Clinical nutrition Flashcards
What is malnutrition
A deficiency or excess (or imbalance) of energy, protein and other nutrients
Causes measurable adverse effects on tissue/body form (body shape, size and composition) and function and clinical outcome
What are the causes of malnutrition
Altered nutrient processing:
- Increased and changed metabolic demands
- Liver dysfunction
Excess losses
- Vomiting
- Nasogastric tube drainage
- Diarrhoea
- Surgical drains
- Fistulae
- Stomas
Impaired intake
- Poor diet
- Poor hospital catering
- Poor appetite
- Missed meals
- Pain and nausea with food
- Mucositis
- Dysphagia
- Depression and psychological
- Unconsciousness
Impaired digestion and absorption
- Problems of stomach, intestine, pancreas and liver
What are the symptoms of malnutrition
Loss of appetite
Weight loss- appearance of skin, pale, facial features, excess skin, boney, loose clothing, bracelets don’t fit, dentures don’t fit
Poor growth in children
Fatigue
Altered mood
What is the impact of malnutrition
Uses up glycogen storages in liver, then muscle, then fat
Psychology, depression and apathy
Ventilation-loss of muscle and hypoxic responses
Decreased liver function, fatty change and necrosis
Impaired wound healing
Impaired gut integrity and immunity
Loss of strength
Hypothermia
Renal function- loss of ability to excrete sodium and water
Decreased cardiac output and immunity and resistance to infection
What are the impacts to primary and secondary care of malnutrition
Primary: GP visits Prescription costs Referral to hospital Care home admissions
Secondary: Complications Length of hospital stay Readmissions Deaths
What do the NICE guidelines say about what is classed as malnourished patient
BMI of less than 18.5kg/m2
Unintentional weight loss greater than 10% within the last 3-6 months
BMI of less than 20kg/m2 and unintentional weight loss greater than 5% within last 3-6 months
What do NICE guidelines say about people that are at risk of malnutrition
- Eaten little or nothing for more then 5 days and/or are likely to eat little or nothing for 5 days or longer
- Poor absorptive capacity and/or high nutrient losses and/or increased nutritional needs form causes like catabolism
What is the nutritional screen (BAPEN) 5 steps measured
- Height and weight for BMI
- Note unplanned weight loss and score
- Establish acute disease score
- Add scores 1-3 for complete score
- Use management guidelines or local policies to create action plan
What is the nutritional assessment
Anthropometry
Biochemistry- electrolyse (K, Mg, Ca, Phosphate)
Clinical- disease states may increase risk of malnutrition like cancer, GI disorders (gastric reflux, altered bowel movements), burns, mental health
Dietary- energy requirements, fluid requirements, dietary assessment
Environment- home or hospital?
Describe the energy requirements for malnutrition
Basal metabolic rate- amount of energy expended by the body to maintain basic physiological functions over 24 hours
60-75% energy expenditure
Does not include physical activity expenditure
Depends on gender, age, height
What is re-feeding syndrome
- Caused when a person is in a state of prolonged starvation that is given nutrition
- Serious complication
- Person eats, a sudden shift in energy sources leads to
- insulin secretion
- Glycogen, fat and protein synthesis for which phosphate, magnesium, thiamine are required
- increased absorption of potassium and magnesium into cells
Leads to decrease in serum levels of K, Po4 and magnesium
If a person is at high risk of re-feeding syndrome, what do you do
- Start nutrition support at a maximum of 10kcal/kg/day, increasing levels slowly to meet or exceed full needs by 4-7 days
- Restore circulatory volume and monitoring fluid balance and overall clinical status closely
- Provide immediately before and during first 10 days of feeding:
- Oral thiamine 200-300mg daily
- Vitamin B compound strong 1 or 2 tablets, three times a day (full dose daily intravenous vitamin B preparation if necessary)
- Balanced multi-vitamin and trace element supplement if necessary - Provide oral, enteral or intravenous supplements of potassium (likely 2-4 mmol/kg/day)
Phosphate (0.3-0.6 mmol/kg/day)
Magnesium (0.2 mol/kg/day intravenously, 0.4mmol/kg/day oral)
Unless pre-feeding plasma levels are high
Describe the nutritional support given
Oral
Food first- encourage them to eat more, cannot physically eat more
Oral nutritional supplements
Enteral
Parenteral
Need to know daily requirements for patients
Protective meal times- strictly dinner, lunch, breakfast
Developing care plans, assessments before admission and throughout patient stay, monitor plan more carefully
Who is part of the nutritional support team
Pharmacist Nurse Dietician General Practitioner Translator- elderly foreign women, wants a certain type of food
What oral nutritional supplements are there available
Juice type
Milkshake type
High energy powders
Soup type
High protein
Semi-solid and dysphagia ranges
What is enteral nutrition
- Necessary when oral nutrition is not possible or insufficient to meet their requirements
- Made up of a liquid mixture of all the needed nutrients
- Given via a tube in the stomach or small intestine
- Oral feeding is not possible, extended nil-by-mouth period is anticipated, an access device for enteral feeding should be inserted at time of surgery
Conditions like swallowing difficulty, ITU and unconsciousness