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