8 - Nutrition Flashcards
What are some causes of malnutrition
See image for specifics
- Reduced dietary intake
- Malaborption
- Increased losses
- Energy expenditure
What are the consequences of malnutrition on the following:
How can we screen for malnutrition?
MUST (5 Steps)
- BMI
- Unintentional weight loss
- Likelihood of future weight loss
What are the four stages of wound healing?
- Haemostasis
- Inflammation
- Proliferation
- Remodelling
How do the following factors influence wound healing and what stages are affected of the healing process:
- Oxygenation
- Infection
- Foreign body
- Venous Insufficiency
- 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
What are some local and systemic factors that can affect wound healing?
Local: oxygenation, infection, foreign body, venous insufficiency
Systemic: age, stress, ischaemia, diabetes, uraemia, obesity, steroids, NSAIDs, chemotherapy, malnutrition, immunocompromised
Why does chemotherapy affect wound healing?
- Inhibition of cell division and protein synthesis which is needed for wound healing
- Immunocompromised so susceptible to infection
Why does diabetes affect wound healing?
- Weaker immune system
- Poor circulation
- Peripheral neuropathy
- Hyperglycaemia increases risk of infection
What are some signs of wound infection?
- Fever
- Pain
- Erythema
- Heat
- Swelling
What is a pressure ulcer?
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
What are the common sites for pressure ulcers?
- Tailbone or hips
- Heels of the feet
- Back of head/ears
- Elbows
- Inner knees
- Shoulder
What are some screening tools used to assess pressure ulcers?
- Braden Scale
- Waterlow Scale
- Norton Scale
When should you do a pressure ulcer risk assessment?
How do you do a skin assessment on the ward?
Check pressure areas for:
- Pain and discomfort
- Skin integrity
- Colour changes, if any erythema see if blanchable
- Variations in heat, moisture, firmness
What should you do if you see a patient has non-blanching erythema on a skin assessment?
Risk of pressure ulcer so needs repositioning every 2 hours until resolves
What are some preventative measures for pressure ulcers?
- 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
What is the Braden Scale?
Six factors contribute to risk of and intensity of pressure ulcer:
- Sensory perception
- Nutrition
- Friction and Shear
- Mobility
- Moisture
- Activity
Lower the score greater the risk!!!!
What is the Waterlow Score?
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
How can you estimate somebody’s height if they are unconscious or immobile?
Ulna Length
How can you estimate somebody’s BMI without a weight or height?
Ulna Length
How can you estimate somebody’s BMI without their weight and height?
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)
How do you generate a plan after calculating somebody’s MUST score?
What interventions do you do for Braden Score 13-18?
If 13-14 need to do all the same as 15-18 PLUS 30 degree lateral incline using foam wedges
What do you do for somebody with Braden Score 9 or less?
What are some causes of nutritional decline?
What are the different levels of feeding that SALT can put patients on?
What are some risk factors for developing pressure ulcers?
- Immobility
- Incontinence
- Lack of sensory perception: spinal cord injuries, neurological disorders
- Poor nutrition and hydration
- Medical conditions affecting blood flow: diabetes and vascular disease
What are some complications of pressure ulcers?
- Cellulitis
- Septic arthritis
- Osteomyelitis
- Long-term, nonhealing wounds (Marjolin’s ulcers) can develop into SCC
- Sepsis
What are some local and systemic factors that can affect wound healing?
Local: oxygenation, infection, foreign body, venous insufficiency
Systemic: age, stress, ischaemia, diabetes, uraemia, obesity, steroids, NSAIDs, chemotherapy, malnutrition, immunocompromised
