Malnutrition and Nutrition Flashcards
What is malnutrition?
a state resulting from lack of uptake or intake of nutrition leading to altered body composition and body cell mass leading to diminished physical and mental function and impaired clinical outcome from disease
What does malnutrition lead to an increase of?
- Mortality
- septic and post surgical complications
- length of hospital-stay
- pressure sores
- re-admissions
- dependency
What does malnutrition lead to an decrease of?
- Wound healing
- response to treatment
- rehabilitation potential
- quality of life
What is the screening for malnutrition?
- Simple tool to identify risk
- Carried out by any HCP
- Not assessment of diagnosis
What is the assessment for malnutrition?
- dietician
- a systematic process of collecting and interpreting information to determine the nature and cause of the nutrient balance
1. anthropometry
2. biochemistry
3. clinical
4. Dietary
5. Social and physical
6. Nutrition requirements
What do you do after assessing malnutrition?
- Diagnose: nutrition diagnosis
2. Plan, implement, monitor, evaluate
What is the credential for malnourishment?
- BMI < 18.5 kg/m2 or
- Unintentional weight loss >10 % past 3 - 6 / 12 or
- BMI < 20 kg/m2 + unintentional weight loss > 5 % past 3 – 6 / 12.
Who is at risk of malnutrition?
- Have eaten little or nothing for > 5 days and / or are likely to eat little or nothing for the next 5 days or longer or
- Have a poor absorptive capacity, and / or have high nutrient losses and/or have increased nutritional needs from causes such as catabolism.
What is the eternal route for artificial nutrition support?
- Enteral nutrition (EN) is superior to parenteral nutrition (PN).
- Where parenteral nutrition is used, the aim is to return to enteral → oral feeding as soon as (where) clinically possible
If gastric feeding possible what access to you use?
Naso-gastric tube (NGT)
If gastric feeding not possible what access to you use?
Naso-duodenal (NDT) / naso-jejunal tube (NJT)
What do you use for long term artificial nutrition?
Long term (> 3 months) = Gastrostomy/jejunstomy
What is part of nutritional feeds?
renal, low sodium, respiratory, immune, elemental, peptide
What are the complication associated with eternal feeding?
- Mechanical
- Metabolic
- GI
What are the indications for PN?
- An inadequate or unsafe oral and/or enteral nutritional intake
- A non-functioning, inaccessible or perforated gastrointestinal tract
What is the composition of PN?
- Ready made / bespoke “scratch” bags.
* MDT → fluid and electrolyte targets
What is the access of PN?
- Central venous catheter (CVC): tip at superior vena cava and right atrium.
- Different CVCs for short / long term use
Where is albumin synthesised?
liver
What are the complications assoicated with parenteral nutrition?
- Metabolic
- Mechanical
- Catheter related infections
What makes up the acute phase response?
- Inflammatory stimulus
2. Cytokines
What is the inflammatory stimulus?
leads to activation of monocytes & macrophages → release cytokines
What do the cytokines do?
act on liver to stimulate production of some proteins whilst downregulating production of others e.g. albumin
When will albumin levels decrease?
- A moderate inflammatory stimulus will induce plasma acute phase protein changes.
- The negative acute phase protein, albumin, will↓
What is refreeding syndrome (RFS)?
A group of biochemical shifts & clinical symptoms that can occur in the malnourished or starved individual on the reintroduction of oral, enteral or parenteral nutrition
What are the consequences of RFS?
- Arrhythmia, tachycardia, CHF → Cardiac arrest, sudden death
- Respiratory depression
- Encephalopathy, coma, seizures, rhabdomyolysis,
- Wernicke’s encephalopy
Is albumin a valid marker of malnutrition in the acute hospital setting?
NOOOO
