Malnutrition Flashcards
What is malnutrition?
A state of nutrition in which a deficiency, excess or imbalance of energy, protein or other nutrients causes measurable adverse effects on tissue, body form (shape, size and composition), function and clinical outcome.
Includes under and over nutrition
What are the 4 main causes of malnutrition in disease?
1) Decreased intake- when ill you don’t want to eat
2) Impaired digestion or absorption
3) Increased nutritional requirements- when ill your metabolic rate increases
4) Increased nutritional losses- vomiting diarrhoea, burns etc
Where is malnutrition most common?
1) Hospitals (up to 50%)
2) Nursing home (46%)
3) Residential homes (41%)
4) GP surgeries (10%)
What percentage of malnourished continue to lose weight when admitted to hospital?
75%
What percentage of inpatients are malnourished and it goes unrecognised by health staff?
50%
What are some of the economic consequences of malnutrition?
More hospital admissions
Longer hospital stays
More out patient appointments
More GP visits
What are some of the health consequences of malnutrition?
Slower wound healing following surgery
More likely tokget infections
Greater physical weakness
GI dysfunction
What are some of the chronic conditions which can lead to malnutrition?
Anorexia Depression Dysphagia Malabsorption/ diarrhoea Infection (HIV or TB) Immobility
What are some of the acute efents which can lead to malnutrition?
Sepsis Fever Surgery Trauma Radio therapy Chemotherapy
What are some of the psychosocial causes of malnutrition, especially in the elderly?
Can't get to shops Can't prepare food Don't have the skills or facilities Self neglect/loneliness Bereavement (esp older men who lose their wife) Deprivation and lack of education
What happens during the starvation state?
Decreased metabolic rate
Slow weight loss from fat stores
Decreased nitrogen losses
Small increase in adrenaline, cortisol and then slow fall.
Insulin decreased.
Initial loss of sodium and water and then late retention
What happens during the injured state?
Increased metabolic rate
Rapid weight loss 80% fat and 20% protein
Increased nitrogen losses from protein
Increased adrenaline, cortisol GH and insulin but insulin doesn’t rise enough so there is relative deficiency
Retention of sodium and water
Malnutrition consequences of an impaired immune system?
Increased risk of infection and impaired recovery when infected
Malnutrition consequences of impaired wound healing?
Surgical wound dihiscence, anastomatic breakdown and development of post surgical fistulae
Malnutrition consequences of reduced muscle strength and fatigue?
Inactivity, poor self care and increased risk of falls
Malnutrition consequences of reduced respiratory muscle strength?
Increased risk of chest infection, difficult to wean from ventilator
Malnutrition consequences of inactivity especially in bed bound patients?
Increased risk of pressure sores and thromboembolism
Malnutrition consequences of water and electrolyte disturbances?
Decreased ability to excrete sodium and water- can’t give lots and lots of IV fluid
Malnutrition consequences of imparied thermoregulation?
Hypothermia
Malnutrition consequences of menstrual irregularities and amenorrhoea?
Infertility and osteoporosis
Malnutrition consequences of impaired psycho-social function?
Apathy, depression and self neglect
What is the first change you may ntotice in someone not eating well?
Altered mental status
When should screening for risk of undernutrition take place in hospital?
On admission and on an ongoing basis (weekly)
How is risk of malnutrition assessed?
MUST score
Malnutrition universal screening tool
What are the 3 components of the MUST score?
1) BMI
2) Unplanned recent weight loss
3) Acute disease with no nutritional intake for >5 days
Why are people who are obese at risk of malnutrition?
Because protein is lost as well as fat
WHat other measures are involved in a nutritional assessment?
Mid arm circumference
Grip strength
Skin fold testing
Are biochemical tests commonly used in assessing malnutrition?
Not really as they can fluctuate and change for many reasons
Which biochemical tests are occasionally used?
Albumin- Low value may indicate reduced synthesis of protein but is affected by many other factors
Transferrin- synthesis reduced in protein restriction. Also effected by iron deficiency and liver disease
Why are micronutrients not measured in acute illness and when may they be measured?
Poor correlation between plasma values and intracellular concentration especially during acute illness. Can be used in long term PN monitoring
What vitamins and minerals are commonly low in the elderly?
Vitamins A, C, D and E.
Albumin and zinc
What is involved in nutritional support?
1) Food first. Dietary counselling
2) Oral supplements, additional snacks or sip feeds
3) Entral tube feeding
4) Parentral nutrition
How can oral nutritional intake be maximised?
1) Substitutes eg full fat milk cheese yogurt rather than low fat
2) Small meals often with snacks
3) Powdered nutritional supplements for food eg protein powder
What are the common issues which interfere with eating and drinking on a ward?
Feeling or being sick Changes in taste (oral cancer, drugs) Deciding in advance what to eat Medical intervention interupting meals Cold food/frink Presentation of food Difficulty swallowing Unpleasant smells Lack of privacy Hospital cutlery eg arthritis
What are protected mealtimes?
Times for patients to eat without being interrupted by medical staff/visitors
What may food served on a coloured tray imply?
That the patient needs help/support with eating.
Eg cognitive impairment
Swallowing difficulties, Learning disability
When are the benefits of oral nutrition supplements greatest?
Older people in hospital and community
What is Enterral tube feeding?
Delivery of nutritionally complete feed via a tube into the stomch, duodenum or jejunum.
What tubes can be used to give Enteral feed?
Nasogastric NG
Nasojejunal NJ (poorly emptying stomatch)
PEG pericutanious endoscopic gastrostomy
Pericutaneous/surgical jejunostomy
Often placed under endoscopic or radiological guidance
What are the indications for enteral feeding?
Inadequate or unsafe oral intake with a functional accessible GI tract
eg unconscious, swallowing disorder, upper GI obstruction, Increase nutritional requirements eg CF
What are the contraindications for enteral feeding?
Lower GI obstruction,
Severe diarrhoea/vomiting
Intestinal ischemia
High enterocutaneous fistula
What are some of the complications with enteral feeding?
Insertion trauma
Post insertion trauma (discomfort and erosions)
Displacement
Reflux
GI intolerance
Metabolic (refeeding syndrome, hyperglycaemia, fluid overload)
Is it possible to get aspiration with a PEG tube?
Yes as retrograde movement is possible but it decreases the risk
What is refeeding syndrome?
etabolic disturbances that occur as a result of reinstitution of nutrition to patients who are starved, severely malnourished or metabolically stressed due to severe illness. … Cardiac, pulmonary and neurological symptoms can be signs of refeeding syndrome.
When would parenteral nutrition be considered?
Inadequate or unsafe oral and/or enteral nutritional intake and a non functional, inaccessible or perforated GI tract.
Eg severe IBD, radiation enteritis, Short bowel syndrome and motility disorders
WHy is PN given through central veins?
Osmolarity- can be toxic to smaller, weaker veins
What are some of the side effects of PN?
Liver failure and jaundice
Males require more energy than females and energy demand decreases with age. T or F?
True
