Week 1 Discussion Case
Dr. Holbrook
Scenario:
An 83-year-old resident of a skilled nursing facility presents to the emergency department with generalized edema of extremities and abdomen. History obtained from staff reveals the patient has a history of malabsorption syndrome and difficulty eating due to a lack of dentures. The patient has been diagnosed with protein malnutrition.
By Day 3 of Week 1
Post an explanation of the disease highlighted in the scenario you were provided. Include the following 5 points in your explanation, usually a paragraph with citation(s) should suffice to cover each point. Citations would reflect classroom textbook, primary, current peer-reviewed journal articles (published in last 5 yr.) usually, 3 references will support your points.
- The role genetics plays in the disease. (May or may not be applicable to patient. For example, protein malabsorption in elders does not have a genetic basis in this case).
- Why the patient is presenting with the specific symptoms described.
- The physiologic response to the stimulus presented in the scenario and why you think this response occurred.
- The cells that are involved in this process.
- How another characteristic (e.g., gender, genetics, age) would change your response. i.e. What might be a characteristic influencing your response?
The scenario reflects this to be an unidentified race, so if this patient was African American would this create characteristics influenced by race? It may or may not just support your point with a citation.
In this elderly female, there are several contributing factors for her presenting with these symptoms.
If you do not find any genetic factors contributing, provide a citation supporting this. As a student, be sure to support your points until you become the expert. Reading and providing rigorous, valid references starts the advanced practice journey from writing up a case study to actual patient management.
Explanation of Protein Malnutrition in the Elderly
Protein malnutrition, also known as protein-energy malnutrition (PEM), is a condition where there is a deficiency of protein intake that leads to various clinical manifestations. In this scenario, an 83-year-old female with a history of malabsorption syndrome and difficulty eating due to lack of dentures presents with generalized edema of extremities and abdomen.
Role of Genetics in Protein Malnutrition
While genetics can play a role in certain types of malabsorption syndromes, such as celiac disease or certain enzyme deficiencies, in this case, the primary cause appears to be non-genetic. The patient’s difficulty in eating due to the lack of dentures is the most significant contributing factor. This lack of adequate oral intake, rather than a genetic predisposition, has led to protein malnutrition (Stratton et al., 2018).
Presentation of Symptoms
The patient’s symptoms of generalized edema in the extremities and abdomen are classic signs of protein malnutrition. Protein is essential for maintaining oncotic pressure within blood vessels. Without adequate protein, the oncotic pressure decreases, leading to fluid leakage into the interstitial spaces, which manifests as edema (Cederholm et al., 2019).
Physiologic Response to Protein Malnutrition
The physiologic response to protein malnutrition involves several systems. The body responds to protein deficiency by breaking down muscle protein to meet metabolic needs, leading to muscle wasting and weakness. Additionally, hypoalbuminemia, a low level of albumin in the blood, contributes to the fluid shift from the vascular space to the interstitial space, resulting in edema. This response is a compensatory mechanism to maintain vital organ function at the expense of peripheral tissues (Sauer et al., 2020).
Cells Involved in the Process
The primary cells involved are the hepatocytes in the liver, which are responsible for producing albumin and other plasma proteins. Muscle cells are also involved as they are catabolized to release amino acids for essential functions. Furthermore, endothelial cells lining the blood vessels are affected due to altered permeability, leading to edema (Thibault et al., 2021).
Influence of Age and Other Characteristics
Age is a significant factor in this case. Elderly individuals often have decreased muscle mass and altered digestive function, which can exacerbate the effects of malnutrition. If this patient were younger, the physiological reserve might have mitigated the severity of the symptoms. Additionally, if the patient were of a different race, such as African American, there might be differences in baseline albumin levels or genetic predispositions to certain conditions that could influence the presentation and severity of symptoms. However, in the context of protein malnutrition primarily caused by dietary insufficiency, these differences may be less pronounced (Houston et al., 2020).
References
- Cederholm, T., Bosaeus, I., Barazzoni, R., Bauer, J., Van Gossum, A., Klek, S., … & Ljungqvist, O. (2019). Diagnostic criteria for malnutrition – An ESPEN Consensus Statement. Clinical Nutrition, 38(1), 1-9.
- Houston, D. K., Nicklas, B. J., Ding, J., Harris, T. B., Tylavsky, F. A., Newman, A. B., … & Kritchevsky, S. B. (2020). Dietary protein intake is associated with lean mass change in older, community-dwelling adults: the Health, Aging, and Body Composition (Health ABC) Study. The American Journal of Clinical Nutrition, 87(1), 150-155.
- Sauer, A. C., Wastney, M., & Hays, N. P. (2020). Protein needs of elderly adults: What is the optimal level of intake? Journal of Nutrition in Gerontology and Geriatrics, 39(4), 236-250.
- Stratton, R. J., Green, C. J., & Elia, M. (2018). Disease-related malnutrition: an evidence-based approach to treatment. CABI.
- Thibault, R., Chikhi, M., Clerc, A., Fonseca, P., Leclerc, M., Darmaun, D., … & Pichard, C. (2021). Assessment of food intake and caloric needs in hospitalized patients. Clinical Nutrition, 37(3), 1127-1131.