Malnutrition & 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
What are the causes of malnutrition in hospital (3)?
-
Reduced intake
- Contraindicated
- Disease related anorexia
- Taste changes
- Nil by mouth
- Food options
- Depression
- Inactivity
- Oral health
- Fatigue
-
Maldigestion / Malabsorption
- Function
- Length
- Losses
- Drug-nutrient interactions
- Altered Metabolism
What is the impact of malnutrition (10 / know 3)?
- Physical and functional decline and poorer clinical outcomes
-
Increased:
- Mortality
- Septic and post surgical complications
- Length of hospital-stay
- Pressure sores
- Re-admissions
- Dependency
-
Decreased:
- Wound healing
- Response to treatment
- Rehabilitation potential
- Quality of life
What is the cost of malnutrition in England per year?
* £ 19.6 billion
* £ 550 million
* £ 24.7 million
£ 19.6 billion
15% of the total public expenditure on health and social care
What is the system in place to diagnose malnutrition?
What are the indications for nutrition support (2)?
Nutrition support should be considered in people who are either:
* 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.
* 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.
What are the 3 forms of nutritional support?
- Oral
- Enteral
- Parenteral
What are the nutritional options available via the oral route (5)?
- Fortification of meals and snacks
- Altered meal patterns
- Practical support
- Oral nutritional supplements (ONS)
- Tailored dietary counselling
- Consider for any patient with inadequate food and fluid intakes to meet requirements, unless they cannot swallow safely, have inadequate gastrointestinal function or if no benefit is anticipated e.g. end of life care.
What is artificial nutrition support?
- The provision of enteral or parenteral nutrients to treat or prevent malnutrition
What are the forms of enteral nutrition support (3)?
- Naso-gastric tube (NGT)
- Naso-duodenal (NDT)
- Naso-jejunal tube (NJT)
Access:
* Is gastric feeding possible?
* Yes: Naso-gastric tube (NGT)
* No: Naso-duodenal (NDT) / Naso-jejunal tube (NJT)
* Long term (> 3 months) = Gastrostomy / jejunostomy
What are the complications associated with enteral feeding (10 / know 3)?
-
Mechanical:
- Misplacement
- Blockage
- Buried bumper
-
Metabolic:
- Hypergylcaemia
- Deranged electrolytes
-
GI:
- Aspiration
- Nasopharyngeal pain
- Laryngeal ulceration
- Vomiting
- Diarrhoea
What is parenteral nutrition (PN)?
- The delivery of nutrients, electrolytes and fluid directly into venous blood
What is the goal of parenteral nutrition (PN)?
- The aim is to return to enteral → oral feeding as soon as (where) clinically possible
What are the indications for parenteral nutrtion (PN) (2)?
- An inadequate or unsafe oral and/or enteral nutritional intake
OR
- A non-functioning, inaccessible or perforated gastrointestinal tract
What is the composition of parenteral nutrtion (PN) (2)?
- Ready made / bespoke “scratch” bags
- MDT → fluid and electrolyte targets
What is the access point of parenteral nutrtion (PN) (2)?
- Central venous catheter (CVC): tip at superior vena cava and right atrium
Different CVCs for short / long term use
What are the complications associated with parenteral nutrition (12 / know 3)?
-
Metabolic:
- Deranged electrolytes
- Hyperglycaemia
- Abnormal liver enzymes
- Oedema
- Hypertriglyceridaemia
-
Mechanical:
- Pneumothorax
- Haemothorax
- Thrombosis
- Cardiac arrhythmias
- Thrombus
- Catheter occlusion
- Thrombophlebitis
- Extravasion
- Catheter related infections
Is albumin a valid marker of malnutrition in the acute hospital setting?
No
* Albumin synthesis decreases in response to inflammation, therefore poor predictor of malnutrition during acute phase. However, do consider the aetiology / impact of the inflammatory response on nutrition status
What is refeeding syndrome (RFS)?
- A group of biochemical shifts & clinical symptoms that can occur in the malnourished or starved individual on the reintroduction of oral, enteral or parenteral nutrition
What are the consequences refeeding syndrome (RFS) (7)?
- Arrhythmia, tachycardia, CHF → Cardiac arrest, sudden death
- Respiratory depression
- Encephalopathy
- Coma
- Seizures
- Rhabdomyolysis
- Wernicke’s encephalopy
According to the National Institute for Health and Care Excellence (NICE), what are the criteria for defining the risk of refeeding syndrome (RFS)?
At risk:
* Very little or no food intake for > 5 days
High risk:
* > 1 of the following:
* BMI < 16 kg/m2
* Unintentional weight loss > 15 % in 3 – 6 /12
* Very little / no nutrition > 10 days
* Low K+, Mg2+, PO43- prior to feeding
* > 2 of the following:
* BMI < 18.5 kg/m2
* Unintentional weight loss > 10 % in 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
