Protein-Energy Malnutrition (PEM) Essay

please have the same writer that wrote order 23307 write the following response. 1.)Responde to Tomi below with 2 references at the end please. and respectfully agree or disagree with your colleague’s assessment and explain your reasoning. In your explanation, include why their explanations make physiological sense or why they do not. Tomi\’s disccussion response Protein-Energy Malnutrition (PEM) The case of the 83-year-old resident shows that he suffers from protein-energy malnutrition. In particular, this condition – PEM with edema results from muscle atrophy and peripheral edema (Gurung, 2010). Similarly, patients suffer from anasarca, hypothermia, hepatomegaly, hypothermia, extreme thinness, and dry skin. When people ingest proteins, these nutrients are broken down into amino acids. Therefore, in the case of protein-energy malnutrition, the body lacks a balanced supply of proteins. Protein-Energy Malnutrition (PEM) Essay This problem is prevalent among children and the elderly. Some of the risk factors causing the disease include genetic, cardiovascular, and renal conditions (Gurung, 2010). The 83-year-old has edema in the legs and stomach because of the accumulation of fluids forced out of blood vessels. Proteins play a key role in maintaining the interactions amongst cells and their environment, hence the accumulation of fluid following protein deficiency in the patient. Protein-energy malnutrition occurs from malnutrition and pancytopenia. Often, hemopoietic tissue needs significant nutrient supply, proliferation, maturation, and differentiation of cells (Kopple, Massry & Kalantar-Zadeh, 2012).

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Since the patients also suffer from malabsorption syndrome, they may exhibit low weight gain and poor social responsiveness. Therefore, with reduced protein in the body, the patient has high levels of glucocorticoids, which intermediate with lymphocyte apoptosis, to reduce the available T cell precursors used for clonal expansion. As a result, protein-energy malnutrition diminishes the CD8 viral-specific T cells (Gurung, 2010). In the worst-case scenario, failing to treat this condition can cause patients to go into a coma, shock, or die. However, PEM is prevalent amongst people who cannot take good care of themselves, such as the elderly. Also, more elderly men than females because their food intake declines faster (Kopple, J. D., Massry, S. G., & Kalantar-Zadeh, 2012). In elderly men, their food consumption declines at approximately 30%, and 20% in women. References Gurung, G. (2010). Social determinants of protein-energy malnutrition: Need to attack the causes of the causes. Journal of Health, Population and Nutrition, 28(3). https://doi.org/10.3329/jhpn.v28i3.5562 Kopple, J. D., Massry, S. G., & Kalantar-Zadeh, K. (2012). Nutritional management of renal disease. Academic Press. 2.)Responde to Adria\’s post below with 2 references at the end please. and respectfully agree or disagree with your colleague’s assessment and explain your reasoning. In your explanation, include why their explanations make physiological sense or why they do not. Adria discussion post. ain Discussion Post Protein is a nutrient that is essential to healthy physiological function on many levels. In this scenario, the diagnosis of protein malnutrition may be contributing to the patient’s symptoms in several ways. Protein deficiency can contribute to impaired mucosal cells of the intestines and inhibit proper nutrient absorption (McCance & Huether, 2019). Protein-Energy Malnutrition (PEM) Essay The impaired intestinal lining can contribute to lowered levels of plasma proteins such as albumin which can throw off the fluid balance inside and outside the cells. This can explain the patient’s symptoms of edema and ascites in the absence of clear liver disease (Nikaki & Gupte, 2016). If the patient has not been able to eat adequately due to not wearing his dentures, it is also reasonable to suspect that his protein malnutrition is resulting from the inadequate protein intake, as opposed to some genetic malabsorption disease. The process of edema can be occurring in the patient who is protein deficient due to decreases in the reabsorption of fluids. There is an imbalance of oncotic pressure that causes fluid to leave the cells and collect in the interstitial spaces. Also, lack of protein can interfere with cell structure in the capillaries and allow fluid to leak out due to increased cell permeability (McCance & Huether, 2019). Rendina et al. (2019) discuss that the fluid in the peritoneal cavity itself is often made up of protein and then contributes to lack of protein throughout the body where it needs to be. This can worsen the malabsorption problem for the patient with nutrients such as protein, as well as carbohydrates and fats, even if the patient is eating enough (Rendina et al., 2019). Other characteristics of the patient might change my response. For example, if the patient had evidence of some genetic disorder that could contribute to inter and intracellular imbalance. McCance & Huether (2019) describe that polycythemia vera is a genetic condition that most commonly occurs in people ages 60-80. It leads to increased red blood cells in the system. One of the outcomes of the imbalance can be portal hypertension and subsequent ascites (McCance & Huether, 2019). References McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children(8th ed.). Mosby/Elsevier. Nikaki, K., & Gupte, G. L. (2016). Assessment of intestinal malabsorption. Best Practice & Research. Clinical Gastroenterology, 30(2), 225–235. https://doi-org.ezp.waldenulibrary.org/10.1016/j.bpg.2016.03.003 Rendina, M., Viggiani, M. T., Di Leo, A., & Barone, M. (2019). Malnutrition, sarcopenia, and refractory ascites in end stage liver diseases: Is there a way to climb back up? Digestive & Liver Disease, 51(11), 1513–1514.

Tomi’s discussion response

Protein-energy malnutrition (PEM) describes a protein deficiency condition characterized by insufficient levels of dietary proteins and calories in the body. The disease caused an osmotic imbalance in the gastro-intestinal system resulting in swelling and retention of water in the body tissues (Marshall, 2016). As such I agree with Tomi’s discussion that PEM causes edema and is caused by reduced protein intake leading to accumulation of fluids in the abdomen and extremities.  However, more support could have been provided in reference to the patient’s lack of dentures which affects his mode of nutrition. The cells involved in the pathologic process are clearly discussed and their role in the development of edema with PEM. On other characteristics influencing the pathophysiology of PEM and edema, the author does not clearly identify the characteristics which are presumed to be age and gender according to the last two sentences of the discussion. Protein-Energy Malnutrition (PEM) Essay

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Adria discussion post

Protein-energy malnutrition (PEM) is associated with insufficient protein and other nutrients in the body.  According to McCance & Huether (2019), this scenario can cause edema through the impairment of the intestinal lining that allows fluids to leak to the outside surrounding. The accumulated fluids cause swelling and edema in the abdomen.  Following this explanation, Adria’s discussion is correct in associating protein deficiency with the patient’s edema symptoms. Increased cell permeability, imbalance of oncotic pressure and alteration of capillary structures caused by protein insufficiency in the body also causes the leakage and retention of fluids in the interstitial tissues through these structures. Therefore, I agree with the author’s articulation of ideas. Moreover, I conquer with her argument of the role of genetics and age in the development of PEM. However, a further explanation on specific gene mutations could have strengthened the argument.

References

Marshall, S. (2016). Protein-energy malnutrition in the rehabilitation setting: Evidence to improve identification. Maturitas, 86, 77-85.

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children(8th ed.). Mosby/Elsevier.Protein-Energy Malnutrition (PEM) Essay