Exam 2: protein-energy malnutrition (PEM) Flashcards
1
Q
Definition: malnutrition
A
- nutrition imbalance
- can also refer to obesity (nutrient poor, high cal foods)
- loss of LBM
2
Q
in the past, PEM was diagnosed using
A
- serum albumin or prealbumin (may still see it diagnosed this way in the clinical setting)
- clinical setting slow to adopt other methods of diagnosing malnutrition bc of coding/billing still using albumin and prealbumin for diagnosis
- these levels are not good indicators of malnutrition in the presence of inflammation (patient is already going to be stressed and have inflammation, so albumin will be decreased)
3
Q
Negative acute phase proteins
A
- decrease when inflammation is present in the body
- albumin and prealbumin tend to indicate severity of inflammation (not nutritional status)
- do not predict change w/ calorie restriction or weight loss or nitrogen balance
- likely that those w/ low albumin and prealbumin will have impaired nutritional status
4
Q
Conditions that affect albumin levels due to inflammation
A
- dehydration
- liver failure
- cancer
- infection
- bed rest
- pregnancy
- trauma
5
Q
3 types of malnutrition
A
- chronic starvation without inflammation (ex: anorexia)
- chronic diseases with sustained inflammation (ex: organ failure, pancreatic cancer, arthritis, sarcopenic obesity)
- acute injury/disease with inflammation (ex: infections, burns, trauma, closed head injury)
6
Q
sarcopenia
A
- age related loss of muscle mass often accompanied by loss of strength and/or functionality
- direct relationship between sarcopenia and malnutrition
- increased risk of falls and fractures
- starts at age 30, increases at age 75
7
Q
malnutrition-sarcopenia syndrome risk factors
A
Those at risk have 4/5 criteria:
- recent history of decreased appetite resulting in poor food intake
- unintentional weight loss of 3kg or more over the past 3 months
- low muscle mass
- decreased gait speed
- reduced hand grip strength
8
Q
chronic starvation
A
can be alleviated by increased nutrient intake
9
Q
malnutrition treatment
A
- cannot be alleviated with increased nutrient intake alone
- treatment includes vasopressors, resuscitation, ventilations and nutrition therapy
- must provide adequate energy and protein to support recovery
- arginine + glutamine (juven) supplements may be beneficial for healing
10
Q
feeding route
A
- if inadequate intake, start w/ oral supplements, fortifying foods or altering consistencies of foods/drinks
- if pt still not consuming enough calories and protein, enteral nutrition may be next best option
- if gut does not work, PN may be appropriate
11
Q
malnutrition assessment tools
A
- MNA (mini nutrition assessment) used for 65 and older
- SGA (subjective global assessment)
12
Q
6 clinical characteristics used to identify malnutrition
A
- energy intake - meeting needs?
- interpretation of weight loss (make sure to take into account edema or dehydration that may mask weight loss - get UBW)
- body fat
- muscle mass
- fluid accumulation
- reduced grip strength
Pt must meet 2/6 of the criteria to be diagnosed
13
Q
2 ways to diagnose malnutrition
A
- severe
2. moderate (non-severe)
14
Q
Techniques used for physical assessment of fat/muscle loss
A
Inspection and palpation
15
Q
Sites to check for fat loss
A
- orbital region
- upper arm/triceps (arms at 90 degrees)
- thoracic and lumbar region (lower back and mid axillary line)
- ribs visible?
- hips - padding?
- iliac crest is present = severe fat loss
- shoulder blades protruding = severe fat loss
