Malnutrition Flashcards
what is malnutrition?
= a state of nutrition in which a deficiency, excess or imbalance of energy, protein and other nutrients cause measurable adverse effects on tissue, body form, function and clinical outcome
what 4 things could you be in deficiency, excess or imbalance in?
- deficit of energy
- protein
- vitamins
- minerals
what is the response of short and long term malnutrition?
Short term = adaptive
Long term = harmful
what are 4 causes of diseases related malnutrition?
1) decreased intake
2) impaired digestion and/or absorption
3) increased nutritional requirements
4) increased nutrient losses
what acute conditions cause malnutrition?
- sepsis, pneumonia
- fever
- surgery
- trauma
- radiotherapy
- chemo
what chronic conditions cause malnutrition?
- anorexia
- asthenia, depression
- dysphagia
- malabsorption, diarrhoea
- infection
- immobility
what are the effects of the acute and chronic conditions on malnutrition effects on GI?
= causes GI dysfunction - increases infection rate - decreases wound healing = physical weakness = poor poor intake
what are psychosocial causes of malnutrition?
- self neglect
- bereavement
- inability to access food
- deprivation
- loneliness
- lack of facilities and skills
- lack of help
describe the effects of starvation on malnutrition?
- decreased metabolic rate
- slow weight loss from fat stores
- decreased nitrogen loss
- early small increase in catecholamines, cortisol, GH then slow fall, insulin decreases
- initial loss of water and Na+ and late retention
describe the effects of slow injury on malnutrition?
- increased metabolic rate
- rapid weight loss from fat stores, remainder from protein
- increased nitrogen loss
- increase in catecholamines, cortisol, GH then slow fall, insulin increased but relative insulin deficiency
- water and Na+ deficiency
what are 8 effects of malnutrition?
- impaired immune response
- impaired wound healing
- reduced muscle strength and fatigue
- reduced respiratory muscle strength
- inactivity, especially bed bound
- water and electrolyte disturbances
- impaired thermoregulation
- menstrual irregularities/amenorrhea
- impaired pyscho-social function
what 2 ways could you assess nutrition?
1) anthropometry
= mid arm muscles circumference
- triceps
- grip strength
2) refer to validated charts
what are 7 biochemical assessments of nutritional status?
1) albumin
(makes up 50% of protein in plasma, not that albumin is also a non-specific marker of illness)
2) transferrin
- synthesis reduced in protein restriction
3) transthyretin (pre-albumin)
- increased in uraemia & dehydration
- decreased by fasting
4) retinol binding protein
- affects more by energy than protein restriction
- levels increase by increased GFR and alcoholism and decreased by chronic liver disorder & vit A and zinc deficiency
5) urinary creatinine
= if renal function is normal, excretion rate reflects muscle mass
6) IGF1
= levels reduce in liver disease & renal failure
7) micro-nutrients
what is statistically lower in high risk group compared to low risk group?
= vitamins A, C, D, E, Albumin and zinc all lower in high risk group
who needs nutritional support?
1) BMI <18.5
2) Unintentional weight loss >10% within the last 3–6 months
3) BMI <20 and unintentional weight loss >5% within the last 3–6 months
4) Have eaten or are likely to eat little or nothing for more than 5 days or longer
5) Poor absorptive capacity and/or high nutrient losses and/or increased nutritional needs from causes such as catabolism
what are 4 options for nutrition support?
1) food fortification & counselling
2) oral nutritional support
e. g. addition snacks or sips
3) enteral tube beefing
- delivery of nutritionally complete deef directly into gut via a tube
4) parenteral nutrition
- the delivery of nutrition intravenously
what are issue that interfere with eating or drinking on ward?
- feeling or being sick
- taste changes
- having to decide day before
- worrying about what to eat
- people interrupting melas
- temperature of food/drink
- presentation
- dysphagia
- unpleasant smells
- lack of privacy
describe oral nutritional supplements.
= ready made drinks (sip feeds)
- powders to reconstitute with milk e.g. build up, enshake
- puddings e.g. forticreme
- carbohydrate supplements
- fat supplements e.g. calogen
- fat and protein supplements (powder or liquid) e.g. Pro-Cal
when are oral nutritional supplements given?
- disease related malnutrition
- intractable malabsorption
- per-operative preparation of malnourished patients
- dysphagia
- proven IBD
- post total gastrectomy
- bowel fistulae
describe enteral tube feeding (ETF)?
= delivery of NUTRITIONALLY COMPLETE feed via a tube into the stomach, duodenum or jejunum;
- nasogastric (NG)
- nasojejunal (NJ)
- percutaneous endoscopic gastronomy (PEG)
- percutaneous jejunostomy
- surgical jejunostomy
when is ETF given?
- inadequate or unsafe oral intake and a function, accessible GI tract
- unconscious patients
- neuromuscular swallowing disorder
- upper GI obstruction
- GI dysfunction
- increased nutritional requirements
when is ETF NOT given?
- lower GI obstruction
- prolonged intestinal ileus
- severe diarrhoea or vomiting
- high entero-cutaneous fistula
- intestinal ischaemia
what are 6 complications of ETF?
1) insertion
- nasal damage, intra-cranial insertion, pharyngeal/oeosphageal pouch perforation, bronchial placement, percipitate variceal bleeding
- bleeding, perforation
2) post insertion trauma
- discomfort
- erosion
- fistulae
- perforation
3) displacement
- tube falls out, bronchial administration of feed
4) reflux
- oesophagitis, aspiration
5) GI intolerance
- nausea, bloating, pain, diarrhoea
6) metabolic
- re-feeding syndrome, hyperglycaemia, fluid overload, electrolyte disturbance
describe parenteral nutrition.
= administration of nutrient solutions via a central or peripheral vein
when is parenteral nutrition given?
= people who are malnourished or at risk of malnutrition and meet the following criteria;
- inadequate or unsafe oral or enteral nutritional intake
- a non-functional, inaccessible or perforated (leaking) GI tract
= IBD with severe malabsorption
= radiation enteritis
= short bowel syndrome
= motility disordered
when is parenteral feeding given in type I intestinal failure?
- severe malnutrition pre-op
- post- op feeding, ileus, organ failure, 5 day rule
- intestinal failure
- multi-organ failure
- post chemo mucositis
what should feeding regimens be taken account of?
- energy, protein, fluid, electrolyte, mineral, micro-nutrient and fibre needed
- activity levels and underlying conditions e.g. catabolism, pyrexia
- GI tolerance, potential metabolic instability & risk of re-feeding syndrome
- duration of nutrition support
