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BRS YR2 > Malnutrition and Nutritional Assessment > Flashcards

Malnutrition and Nutritional Assessment Flashcards

1
Q

What is the definition of malnutrition?

A

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.

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2
Q

What conditions can cause reduced intake in hospital?

A

Contraindicated
Disease related anorexia
Taste changes
Nil by mouth
Food options
Depression
Inactivity
Oral health
Fatigue

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3
Q

What aspects of hospitals encourage malnutrition?

A
  • inflexible meal timings
  • poly-pharmacy
  • inactivity
  • altered metabolism
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4
Q

What is the impact of malnutrition?

A

physical and functional decline and poorer clinical outcomes

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5
Q

What does malnutrition increase?

A
  • mortality
  • sepsis
  • post surgical complications
  • length of hospital stay
  • pressure sores
  • re-admissions
  • dependency
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6
Q

What does malnutrition decrease?

A
  • wound healing
  • response to treatment
  • rehab
  • quality of life
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7
Q

How do you diagnose malnutrition?

A
  • screen
  • assess
  • diagnose
  • plan
  • implement
  • monitor
  • evaluate
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8
Q

What is involved in a screen when looking to diagnose malnutrition?

A
  • tool used to identify risk
  • any HCP
  • NOT an assessment or diagnosis
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9
Q

What is needed to assess malnutrition?

A
  • dietitian
  • a process to determine the cause of the nutrient imbalance
  • anthropometry
  • biochemistry
  • clinical implications
  • dietary restrictions
  • social and physical history
  • nutrition requirements
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10
Q

When should nutrition support be considered?

A

in those that are:

  • malnourished
  • at risk of malnutrition
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11
Q

What values would result in a classification of malnourished?

A
  • BMI < 18.5
    OR
  • unintentional weight loss > 10% over the past 3-6 months
    OR
  • BMI <20, unintentional weight loss >5% in the past 3-6 months
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12
Q

What would result in a classification of at risk of malnutrition?

A
  • have eaten very little for >5 days and/or are likely to eat little/nothing for the next 5 days
  • poor absorptive capacity
  • high nutrient losses
  • increased nutritional needs from causes such as catabolism
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13
Q

What is artificial nutrition support?

A

the provision of enteral or parenteral nutrients to treat or prevent malnutrition

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14
Q

What is the best form of artificial nutrition support?

A

enteral

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15
Q

Which tube is used for enteral nutrition when gastric feeding is possible?

A

naso-gastric tube

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16
Q

Which tube is used for enteral nutrition when gastric feeding is not possible?

A
  • naso-duodenal
  • naso-jejunal tube
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17
Q

What is are possible forms of long term (>3 months) enteral nutrition?

A
  • gastrostomy
  • jejunstomy
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18
Q

What are the different types of nutritional feeds?

A
  • renal
  • low sodium
  • respiratory
  • immune
  • elemental
  • peptide
  • high energy
  • high protein
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19
Q

When is an NGT contraindicated?

A

gastric outlet obstruction

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20
Q

What can be used as a substitute when NGT is contraindicated?

A

NJT

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21
Q

What are the mechanical complications associated with enteral feeding?

A
  • misplacement
  • blockage
  • buried bumper
22
Q

What are the GI complications associated with enteral feeding?

A
  • aspiration
  • nasopharyngeal pain
  • laryngeal ulceration
  • vomiting
  • diarrhoea
23
Q

How do you test for a misplaced NGT?

A
  • aspirate pH < 5.5
  • if >5.5, CXR
24
Q

What is parenteral nutrition?

A

the delivery of nutrients, electrolytes and fluid and directly into venous blood

25
Q

What are the indications for parenteral nutrition?

A
  • inadequate or unsafe oral and/or enteral nutritional intake
  • non-functioning, inaccessible or perforated gastrointestinal tract
26
Q

What is the composition of parenteral nutrition?

A
  • ready made/bespoke ‘scratch bags’
  • MDT decides on fluid and electrolyte targets
27
Q

What are the access points for parenteral nutrition?

