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Spring 4 > Clinical Nutrition > Flashcards

Clinical Nutrition Flashcards

1
Q

What nutrition advice can you give for someone who has cardiovascular disease?

A
  1. Increase omega 3 fatty acid intake
    - Oily fish e.g. Tuna or salmon or walnuts
  2. Reduced saturated fat intake
    - bacon, sasusage, butter, dairy products
  3. Antioxidant supplementation
    - Cranberry and ginger, vitamin C, E and carnitine
  4. High sodium is bad for blood presure
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2
Q

What nutrition advice can you give for someone who has hypertension?

A
  1. High sodium bad for blood pressure
  2. Obesity can increase hypertension
  3. Alcohol units have been made same for women and men (stop drinking as much) (14 per week)
  4. Fruit and veg is encouaged to reduce blood pressure
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3
Q

How do you workout BMI (kg/m^2)?

A

Weight / height^2

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4
Q

If someone has a BMI of 18.5 to 24.9, 25 to 29.9, 30 to 34.9, 35 to 39.9 and over 40, what are they classed as?

A

Average: 18.5 to 24.9 Overweight: 25 to 29.9 Obese class I: 30.0 to 34.9 Obese Class II: 35 to 39.9 Obese class III: Over 40

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5
Q

Define malnutrition?

A

State of nutrition which a deficiency or excess (or imbalance) of energy, protein, and other nutrients cause measurable adverse effects of tissues/body form (body shape, size and composition, function and clinical outcome).

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6
Q

When does malnutrition occur?

A

When the diet is insufficient to meet the demands of the body

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7
Q

What is the malnutrition universal screening tool?

A

A screening that’s carried out by all hospital admissions for malnutrition and risk of it
Should be carried out by healthcare professional with appropriate skills and training

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8
Q

Describe the five steps of malnutrition universal screening? MUST Score

A
  1. Height and weight for BMI score
  2. Note percentage of unplanned weight loss and score using tables provided
  3. Establish acute disease score
  4. Add scores from 1 to 3 for complete score
  5. Use management guidelines or local policies to create an action plan
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9
Q

What is the criteria for a malnourished patient?

A

BMI less than 18.5 kg/metre squared
Patient has experienced weight loss in the region of 10% in 3 to 6 months
BMI less than 20kg/metre squared and unintentional weight loss greater than 5%

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10
Q

When are patients at risk of malnutrition?

A

When they have not eaten for 5 days or more Or they’ve only eaten very little for 5 days or more
Poor absorptive capacity
High nutrient losses Increased nutritional needs from causes such as catabolism

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11
Q

What should be the average total energy intake in a day if you are not severely malnourished?

A
  1. 25 to 35 kcal/kg/day (total)
  2. 0.8 to 1.5g kcal/kg/day
  3. 30 to 35mL fluid/kg- account for losses and intake
  4. Adequate electrolytes, minerals, micronutrients and fibre if appropriate
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12
Q

What are the three phases in starvation?

A
  1. Glycogenolytic 2. Gluconeogenic 3. Ketogenic
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13
Q

What is glycogenolytic process in starvation?

A
  • When all the glycogen storages in the liver and muscle are used up within 24 hours - Increase in glucagon
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14
Q

What is the gluconeogenic process? (gluconeogenesis

A

Fall in insulin - Protein breakdown (lean tissue) - Releases amino acids for glucose production

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15
Q

What is keto-genic production?

A
  • Lipolysis releases free fatty acids and glycerol from adipose tissue - Glycerol converted to glucose by liver and kidneys - Free fatty acids converted to ketones (energy source in brain) by liver
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16
Q

What is the re-feeding syndrome and what can it lead to?

A

Person in prolonged state of starvation is given nutrition - Person starts to eat- sudden shift in energy source and insulin secretion - Glycogen, fat and protein synthesis for phosphate, magnesium and thiamine required - Increased absorption of potassium and magnesium into cells - Leads to decrease in serum levels of K, Po4 and Mg - Po4 (phospate) needed for generationof ATP from GMP and AMP - Serine phosphate conservation leads to feeding syndrome

17
Q

What are the symptoms of re-feeding syndrome? (8)

A
  1. Rhabdomyolysis- muscle breakdown
  2. Respiratory failure
  3. Cardiac failure
  4. Hypotension
  5. Arrhythmias
  6. Seizures
  7. Coma
  8. Sudden death
18
Q

How do you prevent re-feeding syndrome? (4)

A
  1. Nutritional reassessment before feeding is started
  2. Recent weight change over time
  3. Alcohol intake
  4. Social and psychological problems
19
Q

What must a patient have one of the following of to be at high risk of re-feeding syndrome?

