18 Malnutrition Flashcards
Q: Define malnutrition. What can it include?
A: state of nutrition in which a deficiency or excess (or imbalance) of energy, protein and other nutrients causes measurable adverse effects on tissue / body form (body shape, size and composition) and function and clinical outcome
The term malnutrition does include obesity, however this session will relate to “undernutrition” only.
Q: What are the basic causes of malnutrition? (3) Underlying causes? (3) Immediate causes? (2)
A: underlying causes: Household food insecurity
Poor social and care environment
Poor access to healthcare & unhealthy environment
basic causes: Formal and internal infrastructure
Political ideology
Resources
Inadequate food
Disease
Q: What are potential consequences of being malnourished? (8)
A: - reduced ability to fight infection
- muscle weakness-> falls, heart failure
- kidney problems-> inability to regulate salt and water
- brain-> depression, self neglect
- reduced fertility
- decreased ability to control temperature
- growth failure- stunting
- micro-nutrient deficiences eg C (scurvy), B12 (anaemia)
Q: How do we diagnose malnutrition?
A: 1. nutritional screening
- nutritional assessment
- nutritional diagnosis
Q: What is nutritional screening? (4)
A: QUICK and simple, practical
During initial assessment of patient; regular intervals
By non-nutrition professional
not diagnosis
Q: What is a nutritional assessment? (3)
A: More detailed, in-depth
Could use anthropometrics
By a dietitian or specialist nutrition nurse
Q: How would you identify malnutrition?
A: -body size changes- weight, weight loss, BMI
- food intake (food diary)
- biochemistry- urea, creatinine, albumin & CRP
Q: What does nutritional support mean? Types? (3)
A: “Nutrition support is nutrition therapy for people unable to get enough nourishment from food and drink”
- if GIT is functioning-> oral dietary supplements/enteral feeding if they can’t take orally
- if GIT is not functioning-> parenteral feeding
enteral and parenteral= artificial nutritional support
Q: What is enteral nutrition? Access routes? (6)
A: Enteral tube feeding refers to the delivery of a nutritionally complete (usually everything they need) feed via a tube into the stomach, duodenum or jejunum
A tube is placed into GI tract to deliver liquid food.
Specifically named after destination from nose: nasooesophageal, nasogastric, nasoduodenal;
Or destination through percutaneously: oesophagostomy, gastrostomy, jejunostomy
Q: What is nasogastric enteral feeding for? (2)
A: Individuals temporarily unable to meet their nutritional requirements by oral route but with functioning GI tract
Individuals requiring nutritional support for <1 month.
Q: What is gastromic enteral feeding for? (2) Morbidity associated with it? What happens if placed inappropriately?
A: (destination through percutaneously)
Long term enteral feeding >1 month
i.e neurological swallowing problems eg stroke, cognitive impairment, mechanical obstruction
Low morbidity associated with placement (2%)
But when placed inappropriately, high post insertion mortality
Q: When is a jejunostomy tube (enteral feeding) needed? (3)
A: Upper GI obstruction or fistulae i.e. oesophagus stricture neoplastic disease of stomach/ duodenum
Early post-op feeding i.e. post-oesophagectomy, gastrectomy, pancreatoduodenectomy
Management of long term delayed gastric emptying
Q: How do you assess energy requirement?
A: Indirect calorimetry: gold standard for measured energy expenditure (good for research)
but in practice:
-predictive eqn eg weight based= 25-30kcal/Kg
Q: What can go wrong with enteral feeding? (5)
A: -Nausea and Vomiting:
Tube problems
Diarrhoea
Constipation
Metabolic Complications
Q: What can cause nausea and vomiting (enteral feeding)? (4)
A: Medication induced
High enteral feed volume too quickly
Delayed gastric emptying (if you’re going nasogastric route)
GI obstruction / ileus (post-op patients)
Q: What a tube problems in relation to enteral feeding? (4)
A: -Nasopharyngeal pain/ laryngeal ulceration. Tube blockage
- Aspiration of feed into lungs
- Misplacement of tube in lungs
- Migration of tube or accidental removal
Q: What can cause diarrhoea (enteral feeding)? (4) Constipation? (2)
A: -Intestinal infection
- Osmotic over load
- Medications
- Malabsorption
- Insufficient fluid/ fibre intake
- Decreased intestinal mobility
Q: What can cause metabolic complications (enteral feeding)? (2)
A: -Due to over or under feeding
-Re feeding syndrome
Q: What is parenteral feeding? How can it be given? (2) Compared to enteral?
A: The administration of nutrients, either centrally or peripherally, where the gastrointestinal tract is inaccessible OR there is insufficient gastrointestinal function.
PN may be given as the sole source of nutrition support (total parenteral nutrition -TPN) OR in combination with oral or enteral nutrition to meet a patient’s nutritional requirements.
less common, more complications
Q: Where is ‘access’ in parenteral feeding?
A: Peripherally inserted central catheter in arm (PICC)
eg cephalic vein
Q: When is parental feeding used? (3)
A: to prevent or treat malnutrition when the gastrointestinal (GI) tract function is impaired or inaccessible and the patient is therefore unable to absorb an adequate supply of nutrients
PN should only be considered when all routes of enteral nutrition have been considered and dismissed as clinically inappropriate
The potential risk outweighs benefit for the patient if PN is used for < 5 days
Q: What are the complications that can arise from parenteral feeding?
A: -Pneumothorax (collapsed lung) (insertion problem)
- bleeding (insertion problem)
- line sepsis
- thrombosis in line
- blockage in line
- re feeding syndrome (short term metabolic problem)
- liver disease (long term)
Q: What are the main advantages of enteral nutrition? (5) 3 main complications?
A: -lower risk of death
- less complications and easier than PN
- food and nutrient intake can be controlled
- no atrophy of gatsrointestinal structures through underuse (as with PN) // Maintains the internal structure and function of GI tract
- cheaper than PN
Nausea
Vomition
Aspiration
(lower risk of complications)
Q: What are the main advantages of T parenteral nutrition? (3) 4 main complications? cost?
A: -ensure nutrition when EN is inappropriate
-quicker absorption as going straight to blood stream
Blood clots Infection Liver failure Causes atrophy of gatsrointestinal structures through underuse (High risk of serious complications)
5x more expensive
