[9] Nutrition Flashcards
What is a healthy diet?
One which provides the body with the right balance of nutrients
What is a healthy diet visually represented by?
Eatwell Guide
What does the Eatwell Plate show?
The ideal contribution of the different food groups to our diet
Who does the Eatwell Guide apply to?
Most people
What specific groups is it important to recognise that the Eatwell Guide applies to?
- Vegetarians
- Minority ethnic groups
- Overweight
- Healthy BMI
When may the proportions of the Eatwell Guide require adjusting?
In hospital patients who are elderly and/or at nutritional risk
What are the categories on the Eatwell Guide?
- Fruit and veg
- Starchy carbohydrates
- Dairy and alternatives
- Proteins
- Oils and spreads
What are some examples of starchy carbohydrates?
- Potatoes
- Bread
- Rice
- Pasta
What are some example of protein sources?
- Beans
- Pulses
- Fish
- Eggs
- Meat
As well as the food groups, what else forms an important part of nutrition?
Hydration
What can good hydration help to prevent?
- Pressure ulcers
- Constipation
- Blood clots
- Kidney and gallstones
- Heart disease
- Confusion
- Falls
- Memory loss
- Poor oral health
- Diabetic complications
- Dizziness
- UTI
- Incontinence
What is the recommended daily intake of fluids?
2L per day
Is a patient’s nutritional risk static?
No, it can change throughout their admission
How are patients identified as being at nutritional risk?
By nutritional screening
Who usually conducts a nutritional screen for patients?
Nursing staff - all staff should know the process
What are some examples of screening tools used to assess a patient’s nutritional status?
- Leicestershire NST
- MUST
What is the Leicestershire NST?
Leicestershire Nutritional Screening Tool
What is the MUST?
Malnutrition Universal Screening Tool
What should happen to the results of a nutritional assessment?
Recorded in the patient’s notes
What are the steps of MUST?
1 - Measure height and weight to calculate BMI
2 - Note percentage unplanned weight loss
3 - Establish acute disease effect and score
4 - Add scores from steps 1-3
5 - Develop appropriate care plan
What is a high risk score for MUST?
2 or more
What is a medium risk score on MUST?
1
What should happen to patients with a MUST of 2 or more?
Start intervention immediately with dietician input
What should happen to patients with a MUST score of 1?
Monitor closely with food charts for 3 days then decide about further intervention
What are the common underlying causes of malnutrition in older people?
- General function
- Cognitive impairment
- Swallowing problems
- Dentition
- Medication
What aspects of general function can lead to malnutrition?
- Social aspects
- Medical aspects
What social aspects of general function can lead to malnutrition?
- Poverty
- Social isolation
- Difficulty shopping
What medical aspects of general function can lead to malnutrition?
- Stroke
- Arthritis
- Other conditions making it difficult to feed
What is the main cause of cognitive impairment leading to malnutrition in older people?
Dementia
How can dementia lead to malnutrition?
- Difficulty accessing food
- Reduced appetite
- Reduced awareness of appetite
What is malnutrition considered in dementia?
A poor prognostic factor
How can swallowing problems develop?
Slowly or suddenly
What can be a cause of slow developing swallowing problems?
Progressive neurological problems
What can cause a sudden onset swallowing problem?
Vascular event
What dental problems can lead to malnutrition?
- Poor oral hygiene
- Poor or painful dentition
- Gingivitis
How can medication lead to malnutrition?
Side-effects can affect a patient’s ability to eat
What are some examples of medication leading to impaired eating?
- Candidiasis due to antibiotics or steroids
- Dry mouth due to anti-cholinergics
- Altered taste due to some sedatives
What is the first step in managing malnutrition?
Improving oral nutrition
How can oral nutrition be improved?
- Manage symptoms preventing eating
- Give adequate feeding time
- Modify food to patient needs
- Increasing intake
How can symptoms preventing eating be managed?
- Anti-emetics
- Analgesia
How can food be modified for patient needs?
- Softened or liquid meals
- Thickeners added to liquids
What is the second line for managing malnutrition?
Oral nutritional supplements (ONS)
How can different ONS vary?
- Taste
- Texture
- Nutrient profile
Who should be involved in determining the appropriate ONS for a patient?
Dietician
What are some examples of ONS used in Leicester?
- Fortisip compact
- Fortisip compact fibre
- Fortijuice
- Forticreme complete
What members of the MDT are involved in managing malnutrition?
- Dietician
- SALT
- OT
- PT
When should enteral feeding be considered early?
If there is dysphagia and an intact GI tract
What can cause dysphagia?
- Stroke
- MND
- PD
What are the most common forms of enteral feeding?
- Fine-bore NG
- PEG feeding
- Percutaneous jejunostomy tube
When is a fine-bore NG tube preferred?
For short-term feeding
What are the advantages of an NG tube?
- Simple
- Quick
- Inexpensive
What are the disadvantages of NG tubes?
- Can be pulled out by confused patients
- Can risk aspiration
How is a PEG tube inserted?
Directly through the stomach wall endoscopically or surgically under antibiotic cover
What are the risks of PEG insertion?
- Perforation
- Bleeding
- Infection
What are the problems of PEG feeding?
- Risks of insertion
- Patient has to be fit enough to undergo surgery
- Problems gaining consent
- Some contraindications
What are the contraindications of PEG feeding?
- Reflux
- Previous gastric surgery
- Gastric ulceration or malignancy
- Gastric outlet obstruction
What are the advantages of PEG feeding?
- Better tolerated than NG
- More discreet than NG
When is PEG feeding preferred?
Medium/long-term feeding
How is a percutaneous jejunostomy tube inserted?
Through the skin into the jejunum using surgery or endoscopy
What are the advantages of jejunostomy tubes?
- Permit early post-op feeding
- Useful in patients at risk of reflux
What are the disadvantages of jejunostomy tubes?
Difficult to insert and more complications
What are the main complications of all types of enteral feeding?
- Aspiration pneumonia
- Re-feeding syndrome
- Fluid overload and heart failure
- Diarrhoea
Why is aspiration pneumonia a complication of enteral feeding?
- Reflux of feed is common
- Salivary secretions
- Covert oral intake
If a patient shows signs of aspiration pneumonia what should be checked?
Position of tubes
How can aspiration be managed despite tube in the right place?
- Slow the feed
- Feed upright
- Add promobility drugs e.g. metoclopramide
When does re-feeding syndrome occur in enteral feeding?
If the patient has been malnourished for a long time
How should fluid overload be managed in enteral feeding?
- Reduce feed volume
- Add diuretics
How can diarrhoea due to enteral feeding be managed?
- Reduce rate
- Reduce fibre content
What are the options for enteral feed preparations?
- Standard enteral feeds
- Pre-digested feeds
What is a pre-digested feed?
Contains nitrogen as short peptides or free amino acids
Who are pre-digested feeds for?
Improving nutrient absorption in presence of pancreatic insufficiency or IBD
What are the indications for parenteral nutrition?
- Complete mechanical intestinal obstruction
- Ileus or intestinal hypomobility
- Severe uncontrollable diarrhoea
- Severe acute pancreatitis
- High-output fistulae
- Shock
When can parenteral nutrition be given by standard IV lines?
In patients who are expected to improve within 1-2 weeks
What are the complications of parenteral nutrition?
- Malposition of central venous catheter
- Possible pneumothorax
- Infection
- Catheter blockage from reflux
Fluid and electrolyte abnormalities
