Nutrition

Question 1

Name the four main causes of Malnutrition

Answer 1

• Reduced Dietary Intake
• Malabsorption
• Increased losses/altered requirements
• Energy expenditure (lower in ill patients, higher in major trauma/burns)

Question 2

There are many consequences of Malnutrition. How does it affect Muscle Function?

Answer 2

Depletion of fat/muscle/organ mass

Muscle function declines before loss of muscle mass

Question 3

There are many consequences of Malnutrition. How does it affect Cardioresp Function?

Answer 3

Reduced cardiac muscle mass, reduced output, reduced perfusion

Poor diaphragmatic and resp muscle function affects recovery

Question 4

There are many consequences of Malnutrition. How does it affect GI Function?

Answer 4

Colon loses its ability to reabsorb and secrete fluids and electrolytes

Question 5

There are many consequences of Malnutrition. How does it affect Psychosocial Function?

Answer 5

Depression
Anxiety
Self Neglect

Question 6

Describe the MUST tool

Answer 6

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

Question 7

How is a Low Risk MUST Score managed?

Answer 7

Continue clinical care

Question 8

How is a Med Risk MUST Score managed?

Answer 8

Document intake for 3d
If adequate - repeat as appropriate
If inadequate - treat according to local policy

Question 9

How is a High Risk MUST Score managed?

Answer 9

Treat according to local policy

Question 10

Describe the four stages of wound healing

Answer 10

Haemostasis
Inflammation (Neutrophil, Monocytes, Fibroblasts)
Proliferation (granulation tissue formation)
Maturation

Question 11

Name three local factors influencing wound healing

Answer 11

Oxygenation
Infection
Foreign Body

Question 12

Name three systemic factors influencing wound healing

Answer 12

Age
Obesity
Diabetes

Question 13

How can height be estimated from a supine patient?

Answer 13

Ulnar Length

Question 14

How can BMI be estimated without weighing patient?

Answer 14

Mid Upper Arm Circumference

Question 15

What happens in a Nutritional Assessment?

Answer 15

Dietician takes :

Weight
Weight History
Height
BMI
Recent Intake
Other influencing factors (meds, oral health, bowels)

Question 16

Other than BMI, name three bodily measurements of malnutrition

Answer 16

Middle Upper Arm Circumference
Grip Strength
Tricep Fold Thickness

Question 17

Name two initiatives brought in by hospitals to reduce the influence of hospitals on malnutrition

Answer 17

Preserved Meal Times (undisturbed, no procedures)

Red Tray for those malnourished (alerts staff they may need assistance, reminds staff to fill out food diary)

Question 18

Name three things you could recommend malnourished patients do in the community

Answer 18

Frequent Meals
High Calorie Options
Fortifying

Question 19

What are the normal nutritional requirements for patients not at risk?

Answer 19

25-35 Kcal/Kg/Day

0.8-1.5g/Kg Protein a Day

30-35ml/Kg/Day fluids (compensating for IV and losses)

Question 20

How should the standard values for nutrition replacement be altered for those patients seriously ill or at risk?

Answer 20

Start at no more than 50% of total protein and energy requirements

Max 10Kcal/Kg/Day

Immediate Pabrinex and Electrolytes

Question 21

Give four risk factors for patients at risk of Refeeding Syndrome

Answer 21

BMI<16

Unintentional weight loss>15% in last 6m

Little or no intake for 10 days

Pre existing low electrolytes

Question 22

Name 5 different nutritional supplements that can be used on the ward

Answer 22

Fortisip Compact - 2kcal per mood

Fortisip Compact Fibre - good if constipated

Fortisip Compact Protein

Fortijuice - Low volume

Forticreme Complete - Thick, good if dysphagia

Question 23

Describe Level 0 of Liquid thickening

Answer 23

Thin

Flows like water

Question 24

Describe level 1 of feed thickening

Answer 24

Slightly thick
Requires a little more effort than thin fluids

1 scoop thickener per 200 ml

Question 25

Describe level 2 thickening (mildly thick)

Answer 25

Flows off a spoon

Effort is required to drink through straw

2 scoops per 200ml

Question 26

Describe level 3 feed thickening (moderately thick)

Answer 26

Can be drunk from a cup

Requires effort through wide bore

Doesn’t require oral processing

Four scoops per 200ml

Question 27

Describe level 4 thickening (extremely thick)

Answer 27

Have to have a spoon (can’t be drunk from a cup)

No lumps

Can’t be poured

6 scoops per 200 ml

Question 28

Describe Level 3 Liquidising

Answer 28

Same as level 3 thickened

Question 29

Describe level 4 liquidising

Answer 29

Puréed

Same as level 4 thickened

Question 30

Describe level 5 liquidised

Answer 30

Minced and Moist

Eaten with a fork or spoon

No separate thin liquids

Small lumps <4mm that can be easily squashed with tongue

Question 31

Describe level 6 liquidising

Answer 31

Soft and Bitesize

Knife not required

Chewing required

Bitesize pieces <15mm

Question 32

Describe level 7 liquidising

Answer 32

Normal

Question 33

Give an indication, a contraindication and a caution to NG feeding

Answer 33

Indication - Unsafe swallow

CI - Head injuries

Caution - pH <5.5 before feeding

Question 34

Give three advantages and three disadvantages to NG feeding

Answer 34

Good - easy to insert, cheap, buffers gastric acid

Bad- uncomfortable, short term, not good if delirious

Question 35

Give two indications for an NJ tube over an NG

Answer 35

Delayed gastric emptying

Severe stomach pain

Question 36

NJ tubes reduce aspiration risk, give four disadvantages

Answer 36

Uncomfortable
Expensive
Unprotected Mucosa
Lack of Digestive Enzymes from stomach

Question 37

Give an indication for PEG tube feeding

Answer 37

Longer term requirements

Question 38

Give two advantages and two disadvantages to PEG feeding

Answer 38

Uses enzymes, better tolerated

Requires surgery, skin erosions