Category: Malnutrition

A healthy diet according to the National Health Service (2019) Eatwell guide that comes from each food group to achieve a healthy balanced diet. The recommended daily calorie intake per day for women is 2000kcal and for men 2500kcal this includes food and drink. The eat well guide suggests five portions of fruit and vegetables a day, a good source of fiber, minerals, and vitamins that come from these food groups. The British Nutrition Foundation (2018) recommends 30grams of fiber a day per adult. Starchy carbohydrates should make up a third of the food we eat, choose high fiber wholegrain varieties. Starchy foods are the main source of nutrients include bread, brown pasta, and rice (NHS, 2019). Milk, cheese, and yogurt a good sources of protein they include some vitamins mostly important for calcium. Bones need calcium to keep them strong vitamin D helps the body absorb calcium. Lentils, beans, and peas are a good substitute for meat as they are low in fat high in fiber. Two portions of fish a week are recommended, include oily fish salmon, or mackerel. Eggs and meat provide vitamins and minerals. Choose unsaturated fats rapeseed, olive, and sunflower oils. Other foods high in fat, salt, and sugar should be eaten less often, these foods include biscuits, cake, chocolate (NHS, 2019). To maintain the right balance daily is recommended but weekly is acceptable, it does not need to be with every meal. The BNF (2018) says there is evidence to suggest that the energy mix in diet can influence disease. Too much fat can be associated with coronary artery disease and alcohol can increase the risk of cancer. Phase one research carried out individual interviews across Great Britain from mixed age groups and families to see how well the plate met the needs of the consumer. The eat-well guide has some advantages such as raw items worked better than cooked. Disadvantages it did not include water or meet some special dietary requirements. Overall, the study found a high level of consistency across the nations and ethnicity, in terms of perceived accessibility and value (Public Health England, 2015).

Digestive system

The digestive system can be described as a series of tube-like organs which pass through the body starting at the mouth to the anus, also known as the alimentary canal. Connected with other organs such as the pancreas, liver, and gallbladder they all produce and release enzymes (Lean, Fox and Cameron, 2006). Chemical and Mechanical digestion are the two methods used to break down food in the body, digestion starts in the mouth. Saliva contains enzymes that start the chemical breakdown of food continuing into the stomach. Gastric juices and hydrochloric acid create a liquid called chyme. Chemical digestion continues to the small intestine where nutrients are absorbed into the bloodstream to be used by the cells (Khan academy, 2020). Mechanical digestion begins with teeth, chewing breaking down large particles of food. Muscles in the alimentary canal continue to move food through the digestive system. Excretion is a process where waste and excess water are removed from the body (Khan academy, 2020). Macronutrients (macro means large) are carbohydrates, protein, and fats, nutrients needed in large amounts. According to Sharma and Kolahdooz (2015, p. 31) macronutrients are usually expressed as grams per day. They are a major food source needed in a healthy diet, consisting of hydrogen, carbon, and oxygen atoms. They provide the body with energy, growth, and general maintenance (British Nutrition Foundation, 2018). Amylase a starch digestive enzyme begins the breakdown of carbohydrates in the mouth. Protease enzymes are responsible for the breakdown of protein into amino acids. Proteins, however, are digested in the stomach and intestine, helped by pepsin and hydrochloric acid a strong acid that kills any harmful bacteria that may be found in food. Lipase enzymes turn fat into fatty acids and glycerol. Fat digested in the intestine is helped by bile made in the liver, bile is not an enzyme (BBC, 2020). Micronutrients (meaning small) are vitamins and minerals needed in small amounts usually expressed as micrograms per day, absorbed through the bloodstream. All vitamins and minerals should come from a varied and healthy diet. They also contain fiber and important dietary requirements, essential for gut health, and helps reduce the risk of disease. Water is not always included in the definition of nutrition, it is essential for life and health (BNF,2018).

How substrates are converted into useable energy

As described in Salters’s (1999) higher chemistry book ‘scientists often think of the ‘lock and key analogy, in which the enzyme is the lock and the substrate is the key’. In this theory, as it opens the shape must be complimentary as this shape cannot change. Enzymes are proteins made of molecules that have active sites and the substrate will fit exactly (My Tutor, 2019). Some enzymes can break down complex molecules into simple molecules, others build up complex molecules from simple ones. Enzymes need a moderate temperature, suitable Ph and substrates of an adequate amount to function effectively (Torrence et al. (2002). Metabolism is defined as all chemical changes within the cells, tissues, and organisms that maintain homeostasis. Cellular metabolism is a complex biochemical reaction anabolism meaning maintenance, catabolism breakdown (Cell Signaling Technology, 2020). “Cellular respiration (CR) refers to the breakdown of glucose and other respiratory substrates to make energy-carrying molecules called Adenosine triphosphate” (ATP) (BBC, 2020).

Chronic obstructive pulmonary disease

This essay will use Chronic Obstructive Pulmonary Disease (COPD) as both emphysema and chronic bronchitis are no longer used, both are included in the diagnosis of COPD. COPD is the name for a group of lung conditions that cause breathing difficulties. It includes Emphysema damage to the air sacs (alveoli) in the lungs and Chronic Bronchitis Long term inflammation of the airways (bronchi) (National Health Service, 2019). According to British Lung Foundation statistics (2020) COPD patients have varying degrees of both emphysema and chronic bronchitis. Predominantly caused by smoking other factors include occupational exposures, such as harmful dust and chemicals (National Institute for Health and Care Excellence, 2016). In the UK an estimated three million people have COPD two million people are undiagnosed (2016). BLF research suggests the probability of COPD is growing, diagnosis has increased by 27% in the last decade. New research is needed to ascertain the current prevalence of the disease (BLF, 2020). The British Thoracic Society conducted an analysis from 2004-2012 that stated men are more likely to be diagnosed with COPD than women. Rare to be diagnosed under the age of forty, this increases with age affecting 9% over seventy (British Medical Journal, 2016). BLF statistics 2004-12 reported that more people were diagnosed with COPD in the north of the UK including Scotland, North East, and North West of England (BLF, 2020). COPD is one of the three leading contributors to respiratory mortality in the UK. In 2012, 29,776 people died from COPD of these 15,245 males and 14,531 females, 2,719 aged 15-64 and 27,056 aged 65 and above (BLF,2020).

Diet and nutrition are important for patients living with COPD to help maintain strength, fitness and to help fight infection. Food groups include proteins essential for muscle strength including those that help with breathing. Carbohydrates for energy, including starchy foods. Fruit and vegetables are essential for vitamins and minerals helping boost the immune system. Dairy food will help maintain strong bones (BAPEN, 2020).

Malnutrition and hydration

The British Association for Parenteral Enteral Nutrition (2018) define ‘malnutrition as a state of nutrition in which a deficiency or excess (or imbalance) of energy, protein, and other nutrients causes measurable adverse effects on tissue, body form, function, and clinical outcome’. The Malnutrition prevention program was set up by the Malnutrition Taskforce (MTF) involving local stakeholders including NHS trusts, GP surgeries, care homes, and community groups. Age UK is one of the founding members reporting that 1 in 10 people over the age of 65 are malnourished or at risk of malnutrition (MFT, 2019). Malnourishment can increase GP visits and hospital admissions due to long-term health problems. Reasons older people can lose interest in food and appetite are due to loss of loved ones, increasing financial strains, and loneliness. Underlying health problems like COPD, increased breathlessness can affect mobility so not getting to the shops. Poor-fitting dentures or poor oral hygiene make eating difficult (MFT, 2019). Age UK has Nutrition and Hydration week 16th-22nd March 2020 celebrating food and drink and the importance in our health, energy levels, and quality of life. Hydration helps improve concentration, balance, skin, memory, and mood. Aim to drink 6-8 glasses of water a day, and if your struggling with drink ice lollies, jellies and extra milk on cereals can help with fluid intake (Age UK, 2020). Fluids are important for many important processes in the body such as oxygen and nutrients to cells, the blood to carry glucose, water helps digestion, and keeps skin healthy. The body is designed to control its own temperature so if we sweat and lose fluids a stable temperature could be compromised. We need to keep hydrated to prevent feelings of dizziness, headaches, lethargy, and poor concentration. Elderly people struggle with bowel movements and reoccurring urinary tract infections when dehydrated. The best indication of good hydration is the color of urine, the darker it is the more fluids are needed (The Association of UK Dietitians, 2019).

