DNP-810 Topic 5 DQ 2: Choose One Disorder Of Malnutrition That Is Found In Your Clinical Setting Or Community. What Are The Genetic And Environmental Influences On This Disorder, Including Prevalence Rates, Testing, Treatment, And Prognosis? How Can The Doctoral-prepared Nurse Apply This Information Into Practice? Explain. Support Your Rationale With A Minimum Of Two Scholarly Sources.

DNP-810 Topic 5 DQ 2: Choose one disorder of malnutrition that is found in your clinical setting or community. What are the genetic and environmental influences on this disorder, including prevalence rates, testing, treatment, and prognosis? How can the doctoral-prepared nurse apply this information into practice? Explain. Support your rationale with a minimum of two scholarly sources.

Recognized as a developmental disorder, cerebral palsy affects individuals at a very young age. Cerebral palsy can directly impact nutrition because the condition often adversely impacts the muscles necessary for chewing and swallowing (Aydin et al., 2018). Malnutrition in children with CP is usually caused by poor oral-motor function, which impairs the child’s ability to consume calories and nutrients required to support growth (Aydin et al., 2018). Moreover, children need adequate nutrition when concerning the promotion of both development as well as growth. A healthy diet also improves energy levels and body functions, which can positively affect performance during physical therapy (Aydin et al., 2018). Unfortunately, the condition can also require specific medications, making children lose their appetite or interest in food or water.

 Individuals falling within the majority that possess Cerebral Palsy, 93%, will experience feeding difficulties. Since CP results in impairment of muscle groups, facial muscles can be affected. The facial muscles are one of the most important muscle groups in the body. Impairment hampers a child’s ability to chew, suck, or swallow, creating a high risk for undernourishment, failure to thrive, malnutrition, growth delay, and digestive difficulties (Aydin et al., 2018). Medical professionals may potentially suggest brain imaging tests, such as x-ray computed tomography (CT scan) or magnetic resonance imaging (MRI) (Morgan et al., 2019). In addition, an electroencephalogram (EEG), genetic testing, metabolic testing, or a combination of these might also undergo enactment (Morgan et al., 2019). Moreover, in a generalized manner, CP undergoes diagnosis during the first or second year after birth. Furthermore, primary treatment options for cerebral palsy are medication, therapy, and surgery (Morgan et al., 2019).

 Cerebral palsy treatment aims to manage symptoms, relieve pain, and maximize independence to achieve long, healthy life (Novak et al., 2017). When the life expectancy of those with CP, this specific life expectancy undergoes calculations in which a child’s condition severity is considered. Mobility issues, intellectual disabilities, vision/hearing impairments, etc., all impact the lifespan of those with CP (Novak et al., 2017). Most children with milder forms of cerebral palsy have average survival times similar to those of the general population. However, multiple impairments may also lower cerebral palsy life span. According to Dr. Ananya Mandal, children with mild cerebral palsy possess a heightened likelihood (ninety-nine percent chance) of living to 20 years old (Novak et al., 2017). The two factors that have the most significant impact concerning a child’s lifespan with the inclusion of cerebral palsy are addressed to be intellectual and motor developmental challenges (Novak et al., 2017). As these impairments undergo an increase in severity, a child’s life expectancy can see a decline.

The importance of DNP-prepared nurses recognizing and managing cerebral palsy’s many significant comorbidities is as vital as treating motor disabilities and working with the patient’s families to adjust diet, nutrients, and supplements to contribute significantly to an individual’s overall health. Recent advances in understanding cerebral palsy include new ways of thinking about disability, casual pathway recognition, and improvements rooted in measurement, classification, and prognostication (Novak et al., 2017). Challenges entail family as well as child well-being, tackling the lifelong issues faced by individuals with cerebral palsy, as well as the persisting need for tertiary, secondary, as well as primary prevention of the impact that cerebral palsy contributes regards to the daily livelihoods of others (Novak et al., 2017). With most individuals with CP reporting feeding or digestive difficulties, a dietary counseling program can be highly beneficial.

References

Aydin, K., Akbas, Y., Unay, B., Arslan, M., Cansu, A., Sahin, S., … & Sarioglu, A. A. (2018). A multicenter cross-sectional study to evaluate the clinical characteristics and nutritional status of children with cerebral palsy. Clinical Nutrition ESPEN, 26, 27-34.

Morgan, C., Romeo, D. M., Chorna, O., Novak, I., Galea, C., Del Secco, S., & Guzzetta, A. (2019). The pooled diagnostic accuracy of neuroimaging, general movements, and neurological examination for diagnosing cerebral palsy early in high-risk infants: a case-control study. Journal of clinical medicine, 8(11), 1879.

