Nutrition Flashcards
What do you want to assess for nutrition?
- Current BMI
- Calculate weight loss compared to previous weight
- Current dietary intake and comparison to pre-hospital level
- Current clinical condition
- Current urine and bowel output
- Pre-morbid functionality with ADLs compared to current
- Specific dietary requirements and allergies
- Any swallowing issues
What questions help to screen for malnutrition?
- Is the patient at risk of malnutrition?
- What is the pathophysiology of dysphagia?
- Is there an indication for artificial nutrition?
- How will you manage risk of undernutrition?
- Apply 4 principles of medical ethics
What are the normal dietary requirements for inpatients?
- Energy: 30kcal/kg/day
- Protein: 0.8-1g/kg/day
- Fluid: 30-35ml/kg/day
What does the nutritional assessment involve?
PART 1: Dietary hx - what a patients oral intake is, review a food diary or assess typical daily intake
PART 2: Assess for causes of malnutrition
What are the drugs/age/environmental causes of malnutrition?
- Drugs: reduce appetite, constipation
- Age: loss of appetite (taste buds less sensitive, dentition, slow bowels)
- Environmental: frailty, functional decline, unable to shop/prepare meals, dexterity problems, confusion, dislike of certain food, social isolation
What medical conditions can cause malnutrition?
- Long term conditions (COPD, HF, CKD, liver disease)
- Bowel disease
- Bowel obstruction
- Inflammatory conditions
- Malignancy
- Depression
- Dementia
How does the MUST screening tool identify malnutrition?
- BMI (kg/m^2)
- >20 = 0
- 18.5-20 = 1
- <18.5 = 2 - % weight loss - unplanned weight loss in past 3-6 mths
- <5 = 0
- 5-10 = 1
- >10 = 2 - Serious illness score
If patient is acutely ill and there has been or is likely to be no nutritional intake for >5days = 2
What are the results from the MUST?
0 = low risk (routine care)
1 = medium risk (observe and encourage)
2 or more = high risk (treat and consider referral to dietician
How can you categorise malnutrition?
- Increased needs - increased stress on body from surgery or illness
- Increased losses - d+v, fever, wounds, burns
- Reduced intake - reduced appetite, decreased ability to self feed whilst unwell, cognitive/communication issues, dysphagia, dislike of food
What should be