Malnutrition and TIA/Stroke Flashcards
What are the main causes of Malnutrition?
1) Reduced nutrient intake (starvation)
2) Increased nutrient requirements (Injury/sepsis)
3) Inability to use nutrients ingested (Malabsorption)
What are the main consequences of Malnutrition?
1) Immune System: V ability to fight infection
2) Muscle Wasting: Falls/^ chest infections/V mobility
3) Impaired wound healing
4) Micronutrient deficiencies
RESULT: Impaired QOL, ^stay/recovery, ^readmissions, more community needs and ^ complications
What is the MUST tool and what does it score?
Malnutrition Universal Scoring Tool:
- Scores pt. based on BMI, wt loss history and acute disease effect
What are the main treatments for malnutrition?
1) Food first: Snacks, nourishing, food/drinks
2) Oral nutritional supplements e.g. Macro/micronutrients
3) Enteral/parenteral nutrition
What is Parenteral and Enteral feeding?
Parenteral: Feeding into the veins
Enteral: Feeding directly into gut to avoid damage to mucosa and improve nutritional status
What are the 2 routes of enteral nutrition?
1) Nasogastric (NG) tube: Feeds into stomach, inserted at ward level, <30 days,
(check pH aspirate to confirm at position of 5.5)
2) Nasojejunal (NJ) tube: Radiologically guided and short term use (<60 days)
What systems are used for long term enteral nutrition?
1) PEG tube e.g. CF, dysphagia,
2) Post-pyloric/PEJ/surgical JEJ: Gastroparesis, Upper GI/Pancreatic surgery, high risk of aspiration, severe acute pancreatitis
What are the P&C of PICC lines?
Advs: Easily tolerated, helpful to meet nutritional requirements and promote recovery,
DisAdvs: Gut atrophy, more invasive and risk of line infection
Define Refeeding syndrome
Group of clinical symptoms when a malnourished person has food reintroduced
- Shift in use of energy stores from fat to carbohydrate
- Shifts in fluids and electrolytes
- Initiates insulin increase, cellular uptake of Potassium, magnesium and phosphate
- Chance of fluid retention, cardiac arrythmia, respiratory insufficiency
How is Refeeding syndrome managed?
1) Pabrinex/Thiamine + Vit B co-strong
(Prior to feeding and for first 10 days)
2) Slow reintroduction of foods
3) Daily monitoring of refeeding bloods inc U&E’s, PO4, MG
What is the definition of a TIA?
Transient neurological dysfunction by focal brain, spinal cord or retinal ischaemia without evidence of acute infarction
What investigations would be done with a TIA?
1) Bloods
2) ECG, Echo, USS Carotid, Brain imaging
3) Echo, 24x72hr tape of heart rhythm
What medications can normally be given
Aspirin + Clopi (Another DOAC if indicated)
What are the 3 causes of stroke?
1) Cerebral Haemorrhage (BV in brain ruptures)
2) Cerebral Infarction (BV in brain becomes blocked) - Atherothrombotic, Lacunar (Fine bv narrows etc.), Cardiogenic
3) Subarachnoid (Bulge in blood vessel)
What is the definition of a stroke?
Sudden onset of focal/global neurological disturbance lasting over 24hrs with no other cause other than vascular origin
1) Ischaemic (85%)
2) Haemorrhagic (10%Primary, 5%subarachnoid)
