Weight loss, excessive
Weight loss, excessive: Excerpt from Signs & Symptoms: A 2-in-1 Reference for Nurses
Weight loss can reflect decreased food intake, decreased food absorption, increased metabolic requirements, or a combination of the three. Its causes include endocrine, neoplastic, GI, and psychiatric disorders; nutritional deficiencies; infections; and neurologic lesions that cause paralysis and dysphagia. However, weight loss may accompany conditions that prevent sufficient food intake, such as painful oral lesions, ill-fitting dentures, and loss of teeth. It may be the metabolic effect of poverty, fad diets, excessive exercise, or certain drugs.
Weight loss may occur as a late sign in such chronic diseases as heart failure and renal disease. In these diseases, however, it’s the result of anorexia. (See “Anorexia,” page 42.)
History
Begin with a thorough diet history because weight loss almost always is caused by inadequate caloric intake. If the patient hasn’t been eating properly, try to determine why. Ask him about previous weight and if the recent loss was intentional. Be alert to lifestyle or occupational changes that may be a source of anxiety or depression. For example, has he gotten separated or divorced? Has he recently changed jobs?
Inquire about recent changes in bowel habits, such as diarrhea or bulky, floating stools. Has the patient had nausea, vomiting, or abdominal pain, which may indicate a GI disorder? Has he had excessive thirst, excessive urination, or heat intolerance, which may signal an endocrine disorder? Take a careful drug history, noting especially use of diet pills and laxatives.
Physical assessment
Carefully check the patient’s height and weight. Ask about his previous weight. Take his vital signs and note his general appearance: Is he well nourished? Do his clothes fit? Is muscle wasting evident? Ask about exact weight changes (with approximate dates).
Next, examine the patient’s skin for turgor and abnormal pigmentation, especially around the joints. Does he have pallor or jaundice? Examine his mouth, including the condition of his teeth or dentures. Look for signs of infection or irritation on the roof of the mouth, and note any hyperpigmentation of the buccal mucosa. Also check the patient’s eyes for exophthalmos and his neck for swelling; evaluate his lungs for adventitious sounds. Inspect his abdomen for signs of wasting, and palpate for masses, tenderness, and an enlarged liver.
Conventional laboratory and radiologic investigations, such as complete blood count, serum albumin levels, urinalysis, chest X-ray, and upper GI series usually reveal the cause of weight loss.
Medical causes
Adrenal insufficiency
Weight loss occurs with adrenal insufficiency, along with anorexia, weakness, fatigue, irritability, syncope, nausea, vomiting, abdominal pain, and diarrhea or constipation. Hyperpigmentation may occur at the joints, belt line, palmar creases, lips, gums, tongue, and buccal mucosa.
Anorexia nervosa
Anorexia nervosa, a psychogenic disorder that’s most common in young women, is characterized by a severe, self-imposed weight loss ranging from 10% to 50% of premorbid weight, which typically was normal or not more than 5 lb (2.3 kg) over ideal weight. Related findings include skeletal muscle atrophy, loss of fatty tissue, hypotension, constipation, dental caries, susceptibility to infection, blotchy or sallow skin, cold intolerance, hairiness on the face and body, dryness or loss of scalp hair, and amenorrhea. The patient usually demonstrates restless activity and vigor and may also have a morbid fear of becoming fat. Self-induced vomiting or use of laxatives or diuretics may lead to dehydration or to metabolic alkalosis or acidosis.
Cancer
Weight loss is often a sign of cancer. Other findings reflect the type, location, and stage of the tumor and can include fatigue, pain, nausea, vomiting, anorexia, abnormal bleeding, and a palpable mass.
Crohn’s disease
With Crohn’s disease, weight loss occurs with chronic cramping, abdominal pain, and anorexia. Other signs and symptoms include diarrhea, nausea, fever, tachycardia, abdominal tenderness and guarding, hyperactive bowel sounds, abdominal distention, and pain. Perianal lesions and a palpable mass in the right or left lower quadrant may also be present.
Cryptosporidiosis
Weight loss may occur with cryptosporidiosis, an opportunistic protozoan infection. Other findings include profuse watery diarrhea, abdominal cramping, flatulence, anorexia, malaise, fever, nausea, vomiting, and myalgia.
Depression
Weight loss or weight gain may occur with severe depression, along with insomnia or hypersomnia, anorexia, apathy, fatigue, and feelings of worthlessness. Indecisiveness, incoherence, and suicidal thoughts or behavior may also occur.
Diabetes mellitus
Weight loss may occur with diabetes mellitus, despite increased appetite. Other findings include polydipsia, weakness, fatigue, blurred vision, and polyuria with nocturia.
