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ailmentary > malnutrition > Flashcards

malnutrition Flashcards

1
Q

what is malnutrition

A

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

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2
Q

can malnutrition relate to obesity

A

yes

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3
Q

annual cost of under nutrition

A

£19.6billion

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4
Q

how many people in UK are under nourished

A

3 million

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5
Q

describe the conceptual model of malnutrition

A

basic causes - infrasturucture, political ideology, resources

underlying causes - household food insecurity, poor social care and envirmonment, poor access to healthcare and an unhealthy environment

immediate causes - disease and inadequate food

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6
Q

factors contributing to malnutrition - inadequate fodo

A 
poverty 
poor cooking
social isolation
bereavement
limited access to food
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7
Q

disease related contributors

A 
increased nutritritional requirements - Crohns/burns/cancer cachexia 
nausea/vomiting/taste changes 
diarrhoea
early satiety 
depression 
mobility 
frequent hospital admissions
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8
Q

consequences of malnutrition

A

lean body mass – massive effect on how live life and the support needed to stay at home

More likely to fall – readmissions
Low mood
More likely to go into care home – require more support

low immune func

muscle weakness

kidneys

brain - apathy, depression, self-neglect

reduced fertility

hypothermia

growth regulation

micronutrient deficiency

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9
Q

3 ways to assess malnutrition

A

nutrition screening
nutrition assessment
nutritional diagnosis

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10
Q

describe nutrition screening

A 
quick 
Screen everyone that is admitted
Regular and routine – admission and intervals 
Done by nurses or health care assistant 
with 24hours 
validated screening tool
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11
Q

describe nutritional assessment

A

more detailed
anthropometrics
dietician/specialist nurse

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12
Q

purpose of nutritional screening

A

Categorise people into risk so they can get the right support

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13
Q

describe the malnutrition universal screening tool

A

score for BMI
score for weight loss in 3-6months
score 2 if been acutely ill

add scores together to determine the malnutrition risk

0 - low risk - reassess: In hospital screen week
care homes- month
More community – yearly for in risk gps

1 – keep food charts, red trey scheme so people know they need assistance with food

2 – full dietary assessment and put in plan

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14
Q

how do you assess malnutrition and technical difficulties

A

% loss – see if signifivant – what and in how long- quicker is more significant – impact the care plan
Weighing rely on people being able to get on scales – bed/chair/hoist
Height – cant stand – surrogate markers – each measure wrist to sternal notch (demispan) or wrist to elbow (ulnar length)

Handgrip – measure of functional use, skinfold thickness – measure of biceps, tricep, super iliac?

Muscle circumference and how it changes

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15
Q

describe the food chart

A

Food record chart
24 hour – add food frequency

Macronutrient – 3 day enough
Micronutrient and vitamen – longer – need a lot info to get accurate food – weight/brand

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16
Q

assessing nutritional status through biochemistry

A 
Depend on clinical picture of patient 
Albulin – inflamm – trauma and stress so on own doesn’t give whole picture 
Creatine – change in muscle mass
change in cholesterol 
Liver func test
17
Q

practical impact of malnutrition

A 
falls 
muscle wastage 
low mood
increased admissions 
reduced independence 
confusion 
increased infections
18
Q

what is artificial feeding

A

Nutrition therapy for people unable to get enough nourishment from food and drink

19
Q

forms of nutritional support

A

Food first – snacks, butter, more fried food, fortified – more calories for less food

Red tray – need to see how much that person has eaten, encourage more

Oral nutritional supplements – on prescription
assistance with feeding 
swallow assessment 
food and fluid charts 
manage nausea/vomiting/bowels
20
Q

What are the enteral access routes

A 
nasogastric tube 
gastrostomy tube 
jejunostomy 
nasojejunal tube 
nasoduodenal tube
21
Q

When would you use a Nasogastric feed?

