Malnutrition Flashcards
What are the risk factors for malnutrition?
over 65
in residential care or hospital
Long term conditions - eg cancer, dementia
Alcohol or drug dependency
What are the three main ways that someone may become malnourised?
reduced nutritional intake
increased nutritional requirements
inability to utilise nutrients ingested
Why might someone have reduced nutrient intake?
poverty low mood dysphagia repeated nil by mouth reduced appetite nausea eg from medications
Why might someone have increased nutritional requirements?
infection
surgery
wound healing
Why might someone be unable to use the nutrients they are ingesting?
diarrhoea vomiting drains wounds pancreatic insufficiency
How might someone with malnutriton present?
Low or high BMI
history of significant weight loss
comorbidities
What are the complications of malnutrition?
poor immunity and recurrent infections
muscle wasting, reduced mobility, increased falls,
imapried wound healing
micronutrient deficiencies - eg selinium, zinc, vit D deficiency
Osteomalacia
irone deficiency anaemia
How would you investigate malnutrition?
Bloods - FBC, U+Es, haematinics
MUST tool
Dietician assessment
What are the 3 key measurements/info needed for the MUST screening tool?
- BMI
- Percentage unplanned weight loss in last 3-6 months
- Acute disease effect - is the pt acutely ill and there is likely to be/has been no nutritional intake for 5 days
(Add scores from step 1-3 together)
How can you manage malnutrition?
Treat underlying condition if any
Provide help and advice on food and drink
Record needs for special diets, follow local policy
1. Food first - snacks, drinks, food fortification
2. oral nutrient supplements
- liquid, powder or semi-solid
- macro or micronutrients
- Milkshake, juice, pudding, powders, soup, jelly- style (fortisip, fortijuice, forticreme)
3. Enteral feeding
- directly into the stomach, jejunum or duodenum
-Short term: NG tube, NJ tube
- long term: PEG tube, PEJ tube
4. Parenteral - IV
What are the short term methods of enteral feeding?
Nasogastric tube - into stomach
Nasojejunal tube - into jejunum
What are long term methods of enteral feeding?
PEG – percutaneous endoscopic gastrostomy
PEJ – percutaneous endoscopic jejunostomy (Post pyloric/surgical JEJ)
What are the advantages of enteral vs parenteral feeding?
Enteral is cheaper
Enteral perseveres gut mucosa and integrity
What are the disadvantages of enteral feeding?
tube can be uncomfortable to place
nausea, satiety, constipation or diarrhoea
How do you check that an NG tube is in the right place?
aspirate pH measurement - gold standard - <5.5
second line - Xray confirmation
How do you check that an NJ tube is in the right place?
needs X-ray
Can’t check position using pH (as not going to stomach)
How is an NG tube inserted?
On a ward
How is an NJ tube inserted?
Under radiological guidance
Give 3 uses of a PEG tube
dysphagia eg stroke head and neck surgery neurological conditions Cystic fibrosis oral intake inadequate and likely to be long term
Give 3 uses of a PEJ tube
delayed gastric emptying
Upper GI or pancreatic surgery
in pts with high risk of aspiration
severe acute pancreatitis
When is parenteral feeding used?
when the gut is inaccessible or unable to absorb sufficient nutrients to sustain nutritional status
Give 3 conditions where parenteral nutrition is used
short gut syndrome Gastrointestinal fistula Bowel obstruction (bowel rest) Severe malnutrition, significant weight loss
How is MUST scored?
0- low risk
1- medium risk
≥ 2- high risk
What would you do if a patient scored 0 (low risk) on the must tool?
Monitor MUST level:
- Hospital – weekly
- Care Homes – monthly
- Community – annually for special groups e.g. those >75 yrs
