Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

BRS YR2 > Malnutrition and Nutritional Assessment > Flashcards

Malnutrition and Nutritional Assessment Flashcards

1
Q

What is the definition of malnutrition?

A

a state resulting from lack of uptake or intake of nutrition leading to an altered body composition and body cell mass leading to diminished physical and mental function and impaired clinical outcome from disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What conditions can encourage malnutrition?

A
  • low mood/depression
  • dysphagia
  • stomatitis
  • anosmia
  • ill fitting dentures/poor dentition
  • co-morbidities like dementia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What aspects of hospitals encourage malnutrition?

A
  • inflexible meal timings
  • poly-pharmacy
  • inactivity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the impact of malnutrition?

A

physical and functional decline and poorer clinical outcomes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What does malnutrition increase?

A
  • mortality
  • sepsis
  • post surgical complications
  • length of hospital stay
  • pressure sores
  • re-admissions
  • dependency
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What does malnutrition decrease?

A
  • wound healing
  • response to treatment
  • rehab
  • quality of life
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How do you diagnose malnutrition?

A
  • screen
  • assess
  • diagnose
  • plan
  • implement
  • monitor
  • evaluate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is involved in a screen when looking to diagnose malnutrition?

A
  • tool used to identify risk
  • any HCP
  • NOT an assessment or diagnosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What happens when assessing for malnutrition?

A
  • dietitian
  • a process to determine the cause of the nutrient imbalance
  • anthropometry
  • biochemistry
  • clinical implications
  • dietary restrictions
  • social and physical history
  • nutrition requirements
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When should nutrition support be considered?

A

in those that are:

  • malnourished
  • at risk of malnutrition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What values would result in a classification of malnourished?

A
  • BMI < 18.5
    OR
  • unintentional weight loss > 10% over the past 3-6/12
    OR
  • BMI <20, unintentional weight loss >5% in the past 3-6/12.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What values would result in a classification of at risk of malnutrition?

A
  • have eaten very little for >5 days and/or are likely to eat little/nothing for the next 5 days
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is artificial nutrition support?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the best form of artificial nutrition support?

A

enteral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which with enteral support tubes is gastric feeding possible?

A

naso-gastric tube

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which with enteral support tubes is gastric feeding not possible?

A
  • naso-duodenal

- naso-jejunal tube

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is are possible forms of long term (>3 months) enteral nutrition?

A
  • gastrostomy

- jejunstomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the different types of nutritional feeds?

A
  • renal
  • low sodium
  • respiratory
  • immune
  • elemental
  • peptide
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

When is an NGT contraindicated?

A

gastric outlet obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What can be used as a substitute when NGT is contraindicated?

A

NJT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the mechanical complications associated with enteral feeding?

A
  • misplacement
  • blockage
  • buried bumper
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the GI complications associated with enteral feeding?

A
  • aspiration
  • nasopharyngeal pain
  • laryngeal ulceration
  • vomiting
  • diarrhoea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How do you test for a misplaced NGT?

A
  • aspirate pH = 5.5

- if >5.5, CXR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is parenteral nutrition?

A

the delivery of nutrients, electrolytes and fluid and directly into venous blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the indications for parenteral nutrition?

A
  • inadequate or unsafe oral and/or enteral nutritional intake
  • non-functioning, inaccessible or perforated gastrointestinal tract
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the composition of parenteral nutrition?

A
  • ready made/bespoke ‘scratch bags’

- MDT decides on fluid and electrolyte targets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the access points for parenteral nutrition?

A
  • central venous catheter: tip at the superior vena cava and right atrium
  • different CVCs for different length of use
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is a PICC line?

A

Peripherally Inserted Central Catheter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are the mechanical complications associated with parenteral feeding?

A
  • pneumothorax
  • haemothorax
  • thrombosis
  • cardiac arrhythmias
  • thrombus
  • catheter
  • occlusion
  • thrombophlebitis
  • extravasion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are the metabolic complications associated with enteral feeding?

A
  • deranged electrolytes
  • hyperglycaemia
  • abnormal liver
  • enzymes
  • oedema
  • hypertriglyceridaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are the other complications associated with enteral feeding?

A

catheter related infections

32
Q

What does albumin indicate?

A

low albumin tends to indicate high inflammation and therefore a poor prognosis

33
Q

What is the role of albumin?

A

an negative acute phase protein

34
Q

Why does albumin decrease when inflammation increases?

A
  • release of cytokines down regulates the production of some proteins, such as: albumin
35
Q

Is albumin a valid marker of malnutrition in the acute hospital setting?

A

no

36
Q

What is refeeding syndrome?

A

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

37
Q

What is the impact of refeeding syndrome?

A
  • arrhythmia, tachycardia, cardiac arrest, sudden death
  • respiratory depression
  • encephalopathy, comma, seizures, rhabdomyolysis
  • wernicke’s encephalopy
38
Q

What tends to happen refeeding syndrome?

A
  • hypokalaemia
  • hypomagnesaemia
  • hypophosphataemia
  • thiamine deficiency
  • salt and water retention, odema
39
Q

According to the National Institute for Health and Care Excellence (NICE), what are the criteria for defining the risk of RFS?

A
  • at risk
  • high risk
  • extremely high risk
40
Q

What would classify someone as at risk of RFS?

A

Very little or no food intake for > 5 days

41
Q

What would classify someone as high risk of RFS?

