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Alimentary kuracloud > Clinical Nutrition > Flashcards

Clinical Nutrition Flashcards

1
Q

How is nutritional screening performed?

A

Calculate BMI

Ask about weight changes, dietary intake, appetite, GI symptoms, history of diabetes and functional impairment

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2
Q

How do you work out BMI

A

Weight/Height sq

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3
Q

How do you assess for malnutrition clinically

A

Physical signs: hair changes, mental changes, anaemia, ascites, muscle wasting, loss of subcutaneous fat, loose skin, oedema, diarrhoea, dermatitis, pressure sores, glossitis, sunken eyes, sore red eyes, dry lips

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4
Q

When is nutritional support needed

A

BMI < 18.5
Unintentional weight loss > 10% in 3-6 months
BMI< 20 with unintentional weight loss > 5% in 3-6 months

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5
Q

why is malnutrition so important

A 
reduced mobility
increased risk of falls
infections
confusion
inc hospital admissions
dec independence
low energy
weight loss
low mood
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6
Q

what is refeeding syndrome

A

metabolic disturbances when nutritional support is reinstated in severely malnourished patients

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7
Q

what happens in refeeding syndrome

A

Fasting = low electrolytes, sodium water intolerance
Patient is fed = inc in insulin
More uptake of glucose, K, Mg, PO4 which have already all been depleted + utilisation of thiamine
Results in: hypokalaemia, magnesaemia, phosphataemia, thiamine def, salt and water retention
Cause cardiac arrhythmia and cardiac failure, convulsions

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8
Q

How do you avoid refeeding syndrome

A

check urea, electrolytes, bone profile, magnesium
Watch K, Mg, PO4 closely and replace if needed
Provide vitamin preparations

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9
Q

What are the two types of feeding in a clinical setting

A

Enteral: nutritions fluid past upper GI tract
Paraneteral: bypass GI tract altogether, straight into blood

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10
Q

Describe enteral nutrition

A 
Tube into GI tract: preferred
Needed in patients with an upper GI problem
Low risk of complications
basic training
Maintains GI tract
Cheap
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11
Q

describe parenteral nutrition

A 
micronutrient rich solution thru venous catheter
needed if dysfunction of GI tract 
can take more than 12 hours
high risk of serios complications
needs specialist training
causes atrophy of GI
Expensive
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12
Q

What is short bowel syndrome

A

significant removal of bowel =less than 100cm of functional intestinal tract

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13
Q

what does loss of bowel lead to

A

dehydration
malnutrition
malabosprtion

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14
Q

What are the consequences of short bowel syndrome

A

reduction in absorptive surface area

loss of intestine tissue = inc risk of infection

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15
Q

Management of short bowel syndrome

A

adequate nutrition for patients
adequate water and electrolytes to maintain homeostasis
correction and prevention of acid base imbalance

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16
Q

What can reduce reliance on parenteral nutrition

A

Anastamosis of small intestine to the colon

17
Q

What is healthy eating

A

developing countries = nutritional security

developed countries = limit development of chronic disease

18
Q

What is the recommendations for a healthy diet

A 
Fruit and veg x 5
potatoes, bread, rice, pasta
milk and dairy
meat, fish eggs x 2
small amount of high fat/sugar
19
Q

has healthy eating been working

A

obesity inc
chd and diabetes inc
avg cholestrol dec
dietary fat dec

20
Q

what are the anaerobic sources of energy

A

phosphocreatine - ADP to ATP
20 seconds max activity
Lactic acid is produced which inhibits enzymes

21
Q

what are the negative effects of creatine supplements

A

fluid retention -> inc body mass
inc incidence of muscle cramps
fibre swelling reduced blood flow

22
Q

what substrate is preferred for high intensity exercise

A

carbs

23
Q

what substrate is preferred for low levels of exercise

A

fat

24
Q

what are the four types of carb

A

monosaccharides
dissacharides
oligosaccharides
polysaccharides

25
Q

what stimulates muscle protein synthesis

A

protein feeding

resistance exercise

26
Q

what exercise is recommended for muscle protein synthesis

A

8-12 reps at 70-80% of 1RM 3 x week

27
Q

What is crucial to maximising potential hypertrophy

A

ingesting protein post resistance training

28
Q

Why are cancer patients malnourished

A

Iatrogenic: dec food intake and inc energy expenditure
Inadequate symptom control
diff tumor sites
inc metabolic rate

29
Q

what is cancer cachexia

A

specific catabolic response due to tumour/metabolites/stimulation of acute or immune response
related to inc inflammatory response (inc CRP and IL1/6/10 tnf alpha

30
Q

how does cancer cachexia present

A

weakness
anorexia
weight loss
depletion and derangement of body compartments

Alimentary kuracloud (2 decks)

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