malnutrition and nutritional assessment Flashcards

1
Q

what is malnutrition

A

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

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2
Q

what groups are at risk of malnutrition

A
  • 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
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3
Q

what are some reasons behind malnutrition in hospital

A
comorbidities
repeated nbm status
poly pharmacy
low mood and depression
inactivity
quality of food
metabolic response to injury
inactivity
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4
Q

what is the impact of malnutrition

BAPEN,2015

A

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

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5
Q

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

A

15%

£19.6 billion

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6
Q

how to diagnose malnutrition

A

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

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7
Q

what takes place after diagnosis for malnutrition

A

plan
implement
monitor
evaluate

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8
Q

what are the indications for nutritional support

A

if malnourished or at risk of malnutrition

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9
Q

what is meant by malnourished

A

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

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10
Q

what is meant by at risk of malnutrition

A

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

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11
Q

what is the route for enteral artificial nutrition support

A

enteral nutrition is superior to parenteral nutrition

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

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12
Q

what is the access for enteral support

A

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

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13
Q

complications associated with enteral feeding

A

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

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14
Q

what is parenteral nutrition

A

delivery of nutrients,electrolytes and fluids directly into venous blood

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15
Q

what are the indications for parenteral nutrition support

A

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

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16
Q

how to access for parenteral support

A

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

17
Q

composition of parenteral bags

A

ready made/bespoke scratch bags

mdt - fluid and electrolyte targets

18
Q

complications associated with parenteral support

A

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

19
Q

what is albumin

A

most abundant protein found in plasma

10-15g of plasma produced by hepatocytes in aday

20
Q

is albumin a valid marker of malnutrition in acute hosp setting

A

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

21
Q

what is refeeding syndrome

A

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

22
Q

consequences of refeeding syndrome

A

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

23
Q

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

A

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

24
Q

how to manage refeeding syndrome

A

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