Understanding the Effects of the Cachexia Cycle
Assessment
Assessment begins with a thorough history of patient's nutritional intake, weight loss, and symptoms (Table 1). There are several useful tools for measuring subjective reports of appetite loss and accompanying symptoms of cachexia. The Edmonton Symptom Assessment Scale–Revised is a 10-question Likert scale where patients indicate the severity of the symptoms they are experiencing, which includes pain, fatigue, drowsiness, nausea, appetite, dyspnea, anxiety, overall well-being, and any other symptoms they may be experiencing. Another tool is the Simplified Nutritional Assessment Questionnaire, which predicts weight loss. This questionnaire focuses on appetite, the taste, and daily food consumption. A low score of less than or equal to 14 indicates the potential for 5% weight loss in the next 6 months.Table 1 is a simple assessment survey that reviews pertinent areas.
Diagnostics
In addition to the subjective information, the nurse should obtain daily or weekly weights and encourage the patient to keep a daily food journal. Midarm circumference can be used to measure body fat and muscle mass in healthy individuals and can be used for longitudinal follow-up for patients with advanced illness while simultaneously serving as a prognostic indicator (Table 1).
There are some laboratory markers helpful in diagnosing cachexia, including prealbumin, cholesterol, and C-reactive protein. Prealbumin is the best marker of cardiac cachexia as it indicates protein-calorie malnutrition. C-reactive protein becomes elevated as a result of inflammation and is generally a nonspecific indicator but can be helpful to confirm a presumptive diagnosis of cachexia. Normal prealbumin levels are 16 to 35 mg/dL; a diagnosis of cardiac cachexia can be made when levels are less than 16, or if albumin is less than 3.2 g/L. Cholesterol may be lower in cardiac cachexia, and a total cholesterol level of less than 172 is associated with poor prognosis in cachectic patients. Body mass index is not an indicator of adequate body fat and muscle composition and should not be used in diagnosing cardiac cachexia.