14 Malnutrition

Question 1

Define malnutrition

Answer 1

It is a nutrition state in which a deficiency or excess of energy causes measurable adverse effect on body

Question 2

What is the annul cost of under nutrition

Answer 2

19.6 million

Question 3

What is the size of undernutrition in the UK

Answer 3

20% of patients admitted to the mental health units at risk of undernutrition

Question 4

What factors may contribute to a patient becoming malnourished

Answer 4

Inadequate food intake: poverty, poor cooking skills, social isolation, limited access to food, bereavement

Disease related: diarrhoea, nausea/vomiting, depression, side effects of medications, immobility

Question 5

What are the consequences of malnutrition

Answer 5

Immune system - reduced immunity
Brain - depression
Muscle weakness
Kidney - inability to regulate fluid and salt
Reproductive failure
Growth failure
Micronutrient deficiency: vitamin C deficiency causing scurvy

Question 6

True or false: Lean body weight loss correlates with mortality

Answer 6

True

Question 7

What are the methods used to evaluate nutritional status

Answer 7

Nutrition screening
Nutrition assessment
Diagnosis

Question 8

Differentiate between nutrition screening and nutrition assessment

Answer 8

Nutrition screening:
- simple, practical and simple
- during initial assessment of patient; regular interval
- done by non nutritional professional
Nutrition assessment
- more in-depth and detailed
- could use anthropometric
- by a nurse specialist or dietician

Question 9

How do you identify malnutrition

Answer 9

Physical: unintentional weight loss, tiredness, bowel changes, change to hair or skin

Biochemistry: anaemia (vitamin B12), urea and creatinine, vitamin D/calcium phosphate

Nutritional: diet assessment, lifestyle factors

Question 10

Define nutrition support

Answer 10

Nutritional therapy for the people who cannot get enough nourishment from food and drink

Question 11

What are the types of nutrition support

Answer 11

Oral diet/supplement
Enteral feeding
Parenteral feeding

Question 12

What are the access route for enteral feeding

Answer 12

Nasogastric
Nasoduodenal
Nasojujenal
Gastrostomy
Jejunostomy

Question 13

What are the indications for nasogastric feeding

Answer 13

Short term < 1 month

Individual temporarily unable to meet nutritional requirement

Question 14

What are the indications of gastrostomy

Answer 14

Neurological swallowing problems
Mechanical obstruction
Low morbidity associated with placement but high post insertion mortality if placed inappropriately

Question 15

What are the indications of jejunostomy

Answer 15

Upper GI obstruction
Management of long term delay gastric emptying
Early post operation feeding

Question 16

What are the complications of enteral feeding

Answer 16

Diarrhoea, constipation, nausea/vomiting, malabsorption (eg Crohn’s disease), tube issues (such as misplacement),metabolic complications (eg are feeding syndrome)

Question 17

What is the indication of parenteral feeding

Answer 17

Only considered when all other alternatives to treat malnutrition are considered inappropriate (eg GI tract not functional)

Question 18

What are the complications associated with parenteral feeding

Answer 18

Insertion complication: pneumothorax, bleeding, misplacement
Tube complications: line sepsis, thrombosis, leaking, occlusion
Metabolic
- short term: referring syndrome, hyper or hypoglycaemia
- Long term: liver disease, cholelithiasis, metabolic bone disease

Question 19

Compare the advantages between enteral and parenteral feeding

Answer 19

Enteral: cheap, uses the gut, meet nutritional needs, low level of monitoring

Parenteral: can meet nutritional demand when GI tract not functioning

Question 20

What is referring syndrome

Answer 20

It’s a syndrome consisting of metabolic disturbances that occurs as a result of reinstitution of nutrition to patients who are starved or severely malnourished. Usually occurs when a
Edson has been starved over 5 days

Question 21

Describe the biochemical pathology of receding syndrome

Answer 21

1. Patient starved and causes increase in glucagon and cortisol associated with decrease in insulin.
2. The body undergoes glycogenolysis, gluconeogenesis and Protein catabolism
3. Body deficient of electrolytes, proteins, fats, vitamins, minerals
4. Feed the patient -> insulin increase to increase protein and glycogen and uptake of glucose
5. Uptake of phosphate, magnesium and potassium
6. Causes hypophosphataemia, hypokalaemia, hypomagnesia, thiamine deficiency and water, sodium retention

Question 22

What are the consequences of refeeding syndrome

Answer 22

Cardiac: arrhythmia
Respiratory: acute ventilator failure (phosphate), respiratory distress (potassium) and respiratory depression (magnesium)
Neuromuscular: lethargy and confusion (phosphate) weakness

Question 23

What is the management for refeeding syndrome

Answer 23

Electrolyte replacement (phosphate, potassium and magnesium)
Vitamin supplementation (vitamin B and thiamine)
Start nutrition support and increasing slowly