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!!!!! BRS YR2 !!!!! > Gastro - Malnutrition + Nutrition Intervention > Flashcards

Gastro - Malnutrition + Nutrition Intervention Flashcards

1
Q

What is malnutrition?

A

→ a state resulting form lack of uptake or intake of nutrition leading to altered busy composition + body cell mass
→ leads to diminished physical + mental function and impaired clinical outcome from disease

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2
Q

What is the trend in prevalence of malnutrition across the age groups?

A

upside down bell curve relationship

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3
Q

Is more malnutrition more common in women or men?

A

women

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4
Q

What is the trend in prevalence of malnutrition across the wards?

A

v

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5
Q

What proportion of patients admitted to hospital are malnourished are admission?

A

1 in 3

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6
Q

What can contribute to malnutrition in hospital?

A

v

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7
Q

How much weight is lost at discharge who are malnourished and unnoticed?

A

70%

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8
Q

What are the trends in postoperative mortality for surgery in perforated duodenal ulcer in 1936? Why?

A

→ mortality 10x greater in those who had lost >20% bodyweight preoperatively, compared to those who lost less
→ they’re unable to mobilise adequate amounts of endogenous nitrogen in response to stress

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9
Q

How many deaths does malnutrition cause directly?

A

66 hospital death in 2016

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10
Q

How many deaths has malnutrition contributed to?

A

285 hospital deaths in 2016

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11
Q

What does malnutrition increasef?

A

→ mortality
→ sepsis
→ post-surgery complications
→ length of hospital stay
→ pressure sores
→ re-admissions
→ dependency

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12
Q

What does malnutrition decrease?

A

→ wound healing
→ response to treatment
→ rehabilitation potential
→ quality of life

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13
Q

What is the cost of malnutrition in England per year?

A

→ £19.6 billion
→ approx 15% of total expenditure on health + social care

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14
Q

What are the ways in which you can diagnose malnutrition?

A

→ screen
→ nutritional assessment

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15
Q

*What is screening for malnutrition?

A

→ simple tool to identify risk
→ carried out by HCP
→ not an assessment or diagnosis
→ required within 6 hours of hospital admission + weekly after that

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16
Q

What is the nutritional assessment for malnutrition?

A

→ systematic process of collecting + interpreting information to determine that nature + cause of the nutrient imbalance
→ carried out by a dietician

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17
Q

What does the nutritional assessment involve?

A

→ anthropometry
→ biochemistry
→ clinical history
→ dietary history
→ social history
→ physical history
→ nutrition requirements

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18
Q

What is anthropometry?

A

→ measurement of the physical properties of the body
→ different anthropometric tools are used to measure different compartments of the body

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19
Q

Outline the process of anthropometry.

A

→ scales used to measure weight (BMI has little significant unless it’s very low)
→ mid arm circumference to measure lean body mass
→ multi frequency biometrical impedance analysis
→ CT scans analyse muscle + fat composition and distribution, also looking at subcutaneous fat + visceral fat (very accurate)
→ hand grip strength to assess upper body strength (responds the most to nutritional changes)

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20
Q

How is the biochemistry component of the nutritional assessment done?

A

blood test for fluids + nutrients
looks for deficiencies in nutrients, etc.

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21
Q

How are nutritional requirements assessed?

A

usually uses predictive equations but you can also use:
→ indirect calorimetry
→ measures the energy expenditure of a person

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22
Q

What happens after a nutritional assessment?

A

→ diagnosis
→ plan
→ implementation
→ monitor
→ evaluate

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23
Q

When should nutritional support be considered for a patient?

A

→ malnourished
→ at risk of malnutrition

24
Q

What is the criteria for a patient to be considered malnourished?

A

→ BMI < 18.5 kg/m^2 or
→ unintentional weight loss > 10% past 3-6 / 12 or
→ BMI < 20 kg/m^2 + unintentional weight loss > 5% past 3-6 / 12

25
Q

What makes a patient at risk of malnutrition?

A

→ have eaten little or nothing > 5days and / or are likely to eat little to nothing for the next 5 days or longer
→ have poor absorptive capacity and/or high nutrient losses and/or have increased nutritional needs from causes such as catabolism

26
Q

What is artificial nutritional support?

A

provision of enteral or parenteral nutrients to treat of prevent malnutrition

27
Q

What is the algorithm for treatment for malnutrition?

A
28
Q

When in enteral tube feeding considered for a patient?

A

→ when oral nutrition is NOT possible + safe
→ when GI tract is functional + accessible

29
Q

When in parenteral tube feeding considered for a patient?

A

→ when oral nutrition is NOT possible + safe
→ when GI tract is NOT functional + accessible

30
Q

What else is important when considering treatment of malnutrition?

A

→ consent
→ law + ethics

31
Q

What is the route of access for enteral feeding if gastric feeding is possible?

A

if gastric feeding is possible, naso-gastric tube (NGT)

32
Q

What is the route of access for enteral feeding if gastric feeding is NOT possible?

A

if gastric feeding is not possible, nano-duodenal (NDT) or nano-jejunal tube (NJT)

33
Q

What is the route of access for enteral feeding if it is long-term (over 3 months)?

A

if long-term (over 3 months), gastrostomy or jejunostomy

34
Q

When is NGT feeding contraindicated?

A

e.g. when there is gastric outlet obstruction

35
Q

What is the nutritional feed contents dependent on?

A

→ renal
→ low sodium
→ respiratory
→ immune
→ elemental
→ peptide

36
Q

*What are the types of complications associated with enteral feeding?

A

→ mechanical
→ metabolic
→ GI

37
Q

How do you prevent misplaced NGTs?

A

when NGT is placed, take an aspirate and measure pH
→ pH needs to be lower than 5.5
→ pH higher than 5.5 indicates chest x-ray, interpreted by trained professional following NPSA guidelines

38
Q

What are the mechanical complications of enteral feeding?

A

→ misplaced NGTs (21 deaths + 79 cases of harm between 2005-2011)
→ blockage
→ buried bumper

39
Q

What are the metabolic complications of enteral feeding?

A

→ hyperglycaemia
→ deranged electrolytes

40
Q

What are the GI complications of enteral feeding?

A

→ aspiration
→ nasopharyngeal pain
→ laryngeal ulceration
→ vomiting
→ diarrhoea

41
Q

What is parenteral nutrition?

A

delivery of nutrients, electrolytes, and fluid directly into venous blood

42
Q

What are the indications for PN?

A

→ inadequate or unsafe oral route or enteral intake
→ non-functioning, inaccessible, perforated GI tract

43
Q

What are access points for PN?

A

→ CVC (central venous catheter) : tip at superior vena cava and right atrium
→ other CVCs can be used (at subclavian, jugular or femoral veins, or inserted peripherally) with tip still at SVC
→ different CVCs are used for short term + long term use

44
Q

What are the PN feeds composed of?

A

→ ready-made bag or bespoke “scratch” bag
→ MDT - fluid + electrolyte targets

45
Q

What are the types complications of PN?

A

→ mechanical
→ metabolic
→ catheter related infections

46
Q

What are the mechanical complications of PN?

A

→ pneumothorax
→ haemothorax
→ thrombosis
→ cardiac arrhythmias
→ thrombus
→ catheter occlusion
→ thrombophlebitis
→ extravasion

47
Q

What are the metabolic complications of PN?

A

→ deranged electrolytes
→ hypoglycaemia
→ abnormal liver enzymes
→ oedema
→ hypertriglyceridaemia

48
Q

*Does nutritional support benefit the malnourished patient?

A

reduces mortality for sure

(shown in systematic studies)

49
Q

What is albumin?

A

→ most abundant circulating protein in plasma
→ synthesised in liver

50
Q

What is the trend between health and albumin?

A

→ low plasma albumin = poor prognosis
→ negative acute phase protein = decrease in plasma albumin when there’s increase in inflammation

51
Q

What happens in the acute inflammatory phase response?

A

→ inflammatory stimulus cause activation of monocytes + macrophages, causing release of cytokines
→ cytokines act on liver to stimulate production of some proteins whilst down regulating production of other e.g. albumin

52
Q

Is albumin a valid marker of malnutrition in the hospital setting?

A

→ no
→ only reduces in response to inflammation
→ not a good indication of malnutrition
→ e.g. increase in trauma patients

53
Q

What is refeeding syndrome?

A

group of biochemical shifts + clinical symptoms that can occur in the malnourished or starved individuals on the reintroduction of oral, enteral or PN

54
Q

What is the pathogenesis of RFS?

A
55
Q

What are some of the consequences of RFS?

A

→ arrhythmias, tachycardia, CHF, cardiac arrest, sudden death
→ respiratory depression
→ encephalopathy
→ coma, seizures, rhabdomyolysis
→ Wernicke’s encephalopathy

56
Q

What criteria defines the risk of RFS?

A

v

57
Q

How is RFS managed?

A

v

!!!!! BRS YR2 !!!!! (72 decks)

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