15. Malnutrition

Question 1

Malnutrition

Answer 1

state of nutrition in which a deficiency/ excess/ imbalance of energy, protein and other nutrients causes measurable adverse effects on tissue / body form and function

Question 2

What factors may contribute to malnutrition?

Answer 2

Poverty
Poor cooking skills 
Social isolation
Bereavement
Limited access to food

Question 3

What disease related factors may contribute to malnutrition?

Answer 3

Increased nutritional requirements e.g. Crohns disease
Nausea/ Voimiting
Diarrhoea
Early satiety
Depression/ anxiety
Inability to shop/ cook (mobility)

Question 4

List 7 consequences of being malnourished and its overall impact

Answer 4

Immune system: reduced ability to fight infection
Muscle weakness: Falls, heart failure
Kidneys: inability to regulate salt and fluid
Brain: Depression
Reproduction: reduced fertility
Impaired temperature regulation
Growth failure and stunting
=Increased risk of morbidity

Question 5

What is nutrition screening? Give an example

Answer 5

Quick and simple
By non-nutrition professional
Used to assess nutrition status and categorise risk
e.g. Malnutrition Universal Screening Tool (MUST)

Question 6

What is a nutrition assessment?

Answer 6

More detailed, in-depth
Could use anthropometrics
By a dietitian or specialist nutrition nurse

Question 7

List 4 assessments of body size

Answer 7

Weight
% Weight loss
BMI
Anthropometric measures

Question 8

2 methods of assessing food intake

Answer 8

24hr dietary recall

3-7 day food diary

Question 9

3 biochemical markers for nutritional status

Answer 9

Albumin and CRP
Creatinine
Cholesterol

Question 10

What is enteral tube feeding?

Answer 10

delivery of a nutritionally complete feed tube into the stomach, duodenum or jejunum

Question 11

Who would nasogastric enteral feeding be used for? Give an example

Answer 11

Individuals temporarily unable to meet their nutritional requirements by oral route but with functioning GI tract
Requiring nutritional support for <1 month
E.g. stroke patients

Question 12

Who would gastrostomy enteral feeding be used for?

Answer 12

Long term enteral feeding > 1 month

I.e. neurological swallowing problems, cognitive impairment, mechanical obstruction

Question 13

Who would jejunostomy tube enteral feeding be used for?

Answer 13

Upper GI obstruction or fistulae i.e. oesophagus stricture neoplastic disease of stomach/ duodenum
Early post-op feeding
Management of long term delayed gastric emptying

Question 14

What allows you to calculate how much to feed a patient enterically?

Answer 14

Predictive equations e.g. 25-30 kcal/kg

Question 15

List 4 complications of enteral feeding

Answer 15

Nausea/ vomiting
Tube issues e.g. blockage
Diarrhoea
Constipation

Question 16

What is parenteral nutrition?

Answer 16

Administration of nutrients, centrally or peripherally, where the GI tract is inaccessible OR there is insufficient GI function

Question 17

What is the most common access site for parenteral nutrition?

Answer 17

PICC site

Question 18

When is parenteral nutrition used?

Answer 18

To prevent/ treat malnutrition when GI tract function is impaired/ inaccessible and the patient is unable to absorb an adequate supply of nutrients
When all routes of enteral nutrition have been dismissed as clinically inappropriate

Question 19

Give 3 examples of situations that would require parenteral nutrition?

Answer 19

Prolonged ileus
Severe acute pancreatitis
Complex GI surgery

Question 20

What are the 4 types of complications of parenteral nutrition? Give an example of each

Answer 20

Insertion: pneumothorax
Line: Line sepsis
Short term metabolic: re-feeding syndrome
Long term metabolic: Liver disease

Question 21

List 4 advantages of enteral feeding

Answer 21

Cheap
Low level monitoring
Uses the gut
Tube can be placed at bedside

Question 22

List 3 disadvantages of enteral feeding

Answer 22

Metabolic problems e.g. refeeding syndrome
GI issues e.g. Vomiting
Tube complications e.g. misplacement

Question 23

List an advantage of parenteral feeding

Answer 23

Meets nutritional needs when GI tract is inaccessible

Question 24

List 5 disadvantages of parenteral feeding

Answer 24

Expensive
Needs close monitoring
Does not use the gut
Line complications e.g. pneumothorax
Metabolic complications e.g. refeeding syndrome

Question 25

What are the oral routes of nutritional support?

Answer 25

Food e.g. fortified diet

Nutritional supplements

Question 26

What is refeeding syndrome and when does it occur?

Answer 26

Metabolic disturbances that occur as a result of reinstitution of nutrition to patients who arestarved or severely malnourished
Occurs when patient is starved for 5 days then given nutrition

Question 27

List 3 types of potential consequences of refeeding syndrome

Answer 27

Cardiac e.g. Cardiac arrest
Respiratory e.g. Respiratory distress
Neuro-muscular e.g. Paralysis