Answer for DNP 810 Choose one disorder of malnutrition that is found in your clinical setting or community Re: Topic 5 DQ 2
Nutritional management has always been an important part of the multidisciplinary approach to cystic fibrosis (CF) care. In the past poor growth and malnutrition were common features of CF. The disorder was first likened to the changes seen in the pancreas to a coeliac type syndrome and concluded that the ‘fibrocystic disease of the pancreas’ was likely to be caused by vitamin A deficiency. Life expectancy was thought to be about six months. The main factor is fat malabsorption and poor growth results in infants and children being fed very unpalatable low-fat diets.
In the past 2 decades, there have been many more advances in both the respiratory and nutritional management of CF, which have had a significant impact on improving the nutritional status of patients. One advancement has been the introduction of national newborn screening programs with the ability to start treatment early, thereby preventing an early decline in nutritional status and conserving respiratory function. Nutritional management guidelines’ goal is to ensure that infants and children grow normally, achieving the 50th percentile for weight for length (WFL) by the age of two years and that adults have a BMI target in the middle of the normal range. It is also essential that patients achieve a normal body composition, ensuring optimal muscle and bone strength and optimal fat-soluble vitamin and essential fatty acid status. Improved life expectancy has resulted in additional nutritional challenges, including managing CF-related diabetes and liver disease, renal complications, optimizing bone health, and optimizing nutrition during pregnancy and before and following transplantation (Wolfe & Collins, 2017).
Close monitoring of nutritional status is critical to the overall health of a patient with CF. As part of routine CF care, measurement of weight and height should be evaluated and analyzed at each visit. Early recognition of nutritional risk is imperative and evaluation with a multidisciplinary team should be performed to assess for caloric intake, caloric malabsorption, and other causes of poor weight gain and growth (Sullivan & Mascarenhas, 2017).
The DNP nurse should focus on intervention to optimize the nutritional status that will lead to improved health outcomes, including survival. Therefore, Close monitoring of nutrition and growth is essential in caring for pediatric and adult patients with Cystic Fibrosis (CF). The Cystic Fibrosis Foundation (CFF) recommends that nutritional status be monitored as part of routine CF care and that both children and adults with CF achieve a nutritional status comparable to healthy children and adults, as optimal nutritional status is associated with better clinical outcomes (Sullivan & Mascarenhas, 2017).
References
Sullivan, J. S., & Mascarenhas, M. R. (2017). Nutrition: Prevention and management of nutritional failure in Cystic Fibrosis. Journal of Cystic Fibrosis, 16, S87–S93. https://doi.org/10.1016/j.jcf.2017.07.010
Wolfe, S., & Collins, C. (2017). The Changing face of Nutrition in Cystic Fibrosis. Journal of Cystic Fibrosis. https://www.cysticfibrosisjournal.com/article/S1569-1993(17)30763-4/fulltext
