Malnutrition and Nutrition Intervention

Question 1

define malnutrition

Answer 1

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

Question 2

impact of malnutrition

Answer 2

^mortality, septic + post surgical complications, length of hospital stay, pressure sores, readmission, dependency
decreased wound healing, response to treatment, rehab potential, QoL

Question 3

diagnosing malnutrition

Answer 3

screen > assessment by dietitian > diagnosis

Question 4

criteria for malnourished that nutrition support should be considered for?

Answer 4

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

Question 5

criteria for those at risk of malnutrition that nutrition support should be considered for?

Answer 5

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

Question 6

what route of artificial nutrition support is superior?

Answer 6

enteral is superior to parenteral

Question 7

Where parenteral nutrition is used, the aim is?

Answer 7

to return to enteral → oral feeding as soon as (where) clinically possible

Question 8

access for enteral nutrition

Answer 8

gastric feeding possible > naso-gastric tube

gastric feeding not possible > naso-duodenal or naso jejunal tube

Question 9

is patient is on artifical nutritional support for the long term ( >3 months what procedure should be done?

Answer 9

gastrostomy

jejunstomy

Question 10

what are the complications associated with enteral feeding?

Answer 10

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

Question 11

what is parenteral nutrition?

Answer 11

delivery of nutrients, electrolytes and fluid directly into venous blood

Question 12

what is enteral nutrition?

Answer 12

nutrition taken through the mouth or through a tube that goes directly to the stomach or small intestine

Question 13

indications for parenteral nutrition

Answer 13

inadequate or unsafe oral and/or enteral nutritional intake
OR
non-functioning, inaccessible or perforated GI tract

Question 14

composition of parenteral nutrition

Answer 14

Ready made / bespoke “scratch” bags.

MDT > fluid and electrolyte targets

Question 15

access for parenteral nutrition

Answer 15

Central venous catheter (CVC): tip at superior vena cava and right atrium

Question 16

complications of parenteral nutrition

Answer 16

mechanical: insertion
metabolic: injecting treatment
catheter: bacteraemia

Question 17

where is albumin synthesised?

Answer 17

liver

Question 18

what levels of albumin indicate a poor prognosis?

Answer 18

low

Question 19

what happens to levels of albumin when there is increased inflammation?

Answer 19

decreases

negative acute phase protein

Question 20

explain the decreased levels of albumin in inflammation

Answer 20

inflammation > activation of monocytes and macrophages > release cytokines > downregulates albumin

Question 21

refeeding syndrome

Answer 21

group of biochemical shifts & clinical symptoms that can occur in the malnourished or starved individual on the reintroduction of oral, enteral or parenteral nutrition

Question 22

pathogenesis and features of refeeding syndrome

Answer 22

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

Question 23

consequences of refeeding syndrome

Answer 23

Arrhythmia, tachycardia, CHF > Cardiac arrest, sudden death
Respiratory depression
Encephalopathy, coma, seizures, rhabdomyolysis,
Wernicke’s encephalopy

Question 24

management of refeeding syndrome

Answer 24

micronutrients from onset of feeding > correct/monitor electrolytes daily > administer thiamine from onset > monitor fluid shifts and minimise risk of fluid and Na+ overload

Question 25

are albumin levels a valid marker of nutritional status in the acute setting?

Answer 25

no