Malnutrition Flashcards
what is malnutrition
a state of nutrition in which a deficiency, excess or imbalance of energy, protein and other nutrients (vitamins and minerals) causes measurable adverse effects on tissue, body from, function and clinical outcome
disease related causes of malnutrition
decreased intake
impaired digestion and/or absorption
increased nutritional requirements
increased nutrient losses
how may a patient have decreased intake
poor appetite pain on eating medication side effects dysphagia sore mouth
how may a patient have impaired digestion and/or absorption
problems affecting; stomach intestines pancreas liver
how may a patient have increased nutritional requirements
catabolism infection
trauma
burns
surgery
how may a patient have increased nutrient losses
vomiting
diarrhoea
stoma losses
what can malnutrition increase the risk of
GI dysfunction
infection
wound healing
psychosocial causes of malnutrition
self neglect bereavement inability to access food deprivation loneliness
effects of starvation on metabolic rate
decreases
effects of starvation on weight
slow loss - almost all from fat stores
effects of starvation on nitrogen losses
decreases
effects of starvation on hormones
early increases in catecholamines, cortisol, GH, then slow fall
insulin decreased
effects of starvation on water and sodium
initial loss, late retention
effects of injury on metabolic rate
increases
effects of injury on weight
rapid loss, 80% from fat stores, remainder from protein
effects of injury on nitrogen losses
increases
effects of injury on hormones
increases in catecholamines, cortisol, GH
insulin increased but relative deficiency
effects of injury on water and sodium
retention
effects of malnutrition on impaired immune responses
increased risk of infection
impaired recovery when infected
effects of malnutrition on impaired wound healing
surgical wound dehiscence, anastomotic breakdown, development of post-surgical fistulae
effects of malnutrition on reduced muscle strength and fatigue
inactivity
poor self care
increased risk of falls
effects of malnutrition on respiratory muscle strength
increased risk of chest infection
difficult to wean from ventilator
effects of malnutrition on inactivity - especially in bed bound patient
increased risk of pressure sores and thromboembolism
effects of malnutrition on water and electrolyte disturbances
decreased ability to excrete sodium and water
effects of malnutrition on impaired thermoregulation
hypothermia
effects of malnutrition on menstrual irregularities/amenorrhoea
infertility and osteoporosis
effects of malnutrition of impaired psycho-social function
apathy
depression
self-neglect
3 steps of the MUST score
BMI (<18.5)
weight loss score (0 if intentional)
acute disease effect score
nutritional assessments
anthropometry;
mid-arm muscle circumference
triceps
grip strength
biochemical measures of nutritional status
vitamins A, C, D and E
albumin
zinc
what if referring syndrome
fatal shifts in fluids and electrolytes and disturbances in organ function and metabolic regulation that may result from rapid initiation of re feeding after a period of under nutrition
metabolic features of re-feeding syndrome
Hypokalaemia Hypophosphataemia Hypomagnesaemia Altered glucose metabolism Fluid overload
physiological features of re-feeding syndrome
Arrhythmias Altered level of consciousness Seizure Respiratory failure Cardiovascular collapse Death
