Malnutrition - WB

Question 1

Causes of malnutrition and examples

Answer 1

• Reduced dietary intake - anorexia nervosa, chronic illness, socioeconomic factors, swallowing problems
• Malabsoprtion - coeliac, pancreatitis, Crohns
• Increased losses/altered requirments - diarrhoea, nephrotic, burns, pregnancy, high thyroid
• Energy expenditure - sepsis/severe infection, COPD, cancer, post surgery, intense physical activity

Question 2

Consequences on systems of malnutrition

Answer 2

• Muscle - wasting, reduced function
• Cardio-resp - reduced CO, low BP, risk of HF, impaired resp function, suscepitible to resp infection
• GI - reduced enzyme production (worsens malnutrition), atrophy of mucosa, delayed gastric emptying (reduced appetite), gut microbe imbalance
• Immunity and wound healing - weakened and delayed healing, increased risk infection
• Psychological - cognitive impairment, mood disorders, behavioural changes

Question 3

What is MUST Screening tool?

Answer 3

• Malnutrition universal screening tool
• 5 steps
• Identifies those at risk, malnourished or obese
• Takes into account BMI, history of unintentional weight loss and likelihood of future weight loss

Question 4

4 stages of wound healing

Answer 4

• Haemostasis - blood vessels constrict, platelet aggregation, form fibrin clot to stop bleeding
• Inflammation - WBC migrate to wound, remove debris pathogens and dead tissue, release growth factors
• Proliferation - fibroblasts produce collagen, angiogenesis and epiithelial cells migrate over wound = granulation tissue
• Remodelling - cross linked collagen, apoptosis of cells not needed = mature scar

HIPR

Question 5

Local factors affecting wound healing and how

Answer 5

• Oxygenation - proliferation phase (lack new cells), inflammation phase (weakened bacterial clearance)
• Infection - inhibits proliferation phase as toxins degrade granulation tissue
• Foreign body - delays inflammation phase, increases risk infection
• Venous insuffienciency - prolonged inflammation, impairs proliferation of granulation tissue

Question 6

What are some examples of systemic features that affect wound healing and how?

Answer 6

• Age - slower, delayed inflammation, reduced proliferation
• Gender - testosterone can delay, oestrogen can enhance
• Stress - supress immune function - prolonged inflammation, slowed proliferation
• Ischaemia - = O2 deprived –> inflammation longer, reduced proliferation
• Diseases eg diabetes, fibrosis, jaundice and uraemia - delayed, excessive scarring, immune function impaired –> infection
• Obesity - pro-inflam, impairs oxygenation –> long inflam, impaired proliferation
• Medications eg steroids, NSAIDs, chemotherapy - suppress healing, reduced prostaglandins (NSAIDs) = prolonged inflammation and longer to proliferate
• Immunocompromised - longer inflam
• Nutrition = impaired cellular processes, all phases

Question 7

5 signs of wound infection

Answer 7

• Redness around wound (rubor)
• Swelling around wound
• Warmth over wound (calor)
• Pus/cloudy fluid draining from wound
• Painful
• Fever

Question 8

Causes of pressure ulcers - factors that influence

Answer 8

• Pressure
• Shear - sliding motion of skin
• Friction
• Moisture
• Poor nutrition
• Reduced sensation
• Aged related factors - thinner skin, loss elasticity

Question 9

Common sites for pressure ulcers

Answer 9

• Heels
• Inner knees
• Hips
• Lower back (sacrum) and buttocks
• Elbow
• Shoulder
• Back of head/ears

Question 10

Screening tools to assess pressure ulcers

Answer 10

• Waterlow score
• Braden scale
• Norton scale

Question 11

Braden scale

Answer 11

6 factors scored, scored between 1-4
Lower score = higher risk
* Sensory perception
* Nutrition
* Friction and shear
* Mobility
* Moisture
* Activity

Question 12

How can you estimate height from ulna length?

Answer 12

Measure ulna and use conversion chart (often on MUST)

Question 13

BMI from mid upper arm circumference

Answer 13

• MUAC of less than 23.5 cm usually indicates a BMI of less than 20 kg/m2
• MUAC of more than 32.0 cm usually indicates a BMI of more than 30 kg/m2
• <25 for men and 24 for women = undernutrition

Question 14

Management if high risk of pressure sore

Answer 14

• Repositioning regularly
• Weight relieving mattress/cushions
• Ensure nutrition adequate
• Monitor areas at risk