An 80-year-old client has been hospitalized with pneumonia and malnutrition. Physical assessment findings include weakness and decreased muscle mass. Which finding best indicates that the client is responding to treatment?

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Malnutrition occurs due to inadequate intake of major nutrients (eg, calories, carbohydrates, fat, protein) or micronutrients (eg, minerals, vitamins). As malnutrition worsens and protein intake is reduced, muscles become fatigued and weak. Clinical manifestations depend on the severity of the malnutrition, ranging from mild to extreme (eg, emaciation). Weight gain is the best indicator that the client is responding to medical nutritional therapy. (Option A) Consuming 90% of meals indicates that the client's appetite is good or improving but does not provide conclusive evidence of an improved nutritional status. (Option B) Although a serum albumin level of 3.6 g/dL (36 g/L) is within the normal range of 3.5-5.0 g/dL (35-50 g/L), visceral protein stores are poor indicators of nutritional status in acute and chronic disease. During an inflammatory response (eg, pneumonia), protein synthesis by the liver is decreased. Serum albumin has a long half-life, so laboratory levels may not reflect the change in nutritional status for over 2 weeks. Prealbumin has a half-life of only 2 days and is quicker and more reliable than serum albumin as an indicator of acute change in nutritional status. (Option D) A white blood cell count of 15,000/mm³ (15.0 × 10⁹/L) is elevated (normal: 4,000-11,000/mm³ [4.0-10.0 × 11⁹/L]), which indicates that the infection has not resolved. Educational objective: The best assessment finding for indicating improved nutritional status is a steady weight gain over a specified period. Serum prealbumin is a faster and more reliable indicator of current nutritional status than serum albumin.

An 80-Year-Old Client Has Been Hospitalized with Pneumonia and Malnutrition