A nurse is caring for a 79-year-old client admitted from a long-term care facility with weight loss of 9 kg over 4 months, BMI 18.1, MNA-SF score of 6 (high risk for malnutrition), serum albumin 2.4 g/dL, and a stage 2 pressure injury on the sacrum. The client has been NPO for 3 days due to a recent procedure. Which actions support comprehensive nutritional management? Select all that apply.

Severe malnutrition (BMI under 18.5, MNA-SF 0 to 7, low albumin, prolonged NPO) plus pressure injury and weight loss require careful nutritional rehabilitation that prevents refeeding syndrome. Required actions: (1) gradual refeeding at 25 to 50 percent of goal in the first 24 to 48 hours, advance over 3 to 7 days based on tolerance — direct refeeding syndrome prevention; (2) thiamine 100 mg before or with the first carbohydrate load — prevents Wernicke encephalopathy in alcoholics and prolonged starvation; (3) daily monitoring of phosphorus, magnesium, and potassium during the first week with replacement — captures intracellular shifts before arrhythmia or respiratory failure. Full TPN at goal on day 1 (option 2) is the textbook trigger for refeeding syndrome — life-threatening. Stopping oral supplements until weight stabilizes (option 5) worsens malnutrition; supplements should continue with monitoring. Waiting for pressure injury healing before high-protein nutrition (option 6) is backwards — protein deficit IS what impairs healing; aggressive protein (1.2 to 1.5 g/kg/day) supports wound healing while monitoring electrolytes.