14 Malnutrition Flashcards
Define malnutrition
It is a nutrition state in which a deficiency or excess of energy causes measurable adverse effect on body
What is the annul cost of under nutrition
19.6 million
What is the size of undernutrition in the UK
20% of patients admitted to the mental health units at risk of undernutrition
What factors may contribute to a patient becoming malnourished
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
What are the consequences of malnutrition
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
True or false: Lean body weight loss correlates with mortality
True
What are the methods used to evaluate nutritional status
Nutrition screening
Nutrition assessment
Diagnosis
Differentiate between nutrition screening and nutrition assessment
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
How do you identify malnutrition
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
Define nutrition support
Nutritional therapy for the people who cannot get enough nourishment from food and drink
What are the types of nutrition support
Oral diet/supplement
Enteral feeding
Parenteral feeding
What are the access route for enteral feeding
Nasogastric Nasoduodenal Nasojujenal Gastrostomy Jejunostomy
What are the indications for nasogastric feeding
Short term < 1 month
Individual temporarily unable to meet nutritional requirement
What are the indications of gastrostomy
Neurological swallowing problems
Mechanical obstruction
Low morbidity associated with placement but high post insertion mortality if placed inappropriately
What are the indications of jejunostomy
Upper GI obstruction
Management of long term delay gastric emptying
Early post operation feeding
What are the complications of enteral feeding
Diarrhoea, constipation, nausea/vomiting, malabsorption (eg Crohn’s disease), tube issues (such as misplacement),metabolic complications (eg are feeding syndrome)
What is the indication of parenteral feeding
Only considered when all other alternatives to treat malnutrition are considered inappropriate (eg GI tract not functional)
What are the complications associated with parenteral feeding
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
Compare the advantages between enteral and parenteral feeding
Enteral: cheap, uses the gut, meet nutritional needs, low level of monitoring
Parenteral: can meet nutritional demand when GI tract not functioning
What is referring syndrome
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
Describe the biochemical pathology of receding syndrome
- Patient starved and causes increase in glucagon and cortisol associated with decrease in insulin.
- The body undergoes glycogenolysis, gluconeogenesis and Protein catabolism
- Body deficient of electrolytes, proteins, fats, vitamins, minerals
- Feed the patient -> insulin increase to increase protein and glycogen and uptake of glucose
- Uptake of phosphate, magnesium and potassium
- Causes hypophosphataemia, hypokalaemia, hypomagnesia, thiamine deficiency and water, sodium retention
What are the consequences of refeeding syndrome
Cardiac: arrhythmia
Respiratory: acute ventilator failure (phosphate), respiratory distress (potassium) and respiratory depression (magnesium)
Neuromuscular: lethargy and confusion (phosphate) weakness
What is the management for refeeding syndrome
Electrolyte replacement (phosphate, potassium and magnesium) Vitamin supplementation (vitamin B and thiamine) Start nutrition support and increasing slowly