A

Need nutritional support for less than a month
Poor appetite - For people not meeting nutritional requirement – might be full feediung or just a top up
Stroke – cant swallow/not safe – liquid goes into lung if not swallowing properly
ICU- sedated and on a ventilator
After surgery – weak – might not eat well

22
Q

pathway to decide which nutritional support

A 
func GI tract - Yes -> oral diet/supplement or enteral feeding 
No -> parenteral feeding
23
Q

who do you know how much to feed

A

For people not meeting nutritional requirement – might be full feeding or just a top up - research

predictive equations

24
Q

when use a gastrostomy

A

long term
neurological swallowing problems
mechanical obstruction

low morbidity associated - but when done incorrectly - high post insertion mprtaity

25
Q

when use a jujunostomy tube

A

upper GI obstruction (oesophagus/stomach)
early post op feeding
management of long term delayed gastric emptying

26
Q

complications of enteral feeding

A

nausea and vom,
tube issue - pain/ulcer tube block If not flushed properly/aspiration
diarrhoea (intestinal infection/medications/malabsorption), constipation
metabolic complications (over/under feeding)

27
Q

what is parenteral feeding

A

The administration of nutrients, either centrally or peripherally, where the gastrointestinal tract is inaccessible OR there is insufficient gastrointestinal function.

28
Q

when do you use PN

A 
ONLY when the gut isn't working 
prolongued obstruction/pseudoobstruction
ilueus 
prolongued intestinal failure -radiation enteritis, short bowel syndrome, ischemic/necrotic bowel 
severe acute pancreatitis 
inadequate EN 
complex GI surgery 
onchology patients with GVHD
29
Q

how is PN administered

A

PICC line put into large arms of the vein, above or below the elbow

30
Q

complications with PN

A 
pneumothorax
bleeding 
misplacement 
line sepsis 
thrombosis 
phlebitis
occlusion - kinking/clogging 
dislodgement/fracture/leaking 
refeeding synsdorm 
hyper/oglucaemia 
electrolyte diusturbances 
hypertriglkyceridaemia 
liver disease 
cholelithiasis 
metabolic bone disease 
micronutrient imbalances 
liver disease
31
Q

what is refeeding syndrome

A

syndrome consisting of metabolic disturbances that occur as a result of reinstitution of nutrition to patients who arestarved or severely malnourished

when starved for 5 days or more

32
Q

describe the process involved in re-feeding syndrome

A

fast
reduced insulin, raised glucagon and cortisol
glycogenolysis, gluconeogenesis, protein catabolism
depletion of electrolytes, proteins, minerals and vitamins
feed
insulin
increase protein and glycogen synthesis
increase glucose uptake, uptake pf phosphorus, mg and K, thiamine use
= hypophosphtaemia, hypokalaemia, hypomagnesaemia, thiamine deficiency, sodium retention and water retention

33
Q

consequences of re-feeding syndrome - phos

A 
altered myocardial func
arrhythmia 
congestibve heart failure
vent fauilure 
lethargy 
seizures 
confusion 
paralysis,
Rhabdomyolysis
34
Q

consequences of RFS - K

A 
arrhythmia 
cardiac arrest 
resp destress 
paralysis
weakness
Rhabdomyolysis
35
Q

consequences of RFS - Mg

A 
arrhythmia
tachycardia 
rresp depression 
ataxia 
weakness
confusion
muscle tremors 
tetany
36
Q

management of RFS

A

replace electrolytes
vitamin supplements -
start nutrition at 10kca/kg/day

37
Q

nutritional supplements

A

but experts agree that most people can get enough of these nutrients from eating a balanced diet and, in the case of vitamin D, from getting enough sunlight. On the other hand, there is good evidence that certain vitamin supplements may be beneficial to the health of certain groups of people, such as the elderly, pregnant women and children between six months and five years old.
The study found no reduction in mortality in people who took antioxidant supplements, either in healthy people or in those with diseases.

ailmentary (15 decks)

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