Novak, I., Morgan, C., Adde, L., Blackman, J., Boyd, R. N., Brunstrom-Hernandez, J., … & Badawi, N. (2017). Early, accurate diagnosis and early intervention in cerebral palsy: advances in diagnosis and treatment. JAMA pediatrics, 171(9), 897-907.

I agree with you, Cerebral palsy can directly impact nutrition due to its effect on the muscles necessary for chewing and swallowing. According to research studies conducted by Jahan, et al., 2022, malnutrition is substantially higher in children with cerebral palsy (CP) in low-income countries in comparison with the general population. For better management outcomes for these children, access to appropriate nutritional interventions is crucial. Most children will benefit from surgical interventions and placement of gastrostomy tubes to improve nutritional outcomes. DNP-prepared nurses should understand that there is a substantial knowledge gap on nutrition interventions for children with CP in the poor socio-economic group. The best practice guideline for the nutritional management of children with CP is augmentation with Gastrostomy tube feeding. Findings suggest planning of nutrition-focused intervention has better outcomes than behavioral interventions and should be considered in comprehensive services for affected children (Jahan, et al., 2022).

Reference

Jahan, I., Sultana, R., Muhit, M., Akbar, D., Karim, T., Al Imam, M, H., Das, M. C., Smithers-Sheedy, H., McIntyre, S., Badawi, N., & Khandaker, G. (2022). Nutrition Interventions for Children with Cerebral Palsy in Low- and Middle-Income Countries: A Scoping Review. Retrieved from DOI: 10.3390/nu14061211

. I agree that cerebral palsy (CP) is the most common childhood disability that leads to activity limitations and causes an increased risk of malnutrition due to poor nutrition. In addition to other co-morbidities associated with CP, epilepsy, communication, and behavioral difficulties, a neurological impairment, and a high risk of malnutrition (Gellert-Jones, 2020).

Therefore, I would like to add is children need adequate food to encourage growth and development. A healthy diet also improves energy levels and body functions, which may positively impact performance during physiotherapy. As you posted, children with CP often have problems with diet and swallowing, which can lead to poor nutritional status, growth failure, chronic aspiration, esophagitis, and respiratory infections (Gellert-Jones, 2020). The DNP nurse should focus on managing the CP to improve the quality of life for children and families. DNP nurses should educate the family through interventions that maximize autonomy in activities of daily living, mobility, and nutrition.

Reference

Gellert-Jones, M. E. (2020). Assessment and treatment of feeding in children and youth with cerebral palsy. Cerebral Palsy, 2857–2882. https://doi.org/10.1007/978-3-319-74558-9_176 

Malnutrition is a debilitating disorder that is widespread in acute hospitals. Malnutrition is associated with many undesirable effects including depression of the immune system, alteration of wound healing, muscle atrophy, longer hospital stays, higher processing costs, and a rise in mortality. Nutritional risk screening using a validated tool is a simple way to quickly identify patients at risk of malnutrition and provides a basis for rapid dietary recommendations. Non-identified malnutrition not only increases the risk of undesirable complications for patients (Prell & Perner, 2018). It is highly recommended that mandatory nutrition screening be widely adopted according to published best practices to effectively target and reduce the incidence of malnutrition in hospitals.

Like other geriatric syndromes, malnutrition is also a multifactor genesis syndrome. In most cases, malnutrition depends on insufficient food intake and less frequently on a higher nutrient requirement or malassimilation problem. As we get older, a series of physiological changes occur that promote malnutrition. These changes are usually summarized under the term anorexia of aging, defined as the loss of appetite and decreased food intake in late life (Landi et al., 2016). Therefore, the course of acute illness is more challenging in geriatric patients. The doctoral-prepared nurse can apply this information to identify motor and sensory and cognitive impairments such as stroke, Parkinson’s disease or dementia are common among neuro-geriatric patients.

Reference

Landi, F., Calvani, R., Tosato, M., Martone, A., Ortolani, E., Savera, G., Sisto, A., & Marzetti, E. (2016). Anorexia of Aging: Risk Factors, Consequences, and Potential Treatments. Nutrients, 8(2), 69. https://doi.org/10.3390/nu8020069

Prell, T., & Perner, C. (2018). Disease Specific Aspects of Malnutrition in Neurogeriatric Patients. Frontiers in Aging Neuroscience, 10. https://doi.org/10.3389/fnagi.2018.00080