A 
>/= 1 of the following:
BMI < 16 kg/m2
Unintentional weight loss > 15 % 3 – 6 /12
Very little / no nutrition > 10 days
Low K+, Mg2+, PO4 prior to feeding

Or >/= 2 of the following:
BMI < 18.5 kg/m2
Unintentional weight loss > 10 % 3 – 6 / 12
Very little / no nutrition > 5 days
PMHx alcohol abuse or drugs (insulin, chemotherapy, antacids, diuretics)

42
Q

What would classify someone as very high risk of RFS?

A

BMI < 14 kg/m2

Negligible intake > 15 days

43
Q

How do you manage RFS?

A
  • start on 10-20cal/kg, CHO 40-50% energy
  • correct and monitor electrolytes daily
  • administer thiamine from the onset of feeding
  • monitor fluid shifts and reduce the risk of fluid and Na* overload
44
Q

What groups are most at risk of malnutrition?

A
  • elderly
  • cancer
  • chronic illness
  • drug/alcohol abuse
45
Q

What is appropriate nutrition provision in the ICU associated with?

A
  • improved patient outcomes
  • reduced length of hospital stay
  • reduced dependence on mechanical ventilation
  • reduced infections
46
Q

What is the preferred route of feeding for pancreatitis?

A

Enteral nutrition

47
Q

What is the effect of Enteral nutrition?

A
  • supports the function and structural mobility of the gut
  • modulates the system immune response
  • attenuates disease severity
48
Q

What should be prescribed if there is a risk of refeeding syndrome?

A

Pabrinex IV 1&2 ampoules o.d. for 10 days

49
Q

When is there a risk of refeeding syndrome?

A
  • low BMI
  • poor nutrition for greater than 5 days
  • low potassium
  • alcohol history
50
Q

What happens if duodenal inflammation is a problem during NGT feeding?

A

swap to a NJT that is distal to the stenosis

51
Q

What does it mean if the patients faeces become yellow in colour and liquid?

A

not absorbing enteral nutrition and therefore there is diarrhoea and steatorrhoea

52
Q

What should be done if the patient is not absorbing enteral nutrition?

A
  • swap to parenteral nutrition

- continue to challenge gut for gut integrity and reduce the risk of bacterial translocation

53
Q

What is short bowel syndrome?

A

syndrome-intestinal failure results from surgical resection, congenital defect or disease-associated loss of absorption and is characterized by the inability to maintain protein-energy, fluid, electrolyte or micronutrient balances when on a conventionally accepted, normal diet”.

54
Q

When does short bowel syndrome tend to occur?

A

when less than 2 meters from the duodenojejunal flexure

55
Q

What does <100cm of jejunum mean for the patient?

A
  • LT IV fluid

- electrolytes

56
Q

What does <75cm of jejunum mean for the patient?

A
  • LT Parenteral nutrition
  • IV fluids
  • electrolytes
57
Q

What does <50cm of jejunum and colon mean for the patient?

A
  • LT Parenteral nutrition
  • IV fluids
  • electrolytes
58
Q

What is lost when there is a jejunostomy?

A
  • 140mmol Na+/l
  • 5mmol K+/l
  • 135mmol Cl-/l
  • 8mmol HCO3/l
59
Q

What is the target stoma output?

A

< 1.5 L / day

60
Q

What is the initial output post surgery?

A

Initial output post surgery = 6L / day requiring IV fluids, PN and electrolyte replacement

61
Q

What determines the LT management of a jejunostomy?

A

remaining length and quality of the jejunum

62
Q

What oral fluid advice would you give to prevent further dehydration and electrolyte imbalance?

A
  • decrease oral fluids
  • restrict hypotonic and hypertonic fluids <1L/day
  • 1L glucose-saline solution/day
  • lower immediately post op
  • reduce stoma output
  • reduce dehydration and electrolyte imbalance
63
Q

What urinary sodium value indicates dehydration?

A

< 20mmol/L indicates dehydration

64
Q

What are the 2 aims of nutrition?

A
  • prevent dehydration

- improve nutritional status

65
Q

How can you prevent dehydration?

A
  • aim for urine sodium >20mmol/L
    by encouraging:
  • adherence to fluid restriction
  • consumption of an oral rehydration solution over the next 2 weeks.
66
Q

How can you improve nutritional status?

A
  • by showing an increase in lean body mass

- evidenced by increase mid-arm muscle circumference & handgrip strength over next 4 weeks

67
Q

What is taken into a nutritional assessment?

A
  • body composition and function
  • bloods
  • clinical features
  • DHx
  • diet Hx
  • social Hx
68
Q

What is the nutritional impact of Atracurium?

A

Decreases energy expenditure and gut motility

69
Q

What is the nutritional impact of Propofol?

A
  • Contributes additional energy of 1 kcal/mL

- Risk of fat overload

70
Q

What is the nutritional impact of Fentanyl?

A

Can cause constipation and decrease gut motility resulting in reduced gastric emptying

71
Q

What is the nutritional impact of Noradrenaline?

A
  • High doses cause a reduction of hepatic, renal and splanchnic blood flow. - Can lead to enteral feeding intolerance and risk of gut ischaemia
72
Q

What is the nutritional impact of Insulin?

A

Caution when enteral nutrition is held to avoid hypoglycaemia

73
Q

What is the nutritional impact of Sodium docusate?

A

Enteral nutrition is often considered a cause of diarrhoea. Therefore need to check that diarrhoea is not result of repeated doses of laxative

74
Q

What is the nutritional impact of Lansoprazole?

A

Alters pH and can make NG tube placement confirmation by pH paper unreliable

75
Q

What is the nutritional impact of Phenytoin IV?

A

If given via the enteral route requires a break from feed for drug absorption

BRS YR2 (70 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions