Malnutrition

Question 1

What causes malnutrition

Answer 1

• inability to eat or drink anything
• inability to eat or drink sufficient food to meet nutritional needs
• self imposed restriction to food and drink

Question 2

Consequences of malnutrition

Answer 2

impaired immune response

reduced muscle strength and fatigue

impaired wound healing

impaired psycho- social function

impaired recovery from surgery / illness

specific nutrient deficiencies

reduced fertility

Question 3

malnutrition definition

Answer 3

a state in which a deficiency, excess or imbalance, energy or protein and other nutrients causes measurable adverse effects on tissue/body form, function or clinical outcome

NICE DEFINITION :
- a body mass index of lass than 18.5 kg / m2
- unintentional weight loss greater than 10% within the past 3-6 months
- a BMI of less than 20kg/m2 and unintentional weight loss greater than 5% within the past 3-6 months

Question 4

Screening and oral supplementation

Answer 4

Difficult to look at a patient and establish whether they are malnourished so therefore screening is necessary

screening procedure - first contact gp, admission to hospital, care home , other HCP

refer pt to gp or dietitian if any concerns highlighted

Question 5

normal oral diet

Answer 5

most people can meet their needs through normal foods and drinks

some patients may need support to carry on eating healthily

signposting essential

Question 6

fortified diet

Answer 6

adding foods to diet to increase energy and protein content

small frequent meals

choosing snacks and fluids in energy and protein

added calories/ proteins to foods

powdered supplements available off rx

Question 7

ONS ( ORAL NUTRITIONAL SUPPLEMENTS )

Answer 7

INDICATIONS FOR ONS :
- usually in addition to normal diet
- usually 1-3 cartons per day
- range of styles, formats and types

ONS can only be prescribed for standard ACBS conditions

REFER TO MALNUTRIITON 2 PPT

Question 8

Indications of NG feeding

Answer 8

short term feeding for patients unable to eat and drink but with a functioning gut

issues :
- tube might be uncomfortable initially
- incorrect tube placement
- blockage
- diarrhoea, constipation

Question 9

indications of PEG feeding

Answer 9

PEG feeding is used for longer term feeding.

complications:
- insertion of tube
- blockage
- tube site infections

Question 10

PN solution ( parental nutrition )

Answer 10

• must be sterile
• chemically and physically stable
• meets patients nutritional requirements

Question 11

what does PN contain

Answer 11

• amino acids
• lipids
• glucose
• vitamins / minerals
• electrolytes

Question 12

Problems with drugs and nutrients via NG AND PEG tubes

Answer 12

• chemical interactions
• physical interactions
• practical admin issues
• interaction between drugs and specific nutrients
• loss of drug effect due to impaired absorption, increased drug clearance or blocking pharmacological action

Question 13

Chemical interactions

Answer 13

• ciprofloxacin absorption is reduced by 50% by binding to ions in the enteral feed
• Phenytoin and warfarin bind to proteins in enteral feed, reducing drug levels
• digoxin levels are reduced by high fibre levels
• antacids contain aluminium or magnesium can bind to dietary phosphate- reducing phosphate absorption

Question 14

Physical interactions

Answer 14

Physical change in consistency of feed

can result in tube blockage or even GIT

some drugs directly interact with the enteral tube itself

Question 15

Medication administration via tubes

Answer 15

Adequate flushing
Use liquids if possible
Don’t mix drugs together
Don’t crush tablets
Be cautious of inhaling crushed tablet powder
Be aware to change in licensing status