malnutrition and nutritional assessment Flashcards
what is 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 outcome and impaired clinical outcome from disease
what groups are at risk of malnutrition
- 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
what are some reasons behind malnutrition in hospital
comorbidities repeated nbm status poly pharmacy low mood and depression inactivity quality of food metabolic response to injury inactivity
what is the impact of malnutrition
BAPEN,2015
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
what % of total public expenditure on health and social care is spent on malnutrition
15%
£19.6 billion
how to diagnose malnutrition
screening tool - MUST
assess by dietician: anthropometry, biochemistry,medical hx, dietary requirements, social and physical and nutritional requirements
then diagnose
what takes place after diagnosis for malnutrition
plan
implement
monitor
evaluate
what are the indications for nutritional support
if malnourished or at risk of malnutrition
what is meant by malnourished
bmi <18.5kg/m2 or
unintentional weightloss >10% in past3-6-12 months or
bmi <20kg/m2 and unintentional weightloss >5%
what is meant by at risk of malnutrition
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
what is the route for enteral artificial nutrition support
enteral nutrition is superior to parenteral nutrition
where parenteral nutrition is used - aim to return enteral feeding asap
what is the access for enteral support
is feeding possible ?
yes - nasogastrotube
no - nasoduodenal/nasojejunal tube
long term >3mths = gastrostomy/jejunstomy
complications associated with enteral feeding
mechanical - misplaced ngts, blockage,buried bumper
metabolic - hyperglycaemia, deranged electrolytes
gi - aspiration, nasopharyngeal pain, laryngeal ulceration, vomiting and diarrhoea
what is parenteral nutrition
delivery of nutrients,electrolytes and fluids directly into venous blood
what are the indications for parenteral nutrition support
inadequate or unsafe oral and/or enteral nutritional intake
or
non functioning, inaccessible or perforated gi tract
how to access for parenteral support
central venous catheter - tip at superior vena cava and right atrium
different cvs for short/long term use
composition of parenteral bags
ready made/bespoke scratch bags
mdt - fluid and electrolyte targets
complications associated with parenteral support
metabolic - deranged electrolytes, hyperglycaemia, abnormal liver enzymes
mechanical - pneumothorax, thrombosis, occlusion, cardiac arrythmias
andd catheter related infections
what is albumin
most abundant protein found in plasma
10-15g of plasma produced by hepatocytes in aday
is albumin a valid marker of malnutrition in acute hosp setting
no
albumin synthesis reduced in response to inflammation -
can see hypoalbuminaemia in obese trauma patients
what is refeeding syndrome
group of biochemical shifts and clinical symptoms that can occur in malnourished or starved individual on reintroduction of oral,enteral or parenteral nutrition
consequences of refeeding syndrome
biochemical abnormailities in fluid and electrolytes can lead to arrhythmias, tachycardia,chf -> cardiac arrest, sudden death
respiratory depression
encephalopathy, coma,seizures,rhabdomyolysis
wernickes encephalopy
accordingto NICE, what are the criteria for defining risk of refeeding syndrome
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
how to manage refeeding syndrome
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
