Adult Failure to Thrive (New for 2025)
1
Priority
Nutritional assessment and early enteral nutrition
2
Key Markers
Prealbumin and albumin
1
Intervention
Early mobility programs
Nutritional Assessment and Intervention
you cannot recover what you do not replaceUnintentional weight loss greater than 5% in one month
Sarcopenia and progressive muscle wasting
Prealbumin as short-term nutritional marker (half-life 2-3 days)
Albumin as chronic nutritional marker (half-life 20 days)
Early enteral nutrition within 24-48 hours of ICU admission
Caloric and protein targets guided by dietitian assessment
Parenteral nutrition only when enteral route is not available
Prealbumin is a better short-term nutritional marker than albumin because it has a shorter half-life
Mobility and Functional Decline
ICU-acquired weakness develops within days of immobility
Progressive mobility protocol (passive ROM to ambulation)
Physical therapy consultation early in ICU stay
Sedation vacation facilitates participation in mobility
Social withdrawal and depression compound physical decline
Interdisciplinary approach (nursing, PT, OT, dietitian, social work)
Key Values to Memorize
Prealbumin t½ = 2-3 days
Albumin t½ = 20 days
Enteral within 24-48 hrs
>5% weight loss in 1 mo
Early mobility program
New 2025 test topic
nutrition and mobility are now testable on the CCRN
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Practice CCRN QuestionsExam Traps
Prealbumin is better than albumin for short-term status
Prealbumin has a half-life of 2-3 days compared to albumin at 20 days. This makes prealbumin a much more responsive marker for tracking acute changes in nutritional status. If you want to know whether nutritional interventions are working this week, check prealbumin.
Early enteral nutrition is the priority
Enteral nutrition should be started within 24-48 hours of ICU admission when the gut is functional. It maintains gut mucosal integrity, reduces bacterial translocation, and supports immune function. Parenteral nutrition is reserved for patients who cannot tolerate enteral feeding.
Early mobility prevents ICU-acquired weakness
ICU-acquired weakness develops rapidly during critical illness. Patients can lose significant muscle mass within days of immobility. Early progressive mobility programs (passive ROM, dangling, sitting, standing, walking) reduce ventilator days, ICU length of stay, and functional decline.
Albumin Is Too Slow
Albumin half-life is 20 days. It reflects chronic status, not recent changes. Use prealbumin (2-3 day half-life) to track acute nutritional response.
Feed Early, Move Early
Enteral nutrition within 24-48 hours. Mobility program as soon as hemodynamically stable. Both prevent the cascade of decline.
A critically ill patient is like a garden left unwatered and untended. Without nutrition (water), movement (sunlight), and attention (weeding), everything withers. Muscles waste, immune function drops, wounds stop healing, and the patient spirals further from recovery.
Enteral nutrition is the watering schedule. Start it as soon as possible. The gut needs to stay active to maintain its barrier function. A starving gut lets bacteria cross into the bloodstream, creating new infections on top of existing illness.
Early mobility is the sunlight. Muscles that do not move atrophy within days. Getting patients moving, even passively at first, preserves muscle mass, improves respiratory function, and shortens the time they spend dependent on machines.
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