malnutrition and nutritional assessment

Question 1

what is 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 outcome and impaired clinical outcome from disease

Question 2

what groups are at risk of malnutrition

Answer 2

• older people >65
• people with long term conditions e.g diabetes, kidney disease, chronic lung disease
• people with chronic conditions e.g dementia/cancer
• people who abuse drugs/alcohol
• patients with any kind of gi dysfunction

Question 3

what are some reasons behind malnutrition in hospital

Answer 3

comorbidities
repeated nbm status
poly pharmacy
low mood and depression
inactivity
quality of food
metabolic response to injury
inactivity

Question 4

what is the impact of malnutrition

BAPEN,2015

Answer 4

increased mortality, septic and post surgical complications, length of hospital stay, pressure sores, readmissions, dependency
decreased wound healing, response to treatment, rehabilitation potential and quality of life

Question 5

what % of total public expenditure on health and social care is spent on malnutrition

Answer 5

15%

£19.6 billion

Question 6

how to diagnose malnutrition

Answer 6

screening tool - MUST
assess by dietician: anthropometry, biochemistry,medical hx, dietary requirements, social and physical and nutritional requirements
then diagnose

Question 7

what takes place after diagnosis for malnutrition

Answer 7

plan
implement
monitor
evaluate

Question 8

what are the indications for nutritional support

Answer 8

if malnourished or at risk of malnutrition

Question 9

what is meant by malnourished

Answer 9

bmi <18.5kg/m2 or
unintentional weightloss >10% in past3-6-12 months or
bmi <20kg/m2 and unintentional weightloss >5%

Question 10

what is meant by at risk of malnutrition

Answer 10

have eaten little/nothing >5days and/or like to eat little or nothing for next 5 days
or having poor absorptive capacity and/or have high nutrient loss or increased nutritional needs from causes such as catabolism

Question 11

what is the route for enteral artificial nutrition support

Answer 11

enteral nutrition is superior to parenteral nutrition

where parenteral nutrition is used - aim to return enteral feeding asap

Question 12

what is the access for enteral support

Answer 12

is feeding possible ?
yes - nasogastrotube
no - nasoduodenal/nasojejunal tube
long term >3mths = gastrostomy/jejunstomy

Question 13

complications associated with enteral feeding

Answer 13

mechanical - misplaced ngts, blockage,buried bumper
metabolic - hyperglycaemia, deranged electrolytes
gi - aspiration, nasopharyngeal pain, laryngeal ulceration, vomiting and diarrhoea

Question 14

what is parenteral nutrition

Answer 14

delivery of nutrients,electrolytes and fluids directly into venous blood

Question 15

what are the indications for parenteral nutrition support

Answer 15

inadequate or unsafe oral and/or enteral nutritional intake
or
non functioning, inaccessible or perforated gi tract

Question 16

how to access for parenteral support

Answer 16

central venous catheter - tip at superior vena cava and right atrium
different cvs for short/long term use

Question 17

composition of parenteral bags

Answer 17

ready made/bespoke scratch bags

mdt - fluid and electrolyte targets

Question 18

complications associated with parenteral support

Answer 18

metabolic - deranged electrolytes, hyperglycaemia, abnormal liver enzymes
mechanical - pneumothorax, thrombosis, occlusion, cardiac arrythmias
andd catheter related infections

Question 19

what is albumin

Answer 19

most abundant protein found in plasma

10-15g of plasma produced by hepatocytes in aday

Question 20

is albumin a valid marker of malnutrition in acute hosp setting

Answer 20

no
albumin synthesis reduced in response to inflammation -
can see hypoalbuminaemia in obese trauma patients

Question 21

what is refeeding syndrome

Answer 21

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

Question 22

consequences of refeeding syndrome

Answer 22

biochemical abnormailities in fluid and electrolytes can lead to arrhythmias, tachycardia,chf -> cardiac arrest, sudden death
respiratory depression
encephalopathy, coma,seizures,rhabdomyolysis
wernickes encephalopy

Question 23

accordingto NICE, what are the criteria for defining risk of refeeding syndrome

Answer 23

at risk: very little/no food intake for >5days
High risk:
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)

Extremely high risk:
BMI < 14 kg/m2
Negligible intake > 15 days

Question 24

how to manage refeeding syndrome

Answer 24

start 10-20kcal/kg
micronutrients given from onset of feeding
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 and na+ overload