Malnutrition is a common problem in COPD patients, 35% of hospitalized patients and 22% of outpatients are at risk of developing malnutrition (Collins et al, as cited in British Journal of Nursing, 2019). Causes of malnutrition in COPD the disease effects breathlessness, anorexia, inflammation, and low BMI (Body Mass Index). A ‘malnutrition universal screening tool’ (MUST) was developed by the Malnutrition Advisory Group and is regularly reviewed since its launch in 2003. Staff in hospitals, primary care, and care homes use the MUST tool to aid the implementation of the new NICE Quality Standard for Nutritional Support of Adults (BAPEN, 2016). Causes of malnutrition in COPD patients include psychological e.g. motivation, apathy, and depression. Social factors e.g. social isolation, whilst environmental factors include living conditions, and access to shops (Malnutrition pathway, 2020). ‘Pulmonary cachexia’ is defined as a complex metabolic syndrome associated with an underlying illness’ (Shepherd and Bowell, 2019). ‘Pulmonary cachexia’ is defined as a complex metabolic syndrome associated with an underlying illness.

Abstract

The issue of undernutrition in today’s world is applicable to many settings throughout society. The prevalence of this issue does not seem to be decreasing despite the many medical advances in this area in the 21st century and there does not seem to be as much significance on this issue despite its importance in clinical care. Therefore, this essay will investigate the nutritional care of malnourished patients in today’s society and will examine why despite the increase in emphasis being put on human rights in general, nutritional care does not seem to be discussed as significantly as a human rights issue.

Introduction

Malnutrition is defined as ‘a state of nutrition in which a deficiency or excess of energy, protein and other nutrients causes measurable adverse effects on tissue/body form and function and clinical outcome’. (1) According to the World Health Organisation (WHO), the term malnutrition covers 2 groups of conditions. Firstly, undernutrition which includes ‘stunting, wasting, underweight and micronutrient deficiencies or insufficiencies.’ (2) It also covers ‘overweight, obesity and diet-related noncommunicable diseases such as heart disease, stroke, diabetes, and cancer.’ (2) Although both are thought to have a great impact on the health of many patients and require individual treatment plans, we will be focusing on whether the treatment of undernutrition in patients is a human right.

The prevalence of undernutrition in the UK was highlighted in a 2019 British Association for Parenteral and Enteral Nutrition (BAPEN) survey, stating that in terms of malnutrition risk, using the Malnutrition Universal Screening Tool (MUST), ‘42% of individuals in the survey were at medium or high risk of malnutrition while just over half were at low risk of malnutrition.’ (3) Furthermore, patients who were at risk of malnutrition were found in ‘similar quantities’ in hospitals, care homes and at home but were ‘slightly higher’ in community rehab/hospitals and lowest in mental health units. (3) This emphasizes the importance of nutritional care for undernourished patients at all levels of care across the community and opens discussion into how these patients’ human rights in relation to nutritional care are affected in different care settings.

With the increasing prevalence of undernourished patients in hospital and care settings, it emphasizes the importance of nutritional care of malnourished patients as a priority for healthcare providers. Furthermore, the increasing issue of the increase of undernourished patients needing nutritional care raises the question of whether or not this treatment of malnourished patients should be a human right.

Human Rights of Patients

Human Rights are defined by the Equality and Human Rights Commission as ‘the basic rights and freedoms that belong to every person in the world, from birth until death.’ (4) Human rights in patient care are said to ‘bring together both the rights of the patients and health care providers and refers to the application of general human rights principles to the context of patient care.’ (5) In Inpatient care it is necessary to recognize the rights and dignity of the patient and to ensure their treatment or lack of treatment is not denying them their human rights. The nutritional care of undernourished patients is just as important, although it may not be prioritized by caregivers due to the lack of policies and legislation on the importance of nutritional care of malnourished patients.

One of the major instances of this currently is the lack of nutritional care and hospital malnourishment-related goals in the United Nations Sustainable Development Goals. (6) Despite the 17 goals and 169 targets the goals fail to mention any nutritional care targets or disease-related malnutrition goals which are both increasing issues as shown by the increasing prevalence of undernourishment in the community and primary care settings. (3) In fact, it is highlighted by a 2019 study (7) that goal 2 ‘Zero Hunger’ and goal 3 ‘Good Health and Well-being’ both completely neglect to mention either disease-related malnutrition or increasing nutritional care education which is necessary to prevent malnutrition globally. Furthermore, target 2.2 states that they aim to ‘By 2020 end all forms of malnutrition (6) which would be impossible to accomplish without also considering disease-related malnutrition, malnutrition in primary and community care and nutritional care policies. This calls us to question whether the nutritional care of malnourished patients should be of a higher priority with policies in place to protect these patients and their human rights, and may suggest to us that currently the nutritional care of malnourished patients is not considered widely as a human right and more emphasis needs to be put on this issue.

If malnourished patients are not receiving proper nutritional care, and this lack of treatment is putting their health and dignity at risk, this may suggest that there is a violation of their rights. The World Health Organisation (WHO) Constitution envisages “…the highest attainable standard of health as a fundamental right of every human being.” (8) This helps support the idea that the treatment of malnourished patients is a human right as the treatment of these patients is necessary in order to maintain health, let alone a high standard of health for these patients. Therefore, this suggests there is a need for more attention to the issue of nutritional care of the malnourished across healthcare, and for the necessary resources, education, and legislation to be put in place by the government to ensure their dignity and respect is maintained and every patient is treated equally, so as to ensure their rights are not violated.

Causes of malnutrition

When considering the nutritional care of malnourish patients as a human right issue, it is important to explore the causes of undernutrition and barriers to the nutritional care of these patients which may be infringing on their human rights. Firstly, one major cause of undernutrition in the UK is disease-related malnutrition. Some long-term conditions such as ‘cancer, liver disease and lung conditions that cause loss of appetite, nausea, vomiting and bowel problems (9), can result in malnutrition and lead to these patients being hospitalized if they were not already. Mental health conditions can also cause undernutrition as they can affect mood and desire to eat. In fact, a study (9) of community-living elderly men and women found that ‘impaired mental health was strongly associated with the risk of malnutrition.’ (10) Other causes of undernutrition include but are not limited to dementia, Crohn’s disease, ulcerative colitis, and eating disorders. (9)

Physical and social factors can also greatly contribute to malnutrition, for example, ‘dentures that make it difficult to eat, physical disabilities which make it difficult to make food or shop, social isolation, alcohol or drug dependency, low income or having limited knowledge on cooking and/or nutrition. (9) These are just some of the many causes of malnutrition in both the community and primary care settings. With so many causes linked to many different demographics of people, it once again highlights the overbearing need for nutritional care for many patients and supports the suggestion that nutritional care for patients with malnourishment should be a human right, as it is a common problem across the care system.

Barriers to treatment of malnutrition

When considering that the treatment of malnourished patients may be a human right, it is important to also consider the barriers to the nutritional care of these patients, that may be denying them these human rights. It is also important to discuss inequalities that malnourished patients may also experience due to these barriers, as this encourages the idea that nutritional care should be a human right in order for every patient to receive equal care. In a report (11) on behalf of the British Association for Parenteral and Enteral Nutrition (BAPEN), patients, families and carers were asked about their experiences with nutritional care and were given a chance to express their opinions and concerns. In this report, many barriers to proper nutritional care were identified. For example, when patients were asked if they experience inequalities in the nutrition services they receive due to ‘location, lack of attention to ethnic, religious or cultural differences, communication or language difficulties and lastly disabilities such as mobility or flexibility issues affecting treatment options,’ most responded with ‘usually’ or ‘sometimes’. (11) These inequalities in providing nutritional care suggest there may be a lack of resources, training, and experience of staff when treating these patients, which is worrying considering that providing nutritional care to these patients is essential for their health. This was a very insightful report as it included real patient involvement which is very important when considering nutritional care as a human right as a patient is likely to be the most perceptive to when their rights are being violated and will have the best understanding of what standard of care should be considered a human right as each individual will have their own beliefs of what standard of care is necessary to maintain their dignity and respect.

In addition, a study(12) carried out to identify what nurses experience as barriers to ensuring adequate nutritional care for the undernourished hospitalized elderly, also highlighted that many patients are not receiving a sufficient level of nutritional care across the healthcare system. This study (12) highlighted 5 themes that reflect barriers the nurse experience- ‘loneliness in nutritional care, a need for competence in nutritional care, low flexibility in food service practices, system failure in nutritional care and lastly nutritional care being ignored. (12) These barriers reveal that important elements in nutritional care are missing in clinical practice, despite the fact, several of the recommendations are in the national guidelines. This again emphasizes that although every patient has a basic human right to have their healthcare needs met, and therefore nutritional needs met, these fundamental needs are not being achieved.

Defining Nutritional Care

If the nutritional care of malnourished patients is to be considered a human right it is also important to clarify what nutritional care is necessary for these patients to maintain the ‘highest attainable standard of health’ (8). The National Institute for Health Care and Excellence(NICE) guidelines(13) are clear on their advice for the treatment of adult patients with malnourishment or at risk of malnourishment in hospitals, care homes or at home. They clearly state that nutritional support should be considered for patients who are malnourished which is defined by falling under one of the following criteria, a BMI of less than 18.5 kg/m2; unintentional weight loss greater than 10% within the last 3–6 months; a BMI of less than 20 kg/m2 and unintentional weight loss greater than 5% within the last 3–6 months.’ (13) This criteria highlights the standard procedure for classifying patients who need nutritional care as basic supportive care to maintain their health.

Once the healthcare team has assessed the patient’s needs and has attained that they need nutritional care the patient will most likely be offered oral, enteral, or parenteral support. Examples of oral nutritional support is ‘fortified food, additional snacks and/or sip feeds’ (13). Enteral feeding is ‘the delivery of a nutritionally complete feed directly into the gut via a tube’ while parenteral feeding is ‘the delivery of nutrition intravenously.’ (13) Although these methods have been shown to improve outcomes, the decisions on the most effective and safe treatment is complex and must be discussed with the patient’s complete medical team. Furthermore, the NICE guidelines (13) also highlight that it is not always appropriate to provide nutritional support and it may be ‘more suitable to withhold or withdraw this treatment.’ (13)

Therefore, although some may argue that in line with a patient’s right to health’, which is defined by the United Nations as ‘The right to the enjoyment of the highest attainable standard of physical and mental health (14) every patient should be offered nutritional care to treat malnourishment in order to fulfill their human rights, this may not always be the best treatment plan for them. Every individual patient’s healthcare team will be working in the best interests of their patient, and therefore may feel its best to withhold or withdraw treatment that is compliant with the patient’s human rights to achieve the ‘highest attainable standard of physical and mental health.’ (14)

Different patient’s nutritional care

When looking at the human rights of malnourished patients, it is also important to look at how different demographics are affected individually. For example, geriatric patients are a group that are usually at ‘a higher risk of malnutrition and will more commonly have poorer outcomes. (15) In fact, a study (16) identifying malnutrition in the elderly found that of 10,000 elderly people, malnutrition was present in ‘1% of community-healthy elderly persons, 4% in outpatients receiving home care, 5% in patients with Alzheimer’s disease living at home, 20% in hospitalized patients, and 37% in institutionalized elderly persons.’ (16) With this high prevalence of malnutrition especially in hospitalized and institutionalized elderly persons, it may suggest there is some neglect in the treatment of their malnutrition and raises the question of whether their human rights to health is being violated.

Age discrimination is defined as, ‘when someone is treated differently, with an unreasonable or disproportionate impact, simply because of their age’ (17) and is a direct violation of their rights. This suggests that elderly patients with malnourishment may be more likely to have their human rights violated due to the ‘higher prevalence of poorer outcomes’ (15) in these patients which put their right to health at risk. This encourages the importance of more emphasis on nutritional care for malnourished patients as a human right, so as to ensure each patient is treated equally to achieve the ‘highest attainable standard of physical and mental health. (14)

Effectiveness of nutritional care

The nutritional care of malnourished patients traditionally involves oral, enteral, and parenteral feeding. If these types of treatments are to be considered as a human right for malnourished patients it is also important to ensure their efficacy and effectiveness of them and explore any other treatment options that may be effective. To encourage the proper following of guidelines and standardized education of healthcare staff clarification of the most appropriate treatments for each individual patient is necessary. For example, in a 2018 study (18) on the effectiveness of nutritional interventions in older adults at risk of malnutrition it was found that ‘oral nutritional support is effective in increasing energy intake and body weight. (18) However, on the contrary, it was also found that dietary counseling with or without oral nutritional support was more effective compared to oral nutritional support alone. (18)

Similarly, a study (19) explored the effectiveness of supportive interventions such as ‘changes to the organization of nutritional care, changes to the feeding environment, modification of meal profile or pattern, additional supplementation of meals, congregate and home meal delivery systems, in enhancing dietary intake in malnourished or nutritionally at-risk adults. (19) This study found that it is possible that supportive interventions can reduce death from any cause as there were ‘approximately 23 fewer cases of death per 1000 participants in favor of supportive interventions’ (19). However, there needs to be further investigation to support this as the overall quality of evidence for this study were between moderate and low, and therefore may not be as reliable as the aforementioned study with the risk of bias also uncertain.

On the other hand, the 2018 study (18) seems to be very reliable, as it included an analysis of nine randomized control trials, which should support the idea that extra supportive measures such as the dietary counseling mentioned in this study are effective in treating malnourished patients. This poses the problem of what parts of nutritional care are to be valued as a human right. If all these measures can be effective in different ways to each individual patient it may suggest there needs to be more education on the value of not only traditional routes of nutritional care but also these supportive measures as their efficacy in treating the undernourished needs to be valued and should also be viewed as a human right to every patient.

Ethics of nutritional care as a human right

When looking at the human rights of patients it is also important to keep in mind the four pillars of medical ethics, which the members of a patient’s multidisciplinary team should uphold at all times. Recognizing that as a human right every undernourished patient should have the same access to the same nutritional care is also an important aspect of this. Justice, one of the pillars of medical ethics, highlights how each patient should be treated ‘equally and fairly when being offered treatment’. (20) In the context of the treatment of undernourished patients, this highlights how every patient should have an equal chance of receiving the same standard of treatment for undernourishment throughout the world.

The treatment of malnourishment posed as a human right is also supported by the human right to food which is similarly linked to the right to health. According to the Office of the High Commissioner for Human Rights, ‘Human rights are interdependent, indivisible and interrelated.’ (21) Therefore, nutritional care of the undernourished is a component of both the right to health and the right to food and can also be seen as a human right by itself. (21) Furthermore, violating the right to the nutritional care of malnourished patients may subsequently also inhibit other human rights such as the right to health and food, and vice versa. (7)

All healthcare professionals work with the best interests of their patients in mind. This relates to two other pillars of medical ethics, beneficence, and non-maleficence. These encase two of the oldest guidelines in medicine- ‘to do good and avoid harm.’ (21) This again encompasses the idea of knowing when is best to give the patient the necessary treatment or when it is best to withhold nutritional care. This can be a sensitive topic as decisions that involve the withholding or withdrawing of nutrition support require a consideration of both ethical and legal principles. (22)

The autonomy of the patient and their competency to make their own decisions for their health must also be carefully considered in order to ensure their human right to nutritional care is not being violated and nutritional care is still valued as a treatment option. It is a general legal and ethical principle that valid consent must be obtained before starting treatment for a patient(22), and any violation of this can result in the patient’s human rights being violated and legal repercussions for the medical professional involved. Discussion of a patient’s rights and capacity to make decisions is very important, especially in situations such as palliative care, where withholding nutritional care may be in the best interest of the patient, not just in the case of their medical care but also in taking a holistic approach in treating the patient’s needs.

Current initiatives on nutritional care as a human right

Acknowledging the value of nutritional care as a treatment for patients with malnourishment supports nutritional care being recognized as a human right. Subsequently, in the last decade, there have been some new initiatives and campaigns to help raise awareness of the importance of nutritional care for undernourished patients and to increase understanding of the importance of all patients being offered the same opportunity to these treatments. For example, in 2014 a campaign called Optimal Nutritional Care for All (ONCA) was launched as an initiative to ‘facilitate greater screening for risk of disease-related malnutrition/undernutrition and nutritional care implementation across Europe.’ (23) The European Nutrition for Health Alliance worked extensively to get disease-related malnutrition and undernutrition on the European health agenda and subsequently the ONCA campaign collaborates with many countries across Europe to ensure optimal nutritional care is implemented for all in keeping with patients’ human rights.

