Posted: January 26th, 2023
Develop a 1- to 2-page case study analysis in which you:
Case Study Analysis of Protein Malnutrition – NURS 6501: Advanced Pathophysiology
Poor nutritional status and malnutrition in adults aged 65 years or older are significant public health concerns across the globe. Malnutrition in the elderly is attributed to a gradual deterioration in wellbeing, elevated risk of mortality, premature institutionalization, decreased cognitive and physical functional status, and frequent visits to the emergency department (Evans, 2018) Protein Malnutrition Case Study Analysis – nurs 6501 week 2 assignment. Nutritional evaluation and management should be a routine practice of care for all aged adults, especially those in long-term care nursing facilities (Mathewson et al., 2021). This assignment involves a case study analysis of an elderly patient presenting to the emergency room with generalized edema of the abdomen and extremities. A history assessment of the patient’s data confirmed that the 83-year-old patient suffers protein malnutrition, lacks dentures making it difficult to eat, and has a history of malabsorption syndrome.
Typically, the digestion process involves the enzymatic hydrolysis of food after the mechanical breakdown in the gastrointestinal tract (GIT), with the eventual products being absorbed into circulation through epithelial cells lining the small intestine. The physiological function of the GIT can be impaired by a diversity of etiologies, including enteropathies, conditions such as lactose intolerance, cystic fibrosis, chronic pancreatitis, Crohn’s disease, and celiac disease (CD), acquired or congenital reduction in absorptive surface, and impaired enterohepatic circulation (Coulthard, 2015). Protein Malnutrition Case Study Analysis – nurs 6501 week 2 assignment For the elderly patient, impaired absorption of macronutrients resulted in protein malnutrition, which is marked by hypoalbuminemia. Albumin prevents fluid leakage into extravascular spaces by maintaining the oncotic pressure within the vascular compartments. The low albumin levels in the 83-year-old patient due to malabsorption syndrome resulted in water retention causing edema in the extremities and abdomen (Avelino-Silva & Jaluul, 2017). Hypoalbuminemia lowers the osmotic pressure and increases the hydrostatic pressure in the capillary vessels needed for water absorption, subsequently, producing the observed localized accumulation of fluid in the extremities and abdomen. The lack of dentures exacerbates protein deficiency and the formation of generalized edema.
Genes Associated with Protein Malabsorption
Protein malnutrition is an intricate process that is associated with advancing age and other causes, including the presence of predisposing genes and psychosocial and physiological factors (Mathewson et al., 2021). The 83-year-old patient potentially has celiac disease (CD), a genetic intolerance to protein, principally gluten found in rye, barley, and wheat. The consumption of a gluten-rich diet by individuals with CD causes inflammation of the small intestinal lining, consequently impairing absorption of macro-and micro-nutrients, which, in turn, cause protein deficiency (Cecilio & Bonatto, 2017) Protein Malnutrition Case Study Analysis – nurs 6501 week 2 assignment. The pathogenesis of CD involves the consumption of gluten, alterations in the intestinal mucosa, and the presence of surface markers HLA DQ2 and HLA DQ8 (Sallese et al., 2020). Upon ingestion, gluten interacts with the HLA genes triggering hypersensitivity in the intestinal mucosa and tissue injury marked by inflammation and the resulting protein malabsorption (Cecilio & Bonatto, 2017). The typical characteristics of CD make the disease be described as an autoimmune condition that is environmentally elicited by gluten. The gluten-HLA interaction prompts the activation of a T-cell-mediated immune reaction indicated by elevated numbers of intraepithelial lymphocytes in the damaged surface epithelium consistent with cell-mediated injury (Dunne et al., 2020).
Immunosuppression and its Impact on Body Systems
The process of immunosuppression involves the clampdown of a person’s inherent capacity to prevent infections and diseases through the deliberate action of medications or as a result of an infection with viral agents, like HIV, that target immune cells. Immunosuppressed individuals are extremely sick and vulnerable to infection by microbes that would normally cause no danger to healthy people (McSorley et al., 2017). Immunosuppression depletes the body system’s ability to mount an innate or acquired immune response to infectious agents thereby making the immunosuppressed individuals susceptible to opportunistic infections. At times, immunosuppression is deliberately triggered by administering immunosuppressants following the diagnosis of autoimmune disorders and during organ transplants. For example, a confirmed diagnosis of CD in an 83-year-old patient will necessitate the administration of recommended immunosuppressant treatment to decrease the hypersensitivity against the lining of the intestinal mucosa (Iqbal et al., 2017). Thus, immunosuppression helps the body systems by avoiding autoimmunity and hypersensitivity to food.
Avelino-Silva, T. J., & Jaluul, O. (2017). Malnutrition in hospitalized older patients: Management strategies to improve patient care and clinical outcomes. International Journal of Gerontology, 11(2), 56–61. https://doi.org/10.1016/j.ijge.2016.11.002
Cecilio, L. A., & Bonatto, M. W. (2017). The prevalence of HLA DQ2 and DQ8 in patients with celiac disease, in families, and the general population. Arquivos Brasileiros de Cirurgia Digestiva : ABCD = Brazilian Archives of Digestive Surgery, 28(3), 183–185. https://doi.org/10.1590/S0102-67202015000300009 Protein Malnutrition Case Study Analysis – nurs 6501 week 2 assignment
Coulthard, M. G. (2015). Edema in kwashiorkor is caused by hypoalbuminemia. Pediatrics and International Child Health, 35(2), 83–89. https://doi.org/10.1179/2046905514Y.0000000154
Dunne, M. R., Byrne, G., Chirdo, F. G., & Feighery, C. (2020). Coeliac disease pathogenesis: The uncertainties of a well-known immune-mediated disorder. Frontiers in Immunology, 11(July), 1–14. https://doi.org/10.3389/fimmu.2020.01374
Evans, C. (2018). Malnutrition in the elderly: a multifactorial failure to thrive. The Permanente Journal, 9(3), 38–41. https://doi.org/10.7812/tpp/05-056
Iqbal, U., Chaudhary, A., Karim, M. A., Anwar, H., & Merrell, N. (2017). Refractory celiac disease was successfully treated with Azathioprine. Gastroenterology Research, 10(3), 199–201. https://doi.org/10.14740/gr819w
Mathewson, S. L., Azevedo, P. S., Gordon, A. L., Phillips, B. E., & Greig, C. A. (2021). Overcoming protein-energy malnutrition in older adults in the residential care setting: A narrative review of causes and interventions. Ageing Research Reviews, 70(January), 101401. https://doi.org/10.1016/j.arr.2021.101401
McSorley, H. J., Gaze, S., Daveson, J., Jones, D., Anderson, R. P., Clouston, A., Ruyssers, N. E., Speare, R., McCarthy, J. S., Engwerda, C. R., Croese, J., & Loukas, A. (2017). Suppression of inflammatory immune responses in celiac disease by experimental hookworm infection. PLoS ONE, 6(9), 3–9. https://doi.org/10.1371/journal.pone.0024092
Sallese, M., Lopetuso, L. R., Efthymakis, K., & Neri, M. (2020). Beyond the HLA genes in gluten-related disorders. Frontiers in Nutrition, 7(November), 1–7. https://doi.org/10.3389/fnut.2020.575844 Protein Malnutrition Case Study Analysis – nurs 6501 week 2 assignment
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