5- malnutrition & nutritional support Flashcards
what is malnutrition?
state of nutrition where deficiency, excess or imbalance of energy, protein and other nutrients causing adverse effects
is malnutrition common?
yes, lots of hospital admissions - then gets worse in hospital
what are causes of malnutrition??
can be caused by disease but also can cause disease
- dietary (lack of availability or reduced intake physically or mentally)
- impaired digestion/absorption
what is circle of poor food intake just getting worse?
poor food intake →malnutrition →affects body = gut dysfunction, more vulnerable to infection, physical weakness →increased length of hospital say = circle as then makes poor food intake
what are examples of things causing chronic status of malnutrition?
- anorexia
- asthenia, depression
- dysphagia
- malabsorption, fistula
- infection
what are some effects of malnutrition (like physiological effects)?
- impaired immune response = increased risk of infection
- impaired wound healing
- reduced muscle strength & fatigue
- reduced respiratory muscle strength = increase risk of chest infection
- inactivity, especially bed bound
- water & electrolytes disturbances
- impaired thermoregulation
- menstrual irregularities = infertility
- impaired psychosocial = depression
what are some tests to be done to diagnose malnutrition?
- anthropometry = mid arm muscle circumference
- grip strength
- biochemistry like albumin, transferrin and more (not used much anymore)
what are some diseases that malnutrition can cause?
- beri- beri = deficiency of vit b1 (thiamine)
- scurvy = deficiency of vit C
- rickets = deficiency in vit D
- Korsakoff’s = severe thiamine deficiency due to chronic alcoholism
what is the steps of nutritional support?
- Food first
- Oral nutrition supplements = additional snacks or sip feeds
- Enteral nutrition = delivery of nutritionally complete feed directly into gut via tube
- parenteral nutrition = delivery of nutrition intravenously
what are some BMI type reasons for nutritional support?
- BMI <18.5
- BMI <20
- unintentional weight loss of 10% in 3-6 months
what are oral nutritional supplements?
things like ready made drink s(sip feed) and powders and supplements for fat, protein, carbs etc
what are different types of enteral feeding?
= delivery of a nutritionally, complete feed via tube into stomach, duodenum or jejunum
- nasogastric - nasojejunal - percutaneous endoscopic gastrostomy - percutaneous jejunostomy - surgical jejunostomy
what are indications for enteral feeding?
- inadequate or unsafe oral intake (like ability ro swallow)
- if gut is working use it (unconscious, upper GI obstruction, swallowing disorder)
what are contraindications for enteral feeding and why not enteral feeding for each of these?
- lower GI obstruction (pouring nutrition and blocking and causing symptoms)
- prolonged intestinal ileus (gut on strike)
- severe diarrhoea or vomiting (just making worse)
- high enterocutaneous fistula (feed will just go out via fistula)
- intestinal ischaemia (not going to be able to absorb)
what are complications of enteral feeding?
- insertion
- post insertion trauma
- displacement - moving of tubes e.g falling out
- reflux or aspiration
- GI intolerance
- metabolic consequences - fluid overload, electrolyte disturbance