In addition, the James Lind Alliance (JLA) (24) is another non-profit which has initiatives established to combat undernutrition. It brings together patients, carers and clinicians in ‘Priority Setting Partnerships (PSPs)’, to identify the top 10 most important unanswered questions or evidence uncertainties in many areas. Nutritional screening and malnutrition PSPs were added to this list in 2019, and include up to 26 questions that are seen as priorities in order to combat malnutrition and educate on the best standard of nutrition they can achieve. (24) Many of these questions include issues that involve the patient opinion of malnutrition, which is an important topic of discussion if undernutrition is to be prevented.

Consequently, this raised awareness of nutritional care highlights how nutritional care of malnourished patients is becoming more valued in both clinical opinion and public opinion, as these views are essential if nutritional care of malnourished patients is to be appreciated as a human right for all patients. The nutritional care of malnourished patients is a multidimensional problem that leads to many challenges throughout all sectors of the healthcare system in finding interventions and policies that work in the best interest of all patients. (25) This means if it is to be ensured the nutritional care of malnourished patients remains at the forefront of human rights issues, multisectoral approaches are needed to ensure legislation is put in place to protect all patients’ rights equally in relation to the treatment of their malnourishment. Therefore it may be advised that when considering the treatment of malnutrition a human rights-based approach(HRBA) (26) is ensured as the framework on which nutritional care plans are based so as to ensure the human rights of patients are protected when developing new standards and practices to implement to prevent malnutrition.

Conclusion

Malnutrition is still a widespread issue in today’s society among all age groups and demographics of patients, highlighted by the widespread causes of malnutrition. Despite this, it is clear that there is not as much legal, clinical and ethical discussion around this topic as there should be when considering the prevalence of undernourishment in the population.

Bibliography

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4. Equality and Human Rights Commission What are human rights? Available from: https://www.equalityhumanrights.com/en/human-rights/what-are-human-rights (accessed 12th March 2021)
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6. United Nations THE 17 GOALS | Sustainable Development Available from: https://sdgs.un.org/goals (accessed 13th March 2021)
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8. World Health Organisation Human rights and health. Available from: https://www.who.int/news-room/fact-sheets/detail/human-rights-and-health#:~:text=The right to health is one of, food, housing, work, education, information, and participation. (accessed 14th March 2021)
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14. Office of the United Nations High Commissioner for Human Rights (OHCHR) The Right to health OHCHR

Introduction

Malnutrition is defined as deficiencies of energy or imbalances of intake food.

The most acceptable form of malnutrition is poor availability of food or not having sufficient amounts to eat.

Malnutrition can be any kind of situation in which the body is not getting the proper amount of nutrients that are basically important for the survival of mankind.

The worst form of malnutrition is starvation in which a person does not eat sufficiently.

Malnutrition is the greatest single source of poverty and ill health.

Malnutrition is such a condition that must be addressed quickly and doesn’t need any references. Malnutrition is a physical state of unbalanced nutrition. If we take a look at the roots of malnutrition arouse due to some natural disaster and civil disturbances in this condition the people of backward areas were deprived of hunger and there was not enough supply of food which lead to malnutrition in children, women, and especially pregnant women which gave birth to weak children .in Pakistan there are prevention measures but on the other, this factor is uncontrolled .it has a major impact on the national status of Pakistan due to which the economic status of country clashes downward and the people are affected by this and these become the vulnerable groups of community which are at risk of malnutrition

Hunger and fight against hunger:

Until the 20th century, the definition of symptoms causes, treatment and prevention of malnutrition was not discovered. But yes people were aware of the fact that they must eat three times a day to keep themselves working all day long. But the knowledge of malnutrition was not discovered yet.

According to research papers. It was the time of World War 1 and 2 when the concept of malnutrition was first of all discovered and the people came to know about it system, facts, treatment, prevention, and epidemiology and the science of nutrition was established. At that time many researchers first of all discovered the concept of vitamins. Scientific research on the concept of malnutrition was increased in 1920 and 1930 and at the end of world war 2, this concept was clearly described to everyone.

Overnutrition

It is also well known as Hyper alimentation

It is also a form in which a person supplies extra nutrients to his or her body which causes obesity. In this situation, the human body exceeds its limit and also has many disastrous effects.

Many of the people you see on the daily basis around yourself in shopping malls in university, on the streets and in your homes, all the workers that work in a company because of sitting in a particular chair or in a particular place and eating fast food or junk food that has a very high ratio in our countries because of this people become very fat and they get addicted to chickens because of this they cause high uric acid and blood pressure that is a major cause of death ratios now a day. Overeating is very dangerous if you only eat and eat and never exercise. The unused fat gets stored in our bodies and it eventually leads to a slow heartbeat, migraine, and many other disastrous effects that are common now a day. One of the major diseases by which every person is aware is diabetes mellitus. (WIKIPEDIA, n.d.)

Body paragraph:

Epidemiology of malnutrition

• Year

1. 1970
2. 1990

• Percentage of people in the developing world who are undernourished

1. 37 %
2. 20 %

Percentage of malnutrition in Pakistan:

Pakistan has been selected as top of the list of the contents that are having the increased amount of starving children ever because of poor of unavailability of resources. According to the National Nutrition Survey, 33%of all children were underweight, nearly 44% were stunted, 15% are wasted, 50%were anemic, and 33% are affected by severe deficiency of iron. (Pakistan: Food Assistance Fact Sheet, 2017)

Types of malnutrition:

There are two major types of malnutrition: Protein-energy malnutrition – this type of malnutrition results from the deficiency of any type of nutrition in the human body.

Micronutrient deficiency diseases – this type of malnutrition is very specific in nature and it results from the deficiency of a specific amount of micronutrients in the human body. (Types of malnutrition)

Effects of malnutrition on the human body:

Facing the difficulty in behind warm as a result of having less muscle and tissue mass, increasing the risk of hypothermia (the inability to maintain normal body temperature), and. poor libido (sex drive) and fertility problems (Malnutrition, 2009)

Effects of malnutrition on children:

Malnutrition is a result of a poor diet or a lack of food. It occurs when the intake of nutrients in the body or energy is too high, low, and poorly balanced. Undernutrition can lead to delayed growth or waste, while a diet that provides too much food, but not necessarily balanced, leads to obesity

Effects of malnutrition on the liver:

The reason for malnutrition in chronic liver disease is multifactorial. It can generally be stated that the more advanced the liver disease is the more severe the malnutrition. Regardless of the underlying cause of cirrhosis, all cases of cirrhosis and portal hypertension develop malnutrition.

Effects of malnutrition can be reversed:

The condition has debilitating effects on body composition, quality of life, and independent living. But malnutrition among older adults in developed countries is more widespread than most people realize. The good news is that malnutrition is easily diagnosed, managed and even reversed. (Max Gaitán, September 25, 2017)

The following measures can be taken to improve malnutrition in society:

• Always make a good and healthy choice in the selection of your food at as it is a very important step.
• Choosing good quality food is a very important step to providing your body all the possible important nutrients in a healthy way
• Test your food, again and again, to ensure that your food is properly cooked and it is not spoiled
• Ensure to add healthy nutrients and healthy types of supplements that are specially prescribed by doctors to your loved one as it is very important to keep your body healthy form and provide them all nutrients in an artificial way that cannot be provided to the body by a natural manner
• Make sure to get up early in the morning and always do cardio exercises and muscular exercises to lead a very healthy and balanced life
• Always plan social activities and never get afraid of sports and give it is much important (Physicians)

Urban agriculture can help to prevent malnutrition:

About 35% of the household-engaged interviewees said that agricultural performances can help to increase food availability and also reduce the effect of malnutrition in our country the most common activity is staple crop cultivation. Food from farming is often not the major source of food for the household, but constitutes one important source, and is utilized as a reserve for times when cash for the purchase of food is not available. Such a generalization does not cover all cases studied, but it nonetheless constitutes a modal example of noncommercial urban farmers in the city, especially among lower socioeconomic groups where both a man and a woman are presenting the household. (Physicians)

Conclusion:

As we all know that malnutrition symbolizes low or unavailability of nutrients. We must work for the betterment of our country we must help street children who are starving day by day due to the unavailability of food. We must look forward to all our neighbors.

Bibliography

1. (n.d.). Retrieved from WIKIPEDIA: https://en.m.wikipedia.org/wiki/Overnutrition
2. (n.d.). Retrieved from WIKIPEDIA: https://en.m.wikipedia.org/wiki/Malnutrition
3. Malnutrition. ( 2009, MAY 20). Retrieved from Nursing time: https://www.nursingtimes.net/malnutrition/5001811.article
4. Max Gaitán, M. (September 25, 2017). Retrieved from InBody: https://inbodyusa.com/blogs/inbodyblog/what-you-can-do-about-malnutrition/
5. Pakistan: Food Assistance Fact Sheet. ( 2017, Aug 11 ). Retrieved from conflict web: https://reliefweb.int/report/pakistan/pakistan-food-assistance-fact-sheet-august-11-2017
6. Physicians, A. A. (n.d.). America: familydoctor.org.

Introduction

The issues of malnutrition and the healing process are regarded in lots of journals and scientific literature. Mainly, these are related to the healing of wounds, some hardly treatable diseases, and diseases that require a strict diet. (Ghosh, 2004).

Nourishment is of vital importance in wound healing, as it offers the raw substances necessary for wound healing and the avoidance of infection. Wound healing depends on the sufficient ingestion and assimilation of nutrients such as vitamins, minerals, proteins, and calories. Belated or weakened wound healing happens if dietary supplies are lacking due to ingestion (malnutrition), anomalous absorption, and/or augmented metabolic requirements (draining wounds). (Goldstein & Goldstein, 2002) The malnourished patients are at augmented risk for enhancing difficulties while undergoing treatment (for example, diagnostic studies, surgery, and/or other therapies). Such problems include sepsis, abscesses, respiratory failure, decreased wound healing, and death. (Johnston, 2004).

Thus, the relations between nutritional state and wound healing were studied in 66 adult surgical patients. The wound-healing response was assessed by gauging the collagen happy (hydroxyproline) of fine tubes of Goretex interleave subcutaneously all along with regulated needle track arm wounds. After 7 days, the tubes were eliminated and it was established that there was a superior hydroxyproline substance in the tubing of 36 normally nourished patients than there was in the tubing of 21 patients with mild protein-energy malnutrition (p less than 0.01) and 9 patients with moderate to severe protein-energy malnutrition (p less than 0.01). There was no difference in the wound-healing response between the two latter groups of patients who had essentially dissimilar degrees of undernourishment. The consequences offer that exact irregularity in the wound-healing response subsists in malnourished surgical patients, but it occurs previously in the route of the sickness than formerly supposed. (Lewis & Schwartz, 2003).

Pre-operational nutrition

The nutritional status of the patient previous to and after a surgical procedure is significant for speedy and successful healing. Well-nourished patients rise to and get better from sickness and surgical treatment better than malnourished patients. Malnutrition is related to unfavorable results in surgical patients. Undernourishment can interrupt wound healing and immunocompetence and reduce cardiac and respiratory muscle function. (Nayga, 2002).

Malnourished patients subjected to surgery have superior rates of morbidity and transience as well as longer sanatorium stays contrasted with sufficiently nourished patients. (Little, Perry, Volpe, 2002).

Most patients are not at the optimum nutritional status when they are admitted to a hospital. If surgery is to be performed, the patient’s nutritional status must be improved by an appropriate dietary regimen before surgery. This minimizes surgical risk.

Protein shortage is almost universal among these enduring. Low protein storage will incline the patient to upset, augmented edema, and decreased antibody production. The last factor increases the risk of infection. By giving appropriate diets with carbohydrates, protein, fat, vitamin, and minerals for malnourished patients, nutrient deficiencies can be corrected. (Smith, & Smith, 2003).

Obese patients are at superior health jeopardy in operation than those of standard weight. Excess fat confuses surgical procedures, puts a strain on the heart, and increases the risk of disease and respiratory matters, and delays curing. Dietary solutions before the surgical procedure for sufficiently nourished enduring are also significant. The preoperative diet for these individuals should be rich in carbohydrates, protein, minerals, vitamins, and fluids.

Postoperative nutrition

Postoperative diet therapy aims to replace body losses as soon as possible. Energy, protein, and ascorbic acid are major factors in gaining rapid wound healing. Major surgical procedures will greatly increase energy and protein requirements. Minerals and other vitamins also play a vital role in recovery. Adequate energy and protein intakes are essential to limit net protein and fat losses.

Immunonutrients such as arginine, glutamine, nucleotides, and omega 3 fatty acids reduce complications in surgical patients. Immune enhancing feeds reduce the risk of infectious complications and reduce hospital stay. (Wanjek, 2003).

At the stage of post-operative recovery, physicians, dietitians, and nurses should work closely to give maximum support to patients. The dietitians should prepare appropriate diets and give dietary advice for surgical patients from pre-surgery to post-surgery. A good nutrition plan with intelligent supplementation will help you get back on your feet.

The post-operative diet may be liquid, semisolid, soft diet or of regular consistency, but it must be high in calories, protein, vitamins, minerals, and fluids.

Inadequate nutritional supports increase morbidity and mortality, delays the return of normal body functions, and retard the process of tissue rebuilding. Inadequate nutrition prevents wounds from healing at a normal pace and causes edema and muscular weakness.

References

Ghosh, P. K. (Ed.). (2004). Health, Food, and Nutrition in Third World Development. Westport, CT: Greenwood Press.

Goldstein, M. C., & Goldstein, M. A. (2002). Controversies in Food and Nutrition. Westport, CT: Greenwood Press.

Johnston, R. D. (Ed.). (2004). The Politics of Healing: Histories of Alternative Medicine in Twentieth-Century North America. New York: Routledge.

Lewis, K. A., Schwartz, G. M., & Ianacone, R. N. (2003). Service Coordination between Correctional and Public School Systems for Handicapped Juvenile Offenders. Exceptional Children, 55(1), 66.

Little, J. C., Perry, D. R., & Volpe, S. L. (2002). Effect of Nutrition Supplement Education on Nutrition Supplement Knowledge among High School Students from a Low-Income Community. Journal of Community Health, 27(6), 433.

Nayga, J. (2002). Nutrition Knowledge, Gender and Food Label Use. Journal of Consumer Affairs, 34(1), 97.

Smith, R. M., & Smith, P. A. (2003). An Assessment of the Composition and Nutrient Content of an Australian Aboriginal Hunter-Gatherer Diet. Australian Aboriginal Studies.

Wanjek, C. (2003). Bad Medicine: Misconceptions and Misuses Revealed, from Distance Healing to Vitamin O. New York: Wiley.

Introduction

The digestive system performs a vital role in the human body. It provides the body with the elements needed for its survival and further development. Digesting products that a person consumes, the system preserves the balance crucial for its functioning. Therefore, the gastrointestinal tract is one of the elements of this system that is responsible for nutrition as traditional food enters the stomach via the tract. However, there are several cases when this method of nutrition turns out to be inefficient because of a disease or a patients temporary or permanent inability to feed. Under these conditions, the delivery of nutritional substances to the body should be organized in another way to support a patient during his/her recovery. In such cases, enteral nutrition becomes one of the most efficient approaches to performing this task and avoiding undernourishment.

Definition

In general, enteral nutrition could be defined as a way to provide food through a special tube that could be placed in the patients nose, stomach, or the small intestine (Adler 2013). Regarding the method chosen for the insertion, the percutaneous endoscopic gastrostomy or percutaneous endoscopic jejunostomy could be applied (Adler 2013). The first one suggests placing the tube through the skin into the stomach or gastrostomy (Adler 2013). The second approach presupposes that a tube is inserted into the small intestine (Klingensmith & Coopersmith 2016). The choice of the method depends on the state of a patient, his/her disease, and the peculiarities of the health problem that should be solved at the moment. Therefore, if a situation is crucial and a patient demonstrates poor voluntary intake, early enteral nutrition (EEN) should be recommended. It is feeding within 24 to 48 hours from admission (Blumenstein, Shastri & Stein 2014).

Prescription

The use of EEN at early stages could be justified by several factors. First, metabolic support through the gastroenteric tube is provided when patients are not able to take the needed amount of nutritional substances orally; however, it is crucial to avoid progressive lean tissue catabolism due to starvation (Greenberger, Blumberg & Burakoff 2015). There are numerous pieces of evidence admitting that the use of a tube to deliver nutrients via the gut is more efficient and improves outcomes (Taylor 2016). Additionally, EEN plays an essential role in treating patients with chronic neurological or mechanical dysphagia, and gut dysfunction (Kozeniecki & Fritzshall 2015). The critical state of a person also becomes one of the factors that precondition the use of the tube to preserve the needed balance. Finally, prescribing the surgical interference, specialists might use EEN as the a to prepare a patient for the procedure.

