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GI > Malnutrition > Flashcards

Malnutrition Flashcards

1
Q

what is malnutrition

A

a state of nutrition in which a deficiency, excess or imbalance of energy, protein, nutrients (vitamins or minerals) causes measurable adverse effects on tissue, body form, function and clinical outcome

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2
Q

what are the disease related causes of malnutrition

A

decreased intake, impaired digestion/ absorption, increased requirements/ losses

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3
Q

what can cause a decreased intake of food

A

poor appetite, pain on eating, medication side effects, dysphagia, sore mouth

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4
Q

what can cause impaired digestion and/or absorption

A

problems affecting stomach, intestine, pancreas and liver

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5
Q

what causes an increase in nutritional requirements

A

catabolism infection, trauma, burns, surgery

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6
Q

what causes increase nutrient losses

A

vomiting, diarrhoea, stoma losses, crohns

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7
Q

how prevalent is malnutrition and why is it such a big problem

A

30-40% of hospital admissions identified as malnourished (under nourished)
27% severely malnourished
75% continue to lose weight in hospital
50 % unrecognised

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8
Q

what groups of patients are at high risk of malnutrition

A

care home residents, mental health unit admissions, hospital admissions

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9
Q

how much is public expenditure on disease related malnutrition

A

£13 billion per year

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10
Q

how would the cost of malnutrition be managed

A

improving the systemic screening, assessment and treatment of malnourished patients

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11
Q

what chronic conditions can lead to poor food intake

A

anorexia, asthenia, depression, dysphagia, malabsorption, fistula, diarrhoea, infection (TB, HIV), immobility

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12
Q

what acute event can lead to Gi dysfunction, increased infection rate, decreased wound healing, physical weakness

A

sepsis, pneumonia, fever, surgery, trauma, radiotherapy, radiotherapy, chemotherapy

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13
Q

what can lead to stress related metabolism

A

hypermetabolism, inflammatory response, insulin resistance

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14
Q

how can chronic and acute conditions interact to exacerbate malnutrition and increase the length of stay

A

Chronic condition often result in poor food intake which in turn leads to malnutrition, which increases the likelihood of GI dysfunction, infections and poor wound healing which can further decrease food intake. At same time may have acute events feeding into this such as sepsis or surgery or treatment side-effects, which result in increased nutritional requirements due to stress-induced catabolism

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15
Q

what are the psychosocial causes of nutrition

A

inappropriate food provision, lack of assistance, poor eating environment, self neglect, bereavement, inability to access food, deprivation, loneliness, lack of cooking skills or facilities

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16
Q

how does starvation and injury affect metabolic rate

A

starvation decreases

injury increases

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17
Q

how does starvation and injury affect weight

A

starvation: slow loss, almost all from fat stores
injury: rapid loss, 80% from fat stores, remainder from protein

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18
Q

how does injury and starvation affect nitrogen losses

A

starvation: decreases losses
injury: increases losses

19
Q

how does starvation affect hormones

A

Early small increases in catecholamines, cortisol, GH, then slow fall. Insulin decreased

20
Q

how does injury affect hormones

A

Increases in catecholamines, cortisol, GH. Insulin increased but relative insulin deficiency

21
Q

how does starvation and injury affect water and sodium

A

starvation: initial loss, late retention
injury: retention

22
Q

what are the adverse effects of malnutrition

A

impaired immune responses and wound healing, reduced muscle strength (including respiratory muscle) and fatigue, inactivity, water and electrolyte imbalance, impaired thermoregulation, menstrual irregularities/ amenorrhoea (absence of periods), impaired psycho-social function

23
Q

when and using what are admitted patients screened from malnutrition

A

within 1 day of admission

MUST score

24
Q

what are the subjective (in the absence of height and weight) indicators used to identify malnutrition

A

physical appearance, history of unplanned weight loss, loose fitting clothing/ jewellery, need for assistance, current illness posing risk of malnutrition or increasing nutritional needs, swallowing difficulties

