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Phase 1b - Gastroenterology > Malnutrition & Nutritional Assessment > Flashcards

Malnutrition & Nutritional Assessment Flashcards

1
Q

Define 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 are the causes of malnutrition in hospital (3)?

A
  • 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
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3
Q

What is the impact of malnutrition (10 / know 3)?

A
  • 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
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4
Q

What is the cost of malnutrition in England per year?
* £ 19.6 billion
* £ 550 million
* £ 24.7 million

A

£ 19.6 billion

15% of the total public expenditure on health and social care

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5
Q

What is the system in place to diagnose malnutrition?

A
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6
Q

What are the indications for nutrition support (2)?

A

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.

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7
Q

What are the 3 forms of nutritional support?

A
  • Oral
  • Enteral
  • Parenteral
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8
Q

What are the nutritional options available via the oral route (5)?

A
  • 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.
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9
Q

What is artificial nutrition support?

A
  • The provision of enteral or parenteral nutrients to treat or prevent malnutrition
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10
Q

What are the forms of enteral nutrition support (3)?

A
  • 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

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11
Q

What are the complications associated with enteral feeding (10 / know 3)?

A
  • Mechanical:
    • Misplacement
    • Blockage
    • Buried bumper
  • Metabolic:
    • Hypergylcaemia
    • Deranged electrolytes
  • GI:
    • Aspiration
    • Nasopharyngeal pain
    • Laryngeal ulceration
    • Vomiting
    • Diarrhoea
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12
Q

What is parenteral nutrition (PN)?

A
  • The delivery of nutrients, electrolytes and fluid directly into venous blood
Vascular Access for PN
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13
Q

What is the goal of parenteral nutrition (PN)?

A
  • The aim is to return to enteral → oral feeding as soon as (where) clinically possible
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14
Q

What are the indications for parenteral nutrtion (PN) (2)?

A
  • An inadequate or unsafe oral and/or enteral nutritional intake

OR

  • A non-functioning, inaccessible or perforated gastrointestinal tract
Vascular Access for PN
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15
Q

What is the composition of parenteral nutrtion (PN) (2)?

A
  • Ready made / bespoke “scratch” bags
  • MDT → fluid and electrolyte targets
Vascular Access for PN
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16
Q

What is the access point of parenteral nutrtion (PN) (2)?

A
  • Central venous catheter (CVC): tip at superior vena cava and right atrium
Vascular Access for PN

Different CVCs for short / long term use

17
Q

What are the complications associated with parenteral nutrition (12 / know 3)?

A
  • Metabolic:
    • Deranged electrolytes
    • Hyperglycaemia
    • Abnormal liver enzymes
    • Oedema
    • Hypertriglyceridaemia
  • Mechanical:
    • Pneumothorax
    • Haemothorax
    • Thrombosis
    • Cardiac arrhythmias
    • Thrombus
    • Catheter occlusion
    • Thrombophlebitis
    • Extravasion
  • Catheter related infections
This CXR was performed following insertion of a right internal jugular central line (yellow arrow) and shows one of the potential complications of central line insertion – a large pneumothorax. The edge of the lung (‘pleural line’) is indicated by the red arrow.
18
Q

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

A

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

19
Q

What is refeeding syndrome (RFS)?

A
  • 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
20
Q

What are the consequences refeeding syndrome (RFS) (7)?

A
  • Arrhythmia, tachycardia, CHF → Cardiac arrest, sudden death
  • Respiratory depression
  • Encephalopathy
  • Coma
  • Seizures
  • Rhabdomyolysis
  • Wernicke’s encephalopy
21
Q

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

A

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

Phase 1b - Gastroenterology (13 decks)

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