MALNUTRITION AND NUTRITION ASSESSMENT Flashcards
What is the definition of malnutrition?
A state resulting from lack of uptake/intake of nutrition leading to altered body composition and body cell mass leading to diminished physical and mental function and impaired clinical outcome from diseas
Why might malnutrition occur in hospital?
Co-morbidities Disease related anorexia Metabolic response to illness/injury Excess nutritional loss Low mood/depression Inactivity Dysphagia Quality of food Inflexibility of mealtimes
What is the impact of malnutrition in hospital environments?
Increased mortality, complications (septic/post surgical), hospital stay, pressure sores, re-admissions, dependency
Decreased wound healing, response to treatment, rehabilitation potential, QOL
How is malnutrition diagnosed and who by?
Screen to identify risk by any HCP
Assess to determine cause by dietitian
Diagnosis
What are some ways malnutrition can be diagnosed?
Anthropometry (physical properties of body) Biochemistry Clinical (history, symptoms) Dietary Social/physical Nutrition requirements
In which individuals should nutrition support be considered?
Malnourished
At risk of malnutrition
What qualifies a person to be malnourished?
BMI < 18.5
or
Unintentional weight loss > 10% in past 3-6 months
or
BMI < 20 and unintentional weight loss > 5% in past 3-6 months
What qualifies a person to be at risk of malnutrition
Eaten little/nothing for > 5 days and/or likely to eat little/nothing for next 5+ days
Or
Poor absorptive capacity and/or high nutrient losses and/or increased nutritional needs from causes e.g. catabolism
What is artificial nutrition support?
The provision of enteral or parenteral nutrients to treat or prevent malnutrition
What is the aim of parental nutrition?
Return to enteral then oral feeding as soon as clinically possible
If gastric feeding is possible, what should a patient on enteral nutrition use?
Naso-gastric tube (NGT)
If gastric feeding isn’t possible, what should a patient on enteral nutrition use?
Naso-duodenal tube (NDT)
Naso-jejunal tube (NJT)
When should gastrostomy/jejunstomy be done?
Patient on enteral nutritional support for > 3 months
What are the complications associated with enteral nutrition support?
Mechanical - misplacement, blockage, buried bumper
Metabolic - hyperglycaemia, deranged electrolytes
GI - aspiration, nasopharyngeal pain, laryngeal ulceration, vomiting, diarrhoea
What must be done after placing a NGT?
Obtain an aspirate from it.
If aspirate pH =< 5.5 then NGT placed correctly (stomach)
If aspirate pH > 5.5 need to do a chest Xray to see where NGT is
What is parental nutrition?
Delivery of nutrients, electrolytes and fluid directly into venous blood
When should parental nutrition be done?
An inadequate/unsafe oral/enteral nutritional intake
Non-functioning, inaccessible GI tract
Perforated GI tract
What is the composition of parenteral nutrition delivered to patients?
Ready made/bespoke bags by dietician
Fluid and electrolyte targets by MDT
How is parental nutrition administered?
Central venous catheter at subclavian, jugular or femoral vein with tip at SVC and right atrium
What are the complications of parental nutrition?
Mechanical - pneumothorax, haemothorax, thrombosis, arrhythmias, catheter occlusion, thrombophlebitis, extravasion
Metabolic - deranged electrolytes, hyperglycaemia, abnormal liver enzymes, oedema, hypertriglyceridaemia
Catheter related infections
Where is albumin synthesised?
Liver
What increases albumin synthesis?
Insulin, cortisol, GH
Why is albumin measured?
It is a negative acute phase protein so;
- Less plasma albumin when increased inflammation
Why is albumin decreased in inflammation?
Cytokines released act on liver to downregulate albumin production
What is refeeding syndrome?
A group of biochemical shifts and clinical symptoms that can occur in malnourished/starved individual upon oral, enteral or parenteral nutrition.
What are the consequences/signs of refeeding syndrome?
Arrhythmia, tachycardia, CHF –> cardiac arrest/sudden death
Respiratory decompression
Encephalopathy, coma, seizures, rhabdomyolysis
Wernicke’s encephalopy
Describe the NICE criteria for risk of refeeding syndrome?
At risk:
- Very little/no food intake > 5 days
High risk: (1 of the following): - BMI < 16 - Unintentional weight loss > 15% in 3-6 months - Very little/no nutrition > 10 days - Low K+, Mg2+, PO4 prior to feeding
Or
(2 of the following):
- BMI < 18.5
- Unintentional weight loss > 10% in 3-6 months
- Very little/no nutrition > 5 days
- Alcohol abuse/drugs
Extremely high risk:
- BMI < 14
- Negligible intake > 15 days
What is the management for avoiding refeeding syndrome?
Start:
- 10-20 kcal/kg
- carbohydrates 40-50% energy
- micronutrients
Correct and monitor electrolytes daily following trust policy
Administer thiamine from onset of feeding following trust policy
Monitor fluid shifts and minimise risk of fluid/Na+ overload