Benefits

Nevertheless, the application of EEN in critical situations demonstrates its beneficial character compared to the parenteral way of nutrients delivery. First, using the gastroenteric tube, a specialist can reduce catabolism and avoid starvation (Seres, Vlcarcel & Guillaume 2012). The given method shows better results compared to intravenous injection of nutrients or substances that might be needed for a patient (Seres, Vlcarcel & Guillaume 2012). Moreover, if a person has a trauma of experiences a significant blood loss, the use of parenteral ways could be complicated. In such situations, specialists tend to administer EEN to avoid severe complications and support a patient (Seres, Vlcarcel & Guillaume 2012). In the majority of cases, substances delivered via the tube are better absorbed and less allergic. Furthermore, tube feeding could improve the intestinal blood flow and preserve GALT at the appropriate level (Seres, Vlcarcel & Guillaume 2012). It results in a decreased probability of infectious complications among patients who have prescribed surgery. Finally, the use of EEN to feed a patient in the critical state demonstrates the essential reduction of septic complications (Patel & Codner 2016). For this reason, the gastroenteric tube remains one of the most efficient ways to deliver nutrients to patients with the poor voluntary intake (Feldman, Friedman & Brandt 2015).

EEN in the Case

Regarding the suggesting case, the choice of EEN seems justified. Helen, a 55-year old female, has significant health problems which should be given special attention. First, her state remains complicated as she fails to consume nutrients traditionally. Additionally, there is a tendency towards the deterioration of her health status and the occurrence of new issues. For this reason, EEN is recommended as a way to avoid complications and preserve her current health status. Using the gastroenteric tube to deliver glutamine, specialists can prevent starvation and the lack of elements required for the efficient functioning of the body. Helen also enters the catabolic state of injury which makes the income of glutamine crucial. The patient should be able to restore energy and respond to external irritants. That is why the use of EEN to deliver glutamine becomes fundamental for Helens treatment. Regarding the abdominal surgery and the need to reduce the increased intestinal permeability, the consumption of glutamine via the gut is considered the best approach.

Consequences

Therefore, the observed enteral nutrition contributes to the preservation of the patients health status and makes the treatment prescribed for Helen possible. The fact is that the fixed income of nutrients like glutamine promotes the bodys ability to support its functioning and resist the illness (Adler 2013). However, it is still crucial to observe the patient and her response to EEN. For instance, Helen might have loose stool due to the peculiarities of the method chosen for nutrients delivery. At the same time, the income of needed elements along with medicines contributes to the gradual improvement of the patients state and her recovery. The nature of the given health problem presupposes surgery as one of the most efficient treatments. Under these conditions, the introduction of EEN could make the procedure less complicated because of the reduced terms of recovery. As stated above, the beneficial character of EEN presupposes the low probability of septic infections of complications after the surgery compared to other ways to deliver nutrients (Aitken, Marshall & Chaboyer 2015). For this reason, adherence to the practice promotes Helens health and assist the patient in her recovery.

Conclusion

Altogether, early enteral nutrition remains one of the most efficient ways to deliver nutrients to a patient who is not able to feed because of the critical state, traumas, severe illnesses, etc. Using the gastroenteric tube, specialists can avoid starvation and support the body. The suggested practice has several advantages that prove its beneficial character. These are better absorption, tolerance, improved impact on the patient, and decreased probability of allergic reactions. Additionally, in patients with the gastroenteric tube, lower septic infections rates could be observed. For this reason, in complex cases like the suggested one, the use of EEN is justified by the necessity to support a patient and prepare him/her for surgery. It helps to deliver the elements that could assist a patient in his/her recovery and cultivate his/her health.

Reference List

Adler, D 2013, The little gI book: an easily digestible guide to understanding gastroenterology, 1st edn, Slack Incorporated, Thorofare, NJ.

Aitken, A, Marshall, A & Chaboyer, W 2015, ACCCN’s critical care nursing, 3rd edn, Elsevier, Sydney.

Blumenstein, I, Shastri, Y & Stein, J 2014, ‘Gastroenteric tube feeding: techniques, problems and solutions’, World Journal of Gatroenterology, vol. 20, no. 26, pp. 8505-8524, Web.

Feldman, M, Friedman, L & Brandt, L 2015, Sleisenger and fordtran’s gastrointestinal and liver disease- 2 volume set: pathophysiology, diagnosis, management, 10e (gastrointestinal & liver disease (sleisinger/fordtran)), 9th edn, Saunders, New York, NY.

Greenberger, N, Blumberg, R & Burakoff, R 2015, Current diagnosis & treatment gastroenterology, hepatology, & endoscopy, 3rd edn, McGraw-Hill Education, New York, NY.

Klingensmith, N & Coopersmith, C 2016, ‘The gut as the motor of multiple organ dysfunction in critical illness’, Critical Care Clinics, vol. 32, no. 2, pp. 203-212, Web.

Kozeniecki, M & Fritzshall, R 2015, ‘Enteral nutrition for adults in the hospital setting’, Nutrition in Clinical Practice, vol. 30, no. 5, pp. 634-651, Web.

Patel, J & Codner, P 2016, ‘Controversies in critical care nutrition support’, Critical Care Clinics, vol. 32, no. 2, pp. 173-189.

Seres, D, Vlcarcel, M & Guillaume, A 2012, ‘Advantages of enteral nutrition over parenteral nutrition’, Therapeutic Advances in Gastroenterology, vol. 6, no. 2, pp. 157-167, Web.

Taylor, R 2016, ‘Gut motility issues in critical illness’, Critical Care Clinics, vol. 32, no. 2, pp. 191-201.

Patient’s Problems

The first problem for Mr. Dwight is related to malnutrition. According to recent research, malnutrition and the resulting weight loss, namely, the deterioration of muscle tissue, affects patients’ chances for survival (Arends et al., 2017, p. 17). In the case of Mr. Dwight, he had been diagnosed with bowel cancer, and he had not eaten for three days. It is essential for care providers to understand that starving for a long time can have adverse effects on his health. Therefore, researchers say that patients with cancer and bowel failure should be provided with artificial nutrition to prevent starvation.

The second problem for Mr. Dwight can be related to the nurses who lack training about the patient’s diet. According to Kelley and Morrison (2015), the extent of the health practitioners’ expertise on the subject matter is very low, which affects the quality of the provided assessment (p. 748). The areas refer to providing palliative care to patients with serious illnesses (e.g., cancer). Due to a lack of training, nurses often forget to take into account the patient’s diet that can negatively affect their health. Additionally, research states that dieting choices made to keep the nutrition of the patients at an appropriate level will help to increase the patients’ ability to fight cancer due to the presence of a greater number of useful nutrients (Molina-Montes et al., 2017, p. 811). Therefore, the framework for addressing the dieting options of patients has to be revisited.

Patient’s Goals

One goal for Mr. Dwight’s management is to provide him with the most exceptional palliative care service in regards to fluid and nutrition. Several things should be considered: 1) specific training programs for palliative care providers that will improve their productivity; 2) measurable tests; 3) achievable certificate programs; 4) programs relevant to palliative care setting; 5) time-based programs.

Treatment Methods

The collaborative intervention allows better decision-making processes due to the opportunity for experts from different fields to collaborate and introduce a coherent approach toward managing patients’ needs properly (Trosman, Weldon, Kircher, Gradishar, & Benson, 2019, p. 11). In the case of Mr. Dwight, collaborative intervention is essential because of his insecure feelings about fluid and nutrition. The collaborative intervention allows the prevention of bowel cancer and can be beneficial for Mr. Dwight. According to research, the application of the collaborative approach increases the probability of survival in patients with colorectal cancer (Woodall & DeLetter, 2018, p. 71).

In addition, a pharmacological intervention will be needed to prevent possible instances of nosocomial infections. For this purpose, close examination of a patient’s nostrils for possible deformities is required. In addition, a nurse will need to inform a patient about the details of the procedure prior to inserting the tube. The benefits of the specified intervention include an opportunity to reduce the extent of stress experienced by the patient and create the basis for the future patient education (Woodall & DeLetter, 2018, p. 73). Therefore, the specified intervention should also be considered along with the traditional approach toward managing the NG process.

Outcomes

Evaluating the outcomes of the intervention will also be a fundamental step toward the management of the patient’s needs. First, data is collected from the results of the training tests about the effect of the patient’s diet. Second, the collected data (comments from the trainers) are analyzed (Van Rooijen et al., 2018, p. 103). In addition, the assessment of the changes made to the patient’s current health status will be assessed by performing the tests that evaluate the pH of the NG aspirate (Van Rooijen et al., 2018, p. 103). The specified evaluation will provide the results that will help to locate the difference between the regular pH level and that one of the patient. As a result, a strategy for addressing the patient’s immediate health needs will be developed.

Bowel Cancer

According to Kontovounisios et al. (2017), the MDT for an advanced stage of bowel cancer implies the support and assistance of experts with profound and vast knowledge of the subject matter and the interventions that can be used to address the issue effectively (227). These members include surgeons, oncologists, radiologists, and clinical nurse specialists.

First, having an MDT is beneficial because it allows better decision-making. Research says that the incorporation of the MDT-based strategy and several other techniques, one will be able to produce several solutions and offer a patient a variety of options for addressing the disease (Kelley & Morrison, 2015, p. 748). Second, having an MDT allows creating a setting where a proper assessment of patients’ well-being can be performed with the following suggestion of treatment options (Kelley & Morrison, 2015, p. 748).

Checking the Position of the Nasogastric (NG) Tube

In order to ensure that the NG tube is placed correctly in a patient, a nurse will need a radiographic test or an X-ray in order to ensure that the tube is placed correctly. While the use of air auscultation, also known as the whoosh test, used to be quite frequently used for these purposes, the specified approach is no longer adopted (Kisting, Korcal, & Schutte, 2019, p. 2). Additionally, colorimetric capnography may be used to check the tube placement (Erzincanli, Zaybak, & Güler, 2017, p. 48). The specified tools can be seen as the definitive check of the tube’s position since the X-ray and the capnography-based approach will help to locate the exact location of the tube.

References

Akhtar, R., Chandel, S., Sarotra, P., & Medhi, B. (2014). Current status of pharmacological treatment of colorectal cancer. World Journal of Gastrointestinal Oncology, 6(6), 177–183. Web.

Arends, J., Bachmann, P., Baracos, V., Barthelemy, N., Bertz, H., & Bozzetti, F. et al. (2017). ESPEN guidelines on nutrition in cancer patients. Clinical Nutrition, 36(1), 11-48.

Erzincanli, S., Zaybak, A., & Güler, A. (2017). Investigation of the efficacy of colorimetric capnometry method used to verify the correct placement of the nasogastric tube. Intensive and Critical Care Nursing, 38, 46-52.

Kelley, A., & Morrison, R. (2015). Palliative care for the seriously ill. The New England Journal of Medicine, 373(8), 747-755.

Kisting, M. A., Korcal, L., & Schutte, D. L. (2019). Lose the whoosh: An evidence-based project to improve NG tube placement verification in infants and children in the hospital setting. Journal of Pediatric Nursing, 46, 1-5.

Kontovounisios, C., Tan, E., Pawa, N., Brown, G., Tait, D., Cunningham, D.,… Tekkis, P. (2017). The selection process can improve the outcome in locally advanced and recurrent colorectal cancer: activity and results of a dedicated multidisciplinary colorectal cancer centre. Colorectal Disease, 19(4), 331-338.

Molina-Montes, E., Sánchez, M. J., Buckland, G., Weiderpass, E., Amiano, P., Wark, P. A.,… Quirós, J. R. (2017). Mediterranean diet and risk of pancreatic cancer in the European Prospective Investigation into Cancer and Nutrition cohort. British Journal of Cancer, 116(6), 811.

Trosman, J., Weldon, C., Kircher, S., Gradishar, W., & Benson, A. (2019). Innovating cancer care delivery: The example of the 4R oncology model for colorectal cancer patients. Current Treatment Options in Oncology, 20(2), 11.

Van Rooijen, K. L., Shi, Q., Goey, K. K. H., Meyers, J., Heinemann, V., Diaz-Rubio, E.,… Sargent, D. J. (2018). Prognostic value of primary tumour resection in synchronous metastatic colorectal cancer: individual patient data analysis of first-line randomised trials from the ARCAD database. European Journal of Cancer, 91, 99-106.

Woodall, M., & DeLetter, M. (2018). Colorectal cancer: A collaborative approach to improve education and screening in a rural population. Clinical Journal of Oncology Nursing, 22(1), 69-75.

Many people find it challenging to follow dietary guidelines as a result of recent environmental and lifestyle changes. Because of shifting familial and societal dynamics, they are receiving less assistance and are having difficulty eating the necessary nutrient-dense diet. There may be a need for tailored dietary needs for sickness and medicine used in this situation. A fundamental threat to healthy aging and lack of serious diseases is malnutrition. Weight loss, weariness, irritability, and vitamin deficits are all signs of malnutrition (Dewi et al., 2020). On the other side, it can lead to obesity and overweight. Sofia, who is 18 years old, is in the third month of her pregnancy. Anemia, hemorrhage, and mortality in mothers can all be caused by insufficient nutrition during pregnancy (Castrogiovanni & Imbesi, 2017). Low birth weight, malnutrition, and developmental delays in children are all possible outcomes (Dewi et al., 2020). Sofia’s possible malnutrition might be owing to her demanding schedule (40 hours per week) and lack of prenatal care, which is an important part of a healthy pregnancy.

Sofia, at the age of 18, needs to incorporate nutritious carbs into her diet. Protein also serves as an essential component of a teenager’s diet. Teenagers in this age group should consume around 2500-2800 calories per day (Castrogiovanni & Imbesi, 2017). A healthy pregnancy needs an additional 300 calories every day (Lee et al., 2018). These calories should come from a well-balanced diet of protein, fruits, and vegetables, with a minimum of sweets and alcohol (Lee et al., 2018). During pregnancy, fluid intake is also a vital aspect of nutrition. In addition to the fluids present in juices and soups, it may be maintained by drinking several glasses of water each day. Her nutrition (and possible malnutrition) is unaffected by her cultural or socioeconomic position in this instance since she indicates a welcoming atmosphere and cares in her surroundings. In certain cases, this might be an issue, as various cultures and customs deal with pregnancy in different ways.

References

Castrogiovanni, P., & Imbesi, R. (2017). The role of malnutrition during pregnancy and its effects on brain and skeletal muscle postnatal development. Journal of Functional Morphology and Kinesiology, 2(3), 30.

Dewi, N. U., Nurulfuadi, N., Aiman, U., Hartini, D. A., Prasanna, F., & Bohari, B. (2020). Food insecurity and anthropometry in adolescents: A literature review. Open Access Macedonian Journal of Medical Sciences, 8(4), 234-240.

Lee, Y. Q., Collins, C. E., Gordon, A., Rae, K. M., & Pringle, K. G. (2018). The relationship between maternal nutrition during pregnancy and offspring kidney structure and function in humans: a systematic review. Nutrients, 10(2), 241.

Intended Outcomes of the Proposal Recommendations

It is expected that the proposal recommendations will help develop a comprehensive strategy for managing the process of hospitalized patients’ nutrition. As a result, the instances of undernourishment or any other malnutrition cases will hopefully be avoided. Furthermore, both patients and nurses will receive essential guidelines concerning proper nutrition.

Detailed instructions about the screening process will be provided to nurses. Moreover, patient education will require that nurses should engage the target population in the active acquisition of the relevant information about their disease or disorder and the dieting options that they have. Thus, patient independence can be promoted successfully.

Potential Unintended Outcomes/Consequences Resulting from Implementation of the Proposal Recommendations

The proposal recommendations will cause a rapid drop in the cases of malnutrition among inpatients. In addition, the level of proficiency in managing nutrition-related patients’ needs will rise exponentially among nurses. Finally, patients will also receive important information about the nutrition process and will develop the relevant skills.

Among the unintended consequences, the engagement in lifelong learning as the health management strategy may be observed among some of the patients. The identified outcome is quite unlikely, yet, with proper guidance provided by nurses, the target population may develop enthusiasm about gaining new information about health and health-related concern. Thus, a gradual improvement in the well-being of the community members can become a possibility. Furthermore, there is a chance that the patients will be able to determine malnutrition at its early stages and inform nurses about the problem. In addition, the enhancement of the communication process between nurses and patients may be triggered by the suggested changes to the nutrition strategy for hospital inpatients. As a result, a rise in the number of positive patient outcomes will possibly be observed.