Esophagitis
Painful inflammation of the esophagus leads to temporary avoidance of eating and subsequent weight loss. Intense pain in the mouth and anterior chest occurs, along with hypersalivation, dysphagia, tachypnea, and hematemesis. If a stricture develops, dysphagia and weight loss will recur.
Gastroenteritis
Malabsorption and dehydration cause weight loss in gastroenteritis. The loss may be sudden in acute viral infections or reactions or gradual in parasitic infection. Other findings include poor skin turgor, dry mucous membranes, tachycardia, hypotension, diarrhea, abdominal pain and tenderness, hyperactive bowel sounds, nausea, vomiting, fever, and malaise.
Herpes simplex 1
With herpes simplex 1, painful fluid-filled blisters in and around the mouth, especially the tongue, gums, and cheeks, make eating painful causing decreased food intake and weight loss. Fever and pharyngitis may also occur.
Leukemia
Acute leukemia causes progressive weight loss accompanied by severe prostration; high fever; swollen, bleeding gums; and bleeding tendencies. Dyspnea, tachycardia, palpitations, and abdominal or bone pain may occur. As the disease progresses, neurologic symptoms may eventually develop.
Chronic leukemia, which occurs insidiously in adults, causes progressive weight loss with malaise, fatigue, pallor, enlarged spleen, bleeding tendencies, anemia, skin eruptions, anorexia, and fever.
Lymphoma
Hodgkin’s disease and non-Hodgkin’s lymphoma cause gradual weight loss. Associated findings include fever, fatigue, night sweats, malaise, hepatosplenomegaly, and lymphadenopathy. Scaly rashes and pruritus may develop.
Pulmonary tuberculosis
Pulmonary tuberculosis causes gradual weight loss, along with fatigue, weakness, anorexia, night sweats, and low-grade fever. Other clinical effects include a cough with bloody or mucopurulent sputum, dyspnea, and pleuritic chest pain. Examination may reveal dullness on percussion, crackles after coughing, increased tactile fremitus, and amphoric breath sounds.
Stomatitis
Inflammation of the oral mucosa (usually red, swollen, and ulcerated) in stomatitis causes weight loss due to decreased eating. Associated findings include fever, increased salivation, malaise, mouth pain, anorexia, and swollen, bleeding gums.
Thyrotoxicosis
With thyrotoxicosis, increased metabolism causes weight loss. Other characteristic signs and symptoms include nervousness, heat intolerance, diarrhea, increased appetite, palpitations, tachycardia, diaphoresis, fine tremor, and possibly an enlarged thyroid and exophthalmos. A ventricular or atrial gallop may be heard.
Ulcerative colitis
Weight loss is a late sign of ulcerative colitis, which is initially characterized by bloody diarrhea with pus or mucus. Weakness, crampy lower abdominal pain, tenesmus, anorexia, low-grade fever, and occasional nausea and vomiting may also occur. Bowel sounds are hyperactive, and constipation may occur late. With fulminant colitis, severe and steady abdominal pain and diarrhea, high fever, and tachycardia occur.
Other causes
Drugs
Amphetamines and inappropriate dosage of thyroid preparations commonly lead to weight loss. Laxative abuse may cause a malabsorptive state that leads to weight loss. Chemotherapeutic agents cause stomatitis, which, when severe, causes weight loss.
Special considerations
If the patient has a chronic disease, administer hyperalimentation or tube feedings to maintain nutrition and to prevent edema, poor healing, and muscle wasting. Take daily calorie counts and weigh him weekly. Consult a nutritionist to determine an appropriate diet with adequate calories.
Pediatric pointers
In infants, weight loss may be caused by failure-to-thrive syndrome. In children, severe weight loss may be the first indication of diabetes mellitus. Chronic, gradual weight loss occurs in children with marasmus — nonedematous protein-calorie malnutrition.
Weight loss may also occur as a result of child abuse or neglect; an infection causing high fevers; hand-foot-and-mouth disease, which causes painful oral sores; a GI disorder causing vomiting and diarrhea; or celiac disease.
Geriatric pointers
Some elderly patients experience mild, gradual weight loss due to changes in body composition, such as loss of height and lean body mass, and lower basal metabolic rate, leading to decreased energy requirements. Rapid, unintentional weight loss, however, is highly predictive of morbidity and mortality in the elderly. Other nondisease causes of weight loss in this group include tooth loss, difficulty chewing, and social isolation. Alcoholism may also cause weight loss.
Patient counseling
Refer your patient for psychological counseling if weight loss negatively affects his body image. Teach the patient about his diet and recommend that he keep a food diary. Determine his food preferences and try to incorporate them into his diet. Encourage oral hygiene before meals to make the food more palatable.
Pictures
Book Source Details
- Book Title: Signs & Symptoms: A 2-in-1 Reference for Nurses
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2007 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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