MALNUTRITION AND NUTRITION ASSESSMENT Flashcards

1
Q

What is the definition of malnutrition?

A

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

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2
Q

Why might malnutrition occur in hospital?

A
Co-morbidities
Disease related anorexia
Metabolic response to illness/injury
Excess nutritional loss
Low mood/depression
Inactivity
Dysphagia
Quality of food
Inflexibility of mealtimes
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3
Q

What is the impact of malnutrition in hospital environments?

A

Increased mortality, complications (septic/post surgical), hospital stay, pressure sores, re-admissions, dependency

Decreased wound healing, response to treatment, rehabilitation potential, QOL

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4
Q

How is malnutrition diagnosed and who by?

A

Screen to identify risk by any HCP
Assess to determine cause by dietitian
Diagnosis

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5
Q

What are some ways malnutrition can be diagnosed?

A
Anthropometry (physical properties of body)
Biochemistry
Clinical (history, symptoms)
Dietary
Social/physical
Nutrition requirements
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6
Q

In which individuals should nutrition support be considered?

A

Malnourished

At risk of malnutrition

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7
Q

What qualifies a person to be malnourished?

A

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

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8
Q

What qualifies a person to be at risk of malnutrition

A

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

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9
Q

What is artificial nutrition support?

A

The provision of enteral or parenteral nutrients to treat or prevent malnutrition

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10
Q

What is the aim of parental nutrition?

A

Return to enteral then oral feeding as soon as clinically possible

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11
Q

If gastric feeding is possible, what should a patient on enteral nutrition use?

A

Naso-gastric tube (NGT)

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12
Q

If gastric feeding isn’t possible, what should a patient on enteral nutrition use?

A

Naso-duodenal tube (NDT)

Naso-jejunal tube (NJT)

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13
Q

When should gastrostomy/jejunstomy be done?

A

Patient on enteral nutritional support for > 3 months

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14
Q

What are the complications associated with enteral nutrition support?

A

Mechanical - misplacement, blockage, buried bumper

Metabolic - hyperglycaemia, deranged electrolytes

GI - aspiration, nasopharyngeal pain, laryngeal ulceration, vomiting, diarrhoea

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15
Q

What must be done after placing a NGT?

A

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

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16
Q

What is parental nutrition?

A

Delivery of nutrients, electrolytes and fluid directly into venous blood

17
Q

When should parental nutrition be done?

A

An inadequate/unsafe oral/enteral nutritional intake
Non-functioning, inaccessible GI tract
Perforated GI tract

18
Q

What is the composition of parenteral nutrition delivered to patients?

A

Ready made/bespoke bags by dietician

Fluid and electrolyte targets by MDT

19
Q

How is parental nutrition administered?

A

Central venous catheter at subclavian, jugular or femoral vein with tip at SVC and right atrium

20
Q

What are the complications of parental nutrition?

A

Mechanical - pneumothorax, haemothorax, thrombosis, arrhythmias, catheter occlusion, thrombophlebitis, extravasion

Metabolic - deranged electrolytes, hyperglycaemia, abnormal liver enzymes, oedema, hypertriglyceridaemia

Catheter related infections

21
Q

Where is albumin synthesised?

A

Liver

22
Q

What increases albumin synthesis?

A

Insulin, cortisol, GH

23
Q

Why is albumin measured?

A

It is a negative acute phase protein so;

- Less plasma albumin when increased inflammation

24
Q

Why is albumin decreased in inflammation?

A

Cytokines released act on liver to downregulate albumin production

25
Q

What is refeeding syndrome?

A

A group of biochemical shifts and clinical symptoms that can occur in malnourished/starved individual upon oral, enteral or parenteral nutrition.

26
Q

What are the consequences/signs of refeeding syndrome?

A

Arrhythmia, tachycardia, CHF –> cardiac arrest/sudden death

Respiratory decompression
Encephalopathy, coma, seizures, rhabdomyolysis
Wernicke’s encephalopy

27
Q

Describe the NICE criteria for risk of refeeding syndrome?

A

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
28
Q

What is the management for avoiding refeeding syndrome?

A

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