Malnutrition and nutritional assessment Flashcards
Define malnutrition
A state in which deficiency, excess or imbalance, of energy, protein or other nutrients, results in a measurable adverse effect on body composition, function and clinical outcome
- not can be over or under malnutrition
- v. common
- usually unnoticed
Who are at risk of malnutrition?
- those with GI dysfunction
- Alcohol dependence
- chronic/ progressive disease
- age (risk increases as age increases)
What are the causes of malnutrition in hospital?
- reduced intake
- maldigestion/ malabsorption
- altered metabolism
What can cause malnutrition from reduced intake?
Contraindicated
Disease related anorexia
Taste changes
Nil by mouth (prolonged)
Food options
Depression
Inactivity
Oral health
Fatigue
What can cause malnutrition from maldigestion/ malabsorption?
- Function
- Length (reduced bowel length)
- Losses
- Drug-nutrient interactions (bile salts)
What are some consequences of malnutrition?
- postoperative mortality increases
Increases: - Mortality
- septic and post surgical complications
- length of hospital-stay
- pressure sores, re-admissions
- dependency
Decreases: - Wound healing
- response to treatment
- rehabilitation potential
- quality of life
How is malnutrition diagnosed?
- Assessment via dietitian based on:
- Anthropometry (the scientific study of the measurements and proportions of the human body)
- Body composition
- Function
- Biochemistry
- Clinical
- Dietary
- Social
- Physical
- Requirements
When should nutrition support be considered in patients?
In those that are either:
1. Malnourished =
- BMI < 18.5 kg/m2 or
- Unintentional weight loss >10 % past 3 - 6 / 12 or
- BMI < 20 kg/m2 + unintentional weight loss > 5 % past 3 – 6 / 12.
2. At risk of malnutrition =
- Have eaten little or nothing for > 5 days and / or are likely to eat little or nothing for the next 5 days or longer or
- Have a poor absorptive capacity, and / or have high nutrient losses and/or have increased nutritional needs from causes such as catabolism.
How is malnutrition treated?
1st: Oral nutrtional support, if oral nutrition is not possible/ safe
2nd: Enteral tube feeding, if GI tract is not functional/ accessible
3rd: Parenteral nutrition
(2nd/ 3rd= artificial nutrition support)
What is “oral nutrition support”?
The nutritional options available via the oral route:
Fortification of meals and snacks (increase density of food)
Altered meal patterns
Practical support (e.g. weighted utensils to aid tremour)
Oral nutritional supplements (ONS)
Tailored dietary counselling
What is Enteral nutrition?
Drinking nutrition beverages or formulas and tubefeeding are forms of enteral nutrition. There are 3 types of tubes:
- Naso-gastric tube (NGT)
- Naso-duodenal (NDT)
- naso-jejunal tube (NJT)
There are also 2 procedures using surgical openings to to introduce food:
Gastrostomy / jejunostomy
When do you put in certain types of enteral feeding tubes?
Enteral- if oral feeding is possible
- if gastric feeding is possible:
Naso-gastric tube (NGT)
- if gastric feeding is not possible:
Naso-duodenal (NDT) / naso-jejunal tube (NJT)
- Long term support required (> 3 months) = Gastrostomy / jejunostomy
What are the complications associated with enteral feeding?
- Mechanical: misplacement, blockage, buried bumper
- Metabolic: hypergylcaemia, deranged electrolytes
- GI: Aspiration, nasopharyngeal pain, laryngeal ulceration, vomiting, diarrhoea.
How do you detect misplaced NGTs?
- Aspirate pH 5.5
- If pH > 5.5 → chest x-ray, interpreted by trained professional following NPSA guidelines.
What is Parenteral nutrition?
Direct delivery of nutrients into the blood
- given when unsafe or inadequate oral intake
Access:
- Central venous catheter (CVC): tip at superior vena cava and right atrium.
- Different CVCs for short / long term use.
Composition:
- Ready made / bespoke “scratch” bags.
- MDT → fluid and electrolyte targets
