Malnutrition

Question 1

what is malnutrition

Answer 1

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

Question 2

disease related causes of malnutrition

Answer 2

decreased intake
impaired digestion and/or absorption
increased nutritional requirements
increased nutrient losses

Question 3

how may a patient have decreased intake

Answer 3

poor appetite 
pain on eating 
medication side effects 
dysphagia 
sore mouth

Question 4

how may a patient have impaired digestion and/or absorption

Answer 4

problems affecting;
stomach
intestines
pancreas
liver

Question 5

how may a patient have increased nutritional requirements

Answer 5

catabolism infection
trauma
burns
surgery

Question 6

how may a patient have increased nutrient losses

Answer 6

vomiting
diarrhoea
stoma losses

Question 7

what can malnutrition increase the risk of

Answer 7

GI dysfunction
infection
wound healing

Question 8

psychosocial causes of malnutrition

Answer 8

self neglect
bereavement 
inability to access food
deprivation 
loneliness

Question 9

effects of starvation on metabolic rate

Answer 9

decreases

Question 10

effects of starvation on weight

Answer 10

slow loss - almost all from fat stores

Question 11

effects of starvation on nitrogen losses

Answer 11

decreases

Question 12

effects of starvation on hormones

Answer 12

early increases in catecholamines, cortisol, GH, then slow fall
insulin decreased

Question 13

effects of starvation on water and sodium

Answer 13

initial loss, late retention

Question 14

effects of injury on metabolic rate

Answer 14

increases

Question 15

effects of injury on weight

Answer 15

rapid loss, 80% from fat stores, remainder from protein

Question 16

effects of injury on nitrogen losses

Answer 16

increases

Question 17

effects of injury on hormones

Answer 17

increases in catecholamines, cortisol, GH

insulin increased but relative deficiency

Question 18

effects of injury on water and sodium

Answer 18

retention

Question 19

effects of malnutrition on impaired immune responses

Answer 19

increased risk of infection

impaired recovery when infected

Question 20

effects of malnutrition on impaired wound healing

Answer 20

surgical wound dehiscence, anastomotic breakdown, development of post-surgical fistulae

Question 21

effects of malnutrition on reduced muscle strength and fatigue

Answer 21

inactivity
poor self care
increased risk of falls

Question 22

effects of malnutrition on respiratory muscle strength

Answer 22

increased risk of chest infection

difficult to wean from ventilator

Question 23

effects of malnutrition on inactivity - especially in bed bound patient

Answer 23

increased risk of pressure sores and thromboembolism

Question 24

effects of malnutrition on water and electrolyte disturbances

Answer 24

decreased ability to excrete sodium and water

Question 25

effects of malnutrition on impaired thermoregulation

Answer 25

hypothermia

Question 26

effects of malnutrition on menstrual irregularities/amenorrhoea

Answer 26

infertility and osteoporosis

Question 27

effects of malnutrition of impaired psycho-social function

Answer 27

apathy depression self-neglect

Question 28

3 steps of the MUST score

Answer 28

BMI (<18.5) weight loss score (0 if intentional) acute disease effect score

Question 29

nutritional assessments

Answer 29

anthropometry; mid-arm muscle circumference triceps grip strength

Question 30

biochemical measures of nutritional status

Answer 30

vitamins A, C, D and E albumin zinc

Question 31

what if referring syndrome

Answer 31

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

Question 32

metabolic features of re-feeding syndrome

Answer 32

``` Hypokalaemia Hypophosphataemia Hypomagnesaemia Altered glucose metabolism Fluid overload ```

Question 33

physiological features of re-feeding syndrome

Answer 33

``` Arrhythmias Altered level of consciousness Seizure Respiratory failure Cardiovascular collapse Death ```