Malnutrition and Nutrition Intervention Flashcards
define malnutrition
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
impact of malnutrition
^mortality, septic + post surgical complications, length of hospital stay, pressure sores, readmission, dependency
decreased wound healing, response to treatment, rehab potential, QoL
diagnosing malnutrition
screen > assessment by dietitian > diagnosis
criteria for malnourished that nutrition support should be considered for?
BMI <18.5kg/m2
or
Unintentional weight loss >10 % past 3 - 6 / 12 or
BMI < 20 kg/m2 + unintentional weight loss > 5 % past 3 – 6 / 12
criteria for those at risk of malnutrition that nutrition support should be considered for?
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 route of artificial nutrition support is superior?
enteral is superior to parenteral
Where parenteral nutrition is used, the aim is?
to return to enteral → oral feeding as soon as (where) clinically possible
access for enteral nutrition
gastric feeding possible > naso-gastric tube
gastric feeding not possible > naso-duodenal or naso jejunal tube
is patient is on artifical nutritional support for the long term ( >3 months what procedure should be done?
gastrostomy
jejunstomy
what are the complications associated with enteral feeding?
food entering the lungs, constipation, diarrhoea, improper absorption of nutrients, nausea, vomiting, dehydration, electrolyte abnormalities, high blood sugar, vitamin and mineral deficiencies, and decreased liver proteins
what is parenteral nutrition?
delivery of nutrients, electrolytes and fluid directly into venous blood
what is enteral nutrition?
nutrition taken through the mouth or through a tube that goes directly to the stomach or small intestine
indications for parenteral nutrition
inadequate or unsafe oral and/or enteral nutritional intake
OR
non-functioning, inaccessible or perforated GI tract
composition of parenteral nutrition
Ready made / bespoke “scratch” bags.
MDT > fluid and electrolyte targets
access for parenteral nutrition
Central venous catheter (CVC): tip at superior vena cava and right atrium
complications of parenteral nutrition
mechanical: insertion
metabolic: injecting treatment
catheter: bacteraemia
where is albumin synthesised?
liver
what levels of albumin indicate a poor prognosis?
low
what happens to levels of albumin when there is increased inflammation?
decreases
negative acute phase protein
explain the decreased levels of albumin in inflammation
inflammation > activation of monocytes and macrophages > release cytokines > downregulates albumin
refeeding syndrome
group of biochemical shifts & clinical symptoms that can occur in the malnourished or starved individual on the reintroduction of oral, enteral or parenteral nutrition
pathogenesis and features of refeeding syndrome
starvation/malnutrition > glycogenolysis, gluconeogenesis, protein catabolism > depletion > salt + water intolerance > refeeding (switch to anabolism) > insulin secretion > ^protein/glycogen synthesis > ^glucose uptake, utilization of thiamine, uptake of electrolytes > hypoK+/Mg2+/PO34-, thiamine deficiency, oedema
consequences of refeeding syndrome
Arrhythmia, tachycardia, CHF > Cardiac arrest, sudden death
Respiratory depression
Encephalopathy, coma, seizures, rhabdomyolysis,
Wernicke’s encephalopy
management of refeeding syndrome
micronutrients from onset of feeding > correct/monitor electrolytes daily > administer thiamine from onset > monitor fluid shifts and minimise risk of fluid and Na+ overload
