8 - Nutrition

Question 1

What are some causes of malnutrition

Answer 1

See image for specifics

• Reduced dietary intake
• Malaborption
• Increased losses
• Energy expenditure

Question 2

What are the consequences of malnutrition on the following:

Answer 2

Question 3

How can we screen for malnutrition?

Answer 3

MUST (5 Steps)

• BMI
• Unintentional weight loss
• Likelihood of future weight loss

Question 4

What are the four stages of wound healing?

Answer 4

1. Haemostasis
2. Inflammation
3. Proliferation
4. Remodelling

Question 5

How do the following factors influence wound healing and what stages are affected of the healing process:

• Oxygenation
• Infection
• Foreign body
• Venous Insufficiency

Answer 5

• Oxygenation: oxidative killing of bacteria, regeneration of collagen, epithelial cell migration, formation of new blood vessels
• Infection: prolonged inflammatory phase
• Foreign body: prolonged inflammatory phase
• Venous Insufficiency: venous hypertension so lack of oxygen and nutrients to area so tissue damage and breaks down

Question 6

What are some local and systemic factors that can affect wound healing?

Answer 6

Local: oxygenation, infection, foreign body, venous insufficiency

Systemic: age, stress, ischaemia, diabetes, uraemia, obesity, steroids, NSAIDs, chemotherapy, malnutrition, immunocompromised

Question 7

Why does chemotherapy affect wound healing?

Answer 7

• Inhibition of cell division and protein synthesis which is needed for wound healing
• Immunocompromised so susceptible to infection

Question 8

Why does diabetes affect wound healing?

Answer 8

• Weaker immune system
• Poor circulation
• Peripheral neuropathy
• Hyperglycaemia increases risk of infection

Question 9

What are some signs of wound infection?

Answer 9

• Fever
• Pain
• Erythema
• Heat
• Swelling

Question 10

What is a pressure ulcer?

Answer 10

Area of damaged skin and/or tissues below as a result of being placed under pressure

Can be very painful, led to extended hospital stays and get infected and lead to sepsis

Question 11

What are the common sites for pressure ulcers?

Answer 11

• Tailbone or hips
• Heels of the feet
• Back of head/ears
• Elbows
• Inner knees
• Shoulder

Question 12

What are some screening tools used to assess pressure ulcers?

Answer 12

1. Braden Scale
2. Waterlow Scale
3. Norton Scale

Question 13

When should you do a pressure ulcer risk assessment?

Answer 13

Question 14

How do you do a skin assessment on the ward?

Answer 14

Check pressure areas for:

• Pain and discomfort
• Skin integrity
• Colour changes, if any erythema see if blanchable
• Variations in heat, moisture, firmness

Question 15

What should you do if you see a patient has non-blanching erythema on a skin assessment?

Answer 15

Risk of pressure ulcer so needs repositioning every 2 hours until resolves

Question 16

What are some preventative measures for pressure ulcers?

Answer 16

• Repositioning: every 4 hours if high risk, every 6 hours if just risk
• Pressure redistribution foam mattress
• Barrier cream: if risk of moisture lesion or incontinence-associated dermatitis

Question 17

What is the Braden Scale?

Answer 17

Six factors contribute to risk of and intensity of pressure ulcer:

1. Sensory perception
2. Nutrition
3. Friction and Shear
4. Mobility
5. Moisture
6. Activity

Lower the score greater the risk!!!!

Question 18

What is the Waterlow Score?

Answer 18

Looks at risk of development of pressure ulcer

• Build/weight for height
• Skin type/visual risk areas
• Sex and age
• Malnutrition Screening Tool
• Continence
• Mobility

no

Additional points in special risk categories are assigned to selected patients.

• Tissue malnutrition
• Neurological deficit
• Major surgery or trauma

10 is risk, 15 is high risk, 20 is very high risk

Question 19

How can you estimate somebody’s height if they are unconscious or immobile?

Answer 19

Ulna Length

Question 20

How can you estimate somebody’s BMI without a weight or height?

Answer 20

Ulna Length

Question 21

How can you estimate somebody’s BMI without their weight and height?

Answer 21

Mid Upper Arm Circumference (MUAC)

<23.5 cm, BMI is likely to be <20 kg/m2 (underweight)

>32.0 cm, BMI is likely to be >30 kg/m2 (obese)

Question 22

How do you generate a plan after calculating somebody’s MUST score?

Answer 22

Question 23

What interventions do you do for Braden Score 13-18?

Answer 23

If 13-14 need to do all the same as 15-18 PLUS 30 degree lateral incline using foam wedges

Question 24

What do you do for somebody with Braden Score 9 or less?

Answer 24

Question 25

What are some causes of nutritional decline?

Answer 25

Question 26

What are the different levels of feeding that SALT can put patients on?

Answer 26

Question 27

What are some risk factors for developing pressure ulcers?

Answer 27

* **Immobility** * **Incontinence** * **Lack of sensory perception:** spinal cord injuries, neurological disorders * **Poor nutrition and hydration** * **Medical conditions affecting blood flow:** diabetes and vascular disease

Question 28

What are some complications of pressure ulcers?

Answer 28

* **Cellulitis** * **Septic arthritis** * **Osteomyelitis** * Long-term, nonhealing wounds (Marjolin's ulcers) can develop into **SCC** * **Sepsis**

Question 29

What are some local and systemic factors that can affect wound healing?

Answer 29

**Local:** oxygenation, infection, foreign body, venous insufficiency **Systemic:** age, stress, ischaemia, diabetes, uraemia, obesity, steroids, NSAIDs, chemotherapy, malnutrition, immunocompromised