Summary

Malnutrition is a medical term that is used in reference to under-nutrition and over-nutrition (Duggan & Watkins, 2008). Persons whose diets do not provide their bodies with enough proteins and calories for their development experience Under-nutrition issues. On the other hand, individuals whose diets provide their bodies with too many calories experience over-nutrition issues. Currently, the world produces adequate food to feed its inhabitants. As compared to the past century, the world’s food production rate has improved by 25%. Despite these improvements, it is estimated that in the world close to one billion people are suffering from undernutrition. Equally, it is estimated that more than one billion individuals are suffering from over-malnutrition and obesity cases. According to the UN reports, the worst-hit regions by malnutrition are developing countries in South Asia and Africa. In these regions, cases of malnutrition were reported to be rising in areas experiencing civil strife and draught.

Alternatively, adequate nutrition is achieved when an individual consumes sufficient, balanced diet food at the right time. Medical experts suggest that it is appropriate for every individual to maintain adequate nutrition. It is through this habit that individuals can maintain healthy lifestyles. According to medical experts, development in children is greatly affected by their feeding habits. It is for this reason that stunted growth, underweight, and obesity issues are associated with malnutrition. According to the UN reports, malnutrition and development issues in children do not only affect their survival but also affect the quality of their lives. Currently, sufficient knowledge on how to improve the development in children exists (Roth, 2011). As such, several measures have been implemented to treat and reduce incidences of malnutrition in children. Similarly, methods of how to achieve adequate nutrition in children have been developed and implemented. For instance, in the past century, several efforts were focused on the treatment of childhood malnutrition with the effort of enhancing their development (Shils & Olson, 2010). Despite these relentless efforts, malnutrition issues are still considered major health challenges in developing countries. Currently, it is noted that health experts have shifted their efforts of improving children’s development towards adequate nutrition initiatives (Cameron, 2009). In this regard, there is an urgent need to establish adequate facts on whether adequate nutrition or the absence of malnutrition reduces the risk of development.

Descriptive Questions

What are the benefits of enhancing children’s development through the treatment of childhood malnutrition? What are the benefits of enhancing children’s development through adequate nutrition initiatives? What are some of the components of malnutrition primary prevention programs that have been developed and tested over the last few years? What are some of the adequate nutrition programs developed and tested over the last few years? What are the determinants that influence the approach taken towards the enhancement of children’s development? What is the percentage of children whose developments have been affected by malnutrition-related cases?

Comparative Questions

Between adequate nutrition programs and malnutrition primary prevention programs, what approach is the most effective to enhance children’s development? As compared to malnutrition primary prevention programs, why are adequate nutrition programs preferred?

Correlation Questions

What are the similarities between adequate nutrition programs and malnutrition primary prevention programs? What are the dissimilarities between adequate nutrition programs and malnutrition primary prevention programs?

References

Cameron, N. (2009). Human growth and development. San Diego, Calif.: Academic Press.

Duggan, C., & Watkins, J. B. (2008). Nutrition in pediatrics basic science, clinical applications (4th ed.). Hamilton, Ontario: B.C. Decker.

Roth, R. A. (2011). Nutrition & diet therapy (10th ed.). Clifton Park, NY: Delmar Cengage Learning.

Shils, M. E., & Olson, J. A. (2010). Modern nutrition in health and disease (8th ed.). Philadelphia : Lea & Febiger.

Introduction

The normal functioning of body organs is something that requires an adequate amount of mineral salts, fluids, and nutrients that are derived from different food materials. The problem of malnutrition occurs when a person’s nutritional supplements are insufficient, imbalanced, or excess. Many people assume that undernourishment is the only form of malnutrition. The purpose of this paper, therefore, is to analyze the major risk factors and causes of this health predicament.

Thesis statement

Malnutrition is a complex nutritional status caused by not only undernutrition in poor populations but also by overnutrition, poor health conditions, and sedentary lifestyles.

Causes of Malnutrition

Biesalski and Black argue that malnutrition is caused by a wide range of factors that work synergistically or independently (41). To begin with, individuals who do not get adequate nutrients will have increased chances of being malnourished. In poor countries, many people and children lack balanced diets. Similarly, individuals who fail to develop healthy eating habits or ignore the required nutrients such as vitamins, proteins, minerals, and fats will suffer from malnutrition. Additionally, some diets are usually harmful or indigestible. For instance, chewing gums can be swallowed by children, thereby increasing their chances of developing the problem. Some food materials contain numerous chemicals that can result in malnutrition. This is also a risk factor for chronic infections, cancers, and tumors.

Individuals should be encouraged to regulate their diets (Menon et al. 5). Any irregular eating pattern or intake of unhealthy food materials can result in malnourishment. Irregular meals are known to cause ingestion and bloating. Children living in dirty environments will lack pure light and clean oxygen. These attributes will make it impossible for the body to process various food materials and nutrients (Khan et al. 28).

Sahn believes that people who fail to get adequate rest and sleep will have increased chances of becoming malnourished (31). For instance, studies have revealed that children who watch television for long hours will not get adequate sleep. This malpractice is linked to poor digestion and an imbalanced intake of nutrients. The process will eventually result in malnutrition. These aspects explain why people should focus on their nutritional requirements in order to overcome this health problem.

There are some risk factors that are associated with malnutrition. For instance, heavy and tedious activities can affect a person’s digestive process. Children are usually at a higher risk of developing this problem. Some health conditions such as ringworms, measles, and kwashiorkor will expose more children to malnutrition. Such diseases are known to disorient normal body functions, thereby affecting the rate at which the body absorbs various nutrients.

Sahn goes further to explain how individuals who fail to engage in exercises and physical activities record slowed digestive processes (89). Dysphasia, a condition associated with eating difficulty, has been linked to malnutrition by different scientists (Biesalski and Black 102). Consequently, the affected persons tend to have higher chances of becoming obese.

Khan et al. indicate that starvation is a leading cause of malnutrition in the underdeveloped world (29). Many homeless persons and children living in poverty do not get enough food. This reason explains why such individuals have higher chances of suffering from malnutrition. Similarly, people who have various eating problems or disorders will not maintain their body’s nutrition levels. A good example of such a conditions is anorexia nervosa (Oxlade et al. 4). Poverty is something that has been associated with homelessness and discrimination. People living in low-income neighborhoods or marginalized societies will develop a wide range of nutritional problems.

Lack of adequate information is another potential cause of malnutrition in the developed world. The role of human services professionals and nutritionists is to guide people and empower them to design balanced diets for their families (Menon et al. 11). Unfortunately, many individuals with good salaries fail to focus on the right dietary intakes or requirements. They also ignore the nutritional statuses of their children, thereby exposing them to diseases such as obesity.

Some might also lack adequate nutrients and mineral salts. These malpractices will result in malnutrition. Finally, people living in regions that lack adequate medical facilities are at risk of being undernourished (Oxlade et al. 7). This is the case because the health statuses of such persons are not monitored frequently. Some of the underlying diseases that can disorient various digestive processes tend to go undetected. Other potential causes of malnutrition include diarrhea, heart disease, smoking, and drug abuse.

Conclusion

This discussion has revealed that malnutrition is a serious health problem that takes different forms such as obesity and undernourishment. People should be keen to focus on each of these causes of malnutrition in order to improve their nutritional status. These attributes should, therefore, be examined keenly in an attempt to develop powerful models to deal with this preventable health predicament. Governments and local agencies must implement effective campaigns and initiatives to sensitize more people about the causes of malnutrition and the best approaches to improve people’s health outcomes.

Works Cited

Biesalski, Hans K., and Robert E. Black. Hidden Hunger: Malnutrition and the First 1,000 Days of Life: Causes, Consequences and Solutions. Karger Publications, 2016.

Khan, Alamgir, et al. “Causes, Signs and Symptoms of Malnutrition Among the Children.” Journal of Nutrition and Human Health, vol. 1, no. 1, 2017, pp. 24-37.

Menon, Sonia, et al. “Convergence of a Diabetes Mellitus, Protein Energy Malnutrition, and TB Epidemic: The Neglected Elderly Population.” BMC Infectious Diseases, vol. 16, no. 361, 2016, pp. 1-14.

Oxlade, Olivia, et al. “Estimating the Impact of Reducing Under-Nutrition on the Tuberculosis Epidemic in the Central Eastern States of India: A Dynamic Modeling Study.” PLOS ONE, vol. 10, no. 6, 2015, pp. 1-15.

Sahn, David E. The Fight Against Hunger and Malnutrition: The Role of Food, Agriculture, and Targeted Policies. Oxford University Press, 2015.