Nutrition Flashcards
Name the four main causes of Malnutrition
- Reduced Dietary Intake
- Malabsorption
- Increased losses/altered requirements
- Energy expenditure (lower in ill patients, higher in major trauma/burns)
There are many consequences of Malnutrition. How does it affect Muscle Function?
Depletion of fat/muscle/organ mass
Muscle function declines before loss of muscle mass
There are many consequences of Malnutrition. How does it affect Cardioresp Function?
Reduced cardiac muscle mass, reduced output, reduced perfusion
Poor diaphragmatic and resp muscle function affects recovery
There are many consequences of Malnutrition. How does it affect GI Function?
Colon loses its ability to reabsorb and secrete fluids and electrolytes
There are many consequences of Malnutrition. How does it affect Psychosocial Function?
Depression
Anxiety
Self Neglect
Describe the MUST tool
1) BMI >20=0 18.5-20=1 <18.5 =0
2) % unplanned weight loss in last 3-6 months (<5% is 0, 5-10% is 1, >10% is 2)
3) Disease effect score
4) Add 1,2 and 3
How is a Low Risk MUST Score managed?
Continue clinical care
How is a Med Risk MUST Score managed?
Document intake for 3d
If adequate - repeat as appropriate
If inadequate - treat according to local policy
How is a High Risk MUST Score managed?
Treat according to local policy
Describe the four stages of wound healing
Haemostasis
Inflammation (Neutrophil, Monocytes, Fibroblasts)
Proliferation (granulation tissue formation)
Maturation
Name three local factors influencing wound healing
Oxygenation
Infection
Foreign Body
Name three systemic factors influencing wound healing
Age
Obesity
Diabetes
How can height be estimated from a supine patient?
Ulnar Length
How can BMI be estimated without weighing patient?
Mid Upper Arm Circumference
What happens in a Nutritional Assessment?
Dietician takes :
Weight Weight History Height BMI Recent Intake Other influencing factors (meds, oral health, bowels)
Other than BMI, name three bodily measurements of malnutrition
Middle Upper Arm Circumference
Grip Strength
Tricep Fold Thickness
Name two initiatives brought in by hospitals to reduce the influence of hospitals on malnutrition
Preserved Meal Times (undisturbed, no procedures)
Red Tray for those malnourished (alerts staff they may need assistance, reminds staff to fill out food diary)
Name three things you could recommend malnourished patients do in the community
Frequent Meals
High Calorie Options
Fortifying
What are the normal nutritional requirements for patients not at risk?
25-35 Kcal/Kg/Day
0.8-1.5g/Kg Protein a Day
30-35ml/Kg/Day fluids (compensating for IV and losses)
How should the standard values for nutrition replacement be altered for those patients seriously ill or at risk?
Start at no more than 50% of total protein and energy requirements
Max 10Kcal/Kg/Day
Immediate Pabrinex and Electrolytes
Give four risk factors for patients at risk of Refeeding Syndrome
BMI<16
Unintentional weight loss>15% in last 6m
Little or no intake for 10 days
Pre existing low electrolytes
Name 5 different nutritional supplements that can be used on the ward
Fortisip Compact - 2kcal per mood
Fortisip Compact Fibre - good if constipated
Fortisip Compact Protein
Fortijuice - Low volume
Forticreme Complete - Thick, good if dysphagia
Describe Level 0 of Liquid thickening
Thin
Flows like water
Describe level 1 of feed thickening
Slightly thick
Requires a little more effort than thin fluids
1 scoop thickener per 200 ml
Describe level 2 thickening (mildly thick)
Flows off a spoon
Effort is required to drink through straw
2 scoops per 200ml
Describe level 3 feed thickening (moderately thick)
Can be drunk from a cup
Requires effort through wide bore
Doesn’t require oral processing
Four scoops per 200ml
Describe level 4 thickening (extremely thick)
Have to have a spoon (can’t be drunk from a cup)
No lumps
Can’t be poured
6 scoops per 200 ml
Describe Level 3 Liquidising
Same as level 3 thickened
Describe level 4 liquidising
Puréed
Same as level 4 thickened
Describe level 5 liquidised
Minced and Moist
Eaten with a fork or spoon
No separate thin liquids
Small lumps <4mm that can be easily squashed with tongue
Describe level 6 liquidising
Soft and Bitesize
Knife not required
Chewing required
Bitesize pieces <15mm
Describe level 7 liquidising
Normal
Give an indication, a contraindication and a caution to NG feeding
Indication - Unsafe swallow
CI - Head injuries
Caution - pH <5.5 before feeding
Give three advantages and three disadvantages to NG feeding
Good - easy to insert, cheap, buffers gastric acid
Bad- uncomfortable, short term, not good if delirious
Give two indications for an NJ tube over an NG
Delayed gastric emptying
Severe stomach pain
NJ tubes reduce aspiration risk, give four disadvantages
Uncomfortable
Expensive
Unprotected Mucosa
Lack of Digestive Enzymes from stomach
Give an indication for PEG tube feeding
Longer term requirements
Give two advantages and two disadvantages to PEG feeding
Uses enzymes, better tolerated
Requires surgery, skin erosions