A
  • central venous catheter: tip at the superior vena cava and right atrium
  • different CVCs for different length of use
28
Q

What is a PICC line?

A

Peripherally Inserted Central Catheter

29
Q

What are the mechanical complications associated with parenteral feeding?

A
  • pneumothorax
  • haemothorax
  • thrombosis
  • cardiac arrhythmias
  • thrombus
  • catheter
  • occlusion
  • thrombophlebitis
  • extravasion
30
Q

What are the metabolic complications associated with enteral feeding?

A
  • deranged electrolytes
  • hyperglycaemia
  • abnormal liver
  • enzymes
  • oedema
  • hypertriglyceridaemia
31
Q

What are the other complications associated with enteral feeding?

A

catheter related infections

32
Q

What does albumin indicate?

A

low albumin tends to indicate high inflammation and therefore a poor prognosis

33
Q

What is albumin?

A

a negative acute phase protein

34
Q

Why does albumin decrease when inflammation increases?

A
  • activation of monocytes and macrophages in inflammation causes cytokine released
  • cytokines down regulate the production of some proteins, such as albumin
35
Q

Is albumin a valid marker of malnutrition in the acute hospital setting?

A

no

36
Q

What is refeeding syndrome?

A

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

37
Q

What is the impact of refeeding syndrome?

A
  • arrhythmia, tachycardia, cardiac arrest, sudden death
  • respiratory depression
  • encephalopathy, comma, seizures, rhabdomyolysis
  • wernicke’s encephalopathy
38
Q

What tends to happen refeeding syndrome?

A
  • hypokalaemia
  • hypomagnesaemia
  • hypophosphataemia
  • thiamine deficiency
  • salt and water retention, odema
39
Q

According to the National Institute for Health and Care Excellence (NICE), what are the criteria for defining the risk of RFS?

A
  • at risk
  • high risk
  • extremely high risk
40
Q

What would classify someone as at risk of RFS?

A

Very little or no food intake for > 5 days

41
Q

What would classify someone as high risk of RFS?

A 
>/= 1 of the following:
BMI < 16 kg/m2
Unintentional weight loss > 15 % 3 – 6 months
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 months
Very little / no nutrition > 5 days
PMHx alcohol abuse or drugs (insulin, chemotherapy, antacids, diuretics)

42
Q

What would classify someone as very high risk of RFS?

A

BMI < 14 kg/m2
Negligible intake > 15 days

43
Q

How do you manage RFS?

A
  • start on 10-20cal/kg, CHO 40-50% energy
  • correct and monitor electrolytes daily
  • administer thiamine 30 mins before refeeding and for first 10 days
  • monitor fluid shifts and reduce the risk of fluid and Na* overload
  • micronutrients from onset of feeding
44
Q

What groups are most at risk of malnutrition?

A
  • elderly
  • cancer
  • chronic illness
  • drug/alcohol abuse
45
Q

What is the effect of Enteral nutrition?

A
  • supports the function and structural mobility of the gut
  • modulates the system immune response
  • attenuates disease severity
46
Q

When is there a risk of refeeding syndrome?

A
  • low BMI
  • poor nutrition for greater than 5 days
  • low potassium
  • alcohol history
47
Q

What is taken into a nutritional assessment?

A
  • body composition and function
  • bloods
  • clinical features
  • DHx
  • diet Hx
  • social Hx
48
Q

What is oral nutritional support?

A

Fortification of meals and snacks
Altered meal patterns
Practical support
Oral nutritional supplements (ONS)
Tailored dietary counselling

49
Q

When should oral nutrition support be considered?

A

Patients with inadequate food and fluid intake to meet requirement

50
Q

When should oral nutrition support not be considered?

A
  • can’t swallow safely
  • inadequate GI function
  • no benefits e.g. in end of life care
51
Q

What is enteral nutrition support?

A

Nutrition support through the GI tract, bypassing the mouth

BRS YR2 (67 decks)

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