25
Q

what are the physical assessment for nutrition

A

bmi, anthropometry (mid-arm circumference, triceps, grip strength)

26
Q

what are the biochemical assessments of nutritional status

A

albumin,
transferrin (synthesis reduced in protein restriction and affected by abdominoperineal resection, iron deficiency and liver disease),
transthyretin (prealbumin) (reflects dietary intake, increased in uraemia and dehydration, decreased in fasting),
retinol binding protein (reflects recent dietary intake),
urinary creatinine (excretion rate reflects muscle mass),
IGF1 (reduced in malnutrition),
micronutrients

27
Q

what biochemical measures should be taken for older people in the community

A

vitamins A,B,C,D and E, albumin and zinc all lower in high risk groups

28
Q

what parameters means a patient requires nutritional suppport

A

BMI <18.5

Unintentional weight loss >10% within the last 3–6 months

BMI <20 and unintentional weight loss >5% within the last 3–6 months

Have eaten or are likely to eat little or nothing for more than 5 days or longer

Poor absorptive capacity and/or high nutrient losses and/or increased nutritional needs from causes such as catabolism

29
Q

what are the different types of nutritional support

A

Food fortification & dietary counselling

oral nutritional support

enteral tube feeding

parental nutrition

30
Q

what is enteral tube feeding

A

Delivery of a nutritionally complete feed via a tube into the stomach, duodenum or jejunum

31
Q

what should be the first step in managing malnutrition

A

food first: increase energy and protein of diet without increasing volume (food fortification)

32
Q

what issues can interfere with a patient eating an drinking on a ward

A 
Presentation of food/drink
Difficulty swallowing
Unpleasant smells on the ward
Treatment/ scans at mealtimes
Lack of privacy
Hospital crockery or cutlery
33
Q

what alerts staff to patients that require physical assistance with eating and drinking

A

coloured tray

34
Q

why might someone need help eating and drinking

A

cognitive impairment, swallowing difficulties, learning disabilities

35
Q

what are some oral nutritional supplements

A

ready made drinks, powders, puddings, carb fat and protein supplements

36
Q

what are the indications for ETF

A

inadequate or unsafe oral intake,

afunctional, asseccible gastrointestinal tract

37
Q

in what patients should ETF be used instead of PN

A 
‘if the gut works, use it’
Unconscious patients
Neuromuscular swallowing disorder
Upper GI obstruction
GI dysfunction
Increased nutritional requirements
38
Q

what are the contraindications of ETF

A 
Lower gastrointestinal obstruction
Prolonged intestinal ileus
Severe diarrhoea or vomiting
High enterocutaneous fistula
Intestinal ischaemia
39
Q

what are the complications of enteral tube feeding

A

insertion (nasal damage, perforation, bleeding)

post insertion trauma

displacement (bronchial administration of food)

reflux (oesophagitis, aspiration)

GI intolerance (nausea, bloating, pain, diarrhoea)

metabolic (Refeeding syndrome, hyperglycaemia, fluid overload, electrolyte disturbance)

40
Q

describe PN

A

The administration of nutrient solutions via a central or peripheral vein

41
Q

what are the negatives of parental nutrition

A 
Expensive
Complications are life-threatening
Needs specialist skills
Not physiological
Psycho-social disturbance
42
Q

what are the indications for PN

A

inadequate or unsafe oral and/or enteral nutritional intake

a non-functional, inaccessible or perforated (leaking) gastrointestinal tract

  • IBD with severe malabsorption
  • Radiation enteritis
  • Short bowel syndrome
  • Motility disorders
43
Q

what are the indications for PN feeding in type 1 intestinal failure

A 
Severe malnutrition pre-op
Post-op feeding: ileus/organ failure/5 day rule
Intestinal fistulae
Multi-organ failure
Post chemo mucositis
44
Q

what are the ethical considerations of nutritional support

A

Food & fluids essential to life

  • Social and psychological role
  • Viewed as symbols of caring

Withholding nutrition can be perceived as neglect

GI (64 decks)

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