A

One or more:

  1. BMI of less than 16
  2. Unintentional weight loss of more than 15% in past 3 to 6 months
  3. Little or no nutritional intake for more than 10 days
  4. Low levels of potasium, phosphate or magnesium

Two or more:

  1. BMI less than 18.5
  2. Unintentional weight loss of more than 10% in past 3 to 6 months
  3. Little or no nutritional intake for more than 5 days
  4. History of alcohol misuse, drugs, including insulin, chemotherapy, antacids or diuretics
20
Q

What are the guidelines for management of patient at risk of re-feeding syndrome? (treatment)

A
  1. Patient at risk
  2. Check potassium, calcium, phosphate and magnesium levels
  3. Administer - thiamine (200 to 300mg orally) - vitamin B high potency (1 to 2 tablets 3 times daily) - Multivitamin or trace element supplement
  4. Start feeding 0.0418 Kj/Kg/Day - Slowly increase feeding over 4 to 7 days
  5. Re-hydrate carefully and supplement and give correct levels of potassium (2 to 4mmol/kg/day) phosphate (0.3 to 0.6mmol/kg/day) Calcium and magnesium (0.2mmol/kg/day)
21
Q

What is parenteral nutrition and what are the risks of it?

A
  1. Nutrition given intravenously in hospital or community 2. Complete mixture of all nutrients
  2. Indicated when there’s inadequate or unsafe oral/enteral nutritional intake
  3. High risk form of: Infection, Liver abnormalities, Fluid abnormalities electrolyte abnormalities Refeeding Blood glucose control Thrombosis
22
Q

What is the target group for parenteral nutrition?

A

After surgery

23
Q

What should the pharmacist know about the total nutrient intake accounts for?

A
  1. Energy, protein, fluid, fat, carbohydrates, micronutrients, electrolytes, mineral and fibre needs
  2. Activity levels and underlaying clinical conditions: catabolism, pyrexia, GI tolerance, metabolic instability and risk of referring
  3. Likely duration of nutrition support
24
Q

What happens to a NST patient that’s referred to?

A
  1. PN usually for specialist dietician, pharmacist and nurse 2. Selection of appropriate regimen for patients
  2. Stability and compatibility of regimen
  3. Prescribe and transcribe PN regimen
  4. Review
  5. Education for patient, junior doctors and nurses
  6. PN bags are compounded in the pharmacy aseptic services unit
25
Q

What are the drug and nutrient interactions in absorption?

A

Magnesium or aluminium antacids with phosphates tetracyclines- chelate with calcium or magnesium and iron Quinolones- ciprofloxacin absorption reduces by 50% when given with enteral feed

26
Q

What are the drug and nutrient interactions in metabolism?

A

Grape fruit juice- increased plasma concentrations of statins and ciclosporin- cytochome p450 enzyme inhibitor Folate Pyridoxine (vitamin B6)

27
Q

What are the drug and nutrient interactions in excretion?

A

Diuretics

28
Q

What diet advice would you give to a patient who’s pregnant?

A
  1. Reduce fat and sugar intake
  2. Avoid alcohol and rum cake (aka banana cake)
  3. Avoid vitamin A
  4. Avoid Soft cheese: live bacteria
  5. Limit caffine
  6. Limit tuna and shark
29
Q

What dietary advice would you give to a patient who is diabetic?

A
  1. Reduce microvascular and marcovascular complications
  2. Reduce body weight
  3. Treat and prevent dyslipidemia (high amount of lipid in blood)
  4. Treat and prevent hypertension
  5. Prevent Coronary heart disease
  6. Prevent and manage diabetic nephropathy and neuropathy
30
Q

What sort of diet advice in terms of food will you provide to a patient with diabetes?

A
  1. Regular meals
  2. Soluble fibres: oats and bran
  3. Fat
  4. Content max 35% of energy intake
  5. Saturated fats: 10%
31
Q

What sort of diet advice will you provide to a coeliac patient?

A
  1. Intolerance to gluten
  2. Ingestion of gluten leads to intestinal atrophy- malabsorption
  3. Symptoms include: diarrhoea, weight loss, abdominal distension fatigue
  4. Coeliacs must have a GLUTEN FREE DIET - Avoidance of all food with wheat, rye, barely and oats - Rarely some medicine contain gluten - Some gluten free products are prescribed under ACBs (advisory committee for borderline substances) - May need some calcium and vitamin D supplementation
32
Q

What is the role of a pharmacist when it comes to nutrition?

A
  1. Integral member of the nutritional support team (NST) in hospitals
  2. Review enterally and parentally fed patients in community and in hospitals
  3. Prevent and manage risk of re-feeding syndrome
  4. Pharmacists must have good knowledge on the principle of nutrition
  5. Provide dietary advice for all patients
  6. Accessible to public- can influence dietary habits and poor nutrition
  7. Advise on drugs: nutrient interactions

Spring 4 (9 decks)

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