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Geriatrics > Malnutrition > Flashcards

Malnutrition Flashcards

1
Q

What causes malnutrition

A

Poor intake
Provision - shopping / poverty / fussy
Increased requirement
Excess loss

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2
Q

What causes increased requirements

A

Disease - cancer / infection
Respiratory disease / liver = very high requirement
Surgery
Treatment

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3
Q

What causes excess loss

A

Burns
Malabsorption
Intolerances
High output stoma

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4
Q

What are complications of malnutrition

A 
Poor immune system
Pour wound healing 
Pressure sores
Muscle wasting
Weakness
Lethargy
Increased hospital risk and readmission
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5
Q

How do you prevent malnutrition

A

MUST screening within 24 hours and then weekly

Weight on admission

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6
Q

What does MUST take in

A

BMI
Unexplained weight loss
Acute disease where no intake for >5 days

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7
Q

What do you do for a score of 1

A

3 day food diary

1st line support e.g. extra snacks

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8
Q

What do you do if the score is 2

A

Refer for dietician input
Food fortification = 1st line to make what eating higher calories
Nutritional supplement on top of oral
Estimate energy and protein requirement

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9
Q

What should you be careful with when prescribing nutirional supplement

A

U+E

Can put potassium etc wrong

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10
Q

What is enteral feeding

A

Enteric tube direct into gut

If can’t maintain oral intake e.g. aspiration after stroke

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11
Q

What are types of enteral feeding

A

NG tube
Gastrostomy
Jejunostomy

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12
Q

When would you do a NG tube

A 
Quick and easy 
Acute setting <6 weeks 
Easy to pull out / move
Aspirate before and feed if PH <5.5
CXR to check it is in stomach
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13
Q

What is a gastrostomy

A

Inserted surgically / radiologically / endoscopic

PEG = most common if need feed long term / NG dislodge

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14
Q

When is a jejunostomy used

A

If blockage below gastrostomy
Less likely to dislodge
Common after surgery

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15
Q

What are the benefits of enteral feeding

A 
Maintains gut integrity so no difficulty when restart on oral
Low risk and low cost
Physiologically normal 
Increased muscle strength 
Decreased hospital and mortality
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16
Q

What are the complications of enteral feeding

A 
Refeeding syndrome 
Aspiration - 30 degree angle
Diarrhoea
Tube blockage
Infection
17
Q

What does the type of feed depend on

A 
Clinical condition
Period of NBM prior
Requirement
Fluid restriction
Oral intake
Continous vs bolus
18
Q

When is TPN used

A

ONLY in gut failure or inaccessible
Given via a central venous line or PICC
If gut works = use

19
Q

What is refeeding syndrome

A

Severe fluid and electrolyte shift and related metabolic concentration disturbance when feed restarted in malnourished patient

Can occur with oral as well as enteral / parenteral

20
Q

What happens in refeeding syndrome

A

Dangerous change due to increased insulin + ATP when switch from fat to carb metabolism

Intracellular Na and H20 shift out of cells
Glucose, K, phosphate taken up by cells

Increased demand for electroyltes and nutrients

21
Q

What are indicators of refeeding syndrome

A 
CF - pulmonary oedema / arrthymia
Acute circulatory overload or depletion 
Hypophosphate / K and Mg 
Hyperglycaemia 
Rhabdomyolysis 
Resp failure
Leucocyte dysfunction
Hypotension
Seizure
Coma
22
Q

You are at risk with 1+ of

A

BMI <18
Unintentional weight loss >15% 3-6 months
Little or no intake >10 days
Low K, phosphate or Mh prior to feed

23
Q

At risk if 2+ of

A

BMI <18.5
Weight loss >10% 3-6 months
Little or no intake >5 days
Alcohol / drug abuse Hx

24
Q

How do you manage the risk of refeeding syndrome

A

Calculate additional requirement
Baseline blood prior - U+E, FBC, LFT, Ca, Mg, phosphate, glucose
Monitor DAILY
Supplement as need
Delivery slowly if high risk (10cal/kg/day)
Aim to meet needs 4-7 days

Cardiac monitor where appropriate

Thiamine / Paprinix prior to feed
Vit B compound and forceval + thiamine first 10 days

25
Q

How do you monitor tolerance to feed

A

Bowel
N+V
Biochemical

26
Q

What do you require if artificial feed

A

Daily bloods

27
Q

What are complications of TPN

A 
Sepsis 
Thrombophlebitis
LFT abnormality 
Central vein thrombosis leading to PE 
Metabolic imbalance
Pneumothorax
28
Q

How do you deal

A

Sterile technique
Review fluid balance 2x daily
Check weight, glucose, U+E and FBC daily
Check LFT 3x

Geriatrics (8 decks)

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