of calcium over a number of years.

Laboratory findings

* RBC and hemoglobin are low. Anemia is present and the cause needs to be determined. The numbers actually look better than they are because of dehydration.

* Increased hematocrit, sodium, and BUN indicate dehydration.

* Decreased albumin indicates moderate malnutrition. Albumin is sensitive to changes in nutritional status but has a long half-life (17-21 days) and therefore is not a useful measure of current nutritional status. Albumin can also be affected by hydration; T.E's nutritional status is likely poorer than her albumin indicates.

What additional laboratory tests would give better information about her nutritional status? Other fairly common laboratory tests for objective information about nutritional status are pre-albumin and transferrin (see Table 1). Supplementary information can be obtained from iron, iron binding capacity, cholesterol, and total lymph count. Because of the long half-life, albumin is not useful in assessing acute malnutrition or in monitoring the early effectiveness of protein supplementation. Transferrin (half-life 8 to 10 days) and pre-albumin (half-life 2 days) more accurately reflect the current nutritional status and therefore are better tests in those situations. A rise in pre-albumin of 1 mg/day indicates a good response to nutritional intervention.

Table 1.
Laboratory Values Related to Nutritional Status

    Lab          Normal         Moderate        Severe
   Test           Value          Deficit        Deficit

  Albumin     3.5-4.8 g/dl    2.8-3.2 g/dl    < 2.8 g/dl
Transferrin   250-425 mg/dl   170-250 mg/dl   < 160 mg/dl
Pre-Albumin    19-38 mg/dl     10-15 mg/dl     < 5 mg/dl

Source: Fischbach, 2004

Note: Self-Study Module written by Virginia K. Lee is based on module developed by Alesia Amburn, Carol Clerico, Laura Knotts, Betty King and Virginia Lee in 1996. Copyright [c] 2002 by the Rectors and Visitors of the University of Virginia. Reprinted with permission.

References

Fischbach, ET. (2004). A manual of laboratory and diagnostic tests (7th ed.). Philadelphia, PA: Williams and Wilkins.

Johnson, L. (1997). Nutrition. In R. Ham & P. Sloane (Eds.), Primary care geriatrics: A case based approach (3rd ed.) (pp. 108) St. Louis: Mosby.

Lee, V., Fletcher, K., Westley, C., & Fankhauser, K.A. (2004). Competent to care: Strategies to assist staff in caring for elders. MEDSURG Nursing, 13(5), 281-289.

Resources

Nutrition

Amella, E. (1998). Assessment and management of eating and feeding difficulties for older people. Geriatric Nursing, 19(5), 269-274.

Cammon, S.A., & Hackshaw, H.S. (2000). Are we starving our patients? American Journal of Nursing, 100(5), 43-45.

General Aging

Beers, M.H., & Berkow, R. (2000). Merck manual of geriatrics (3rd ed.). Whitehouse Station, NJ: Merck Research Laboratories.

Ebersole, P., & Hess, P. (Eds.) (1998). Toward healthy aging: Human needs and nursing response (5th ed.). St. Louis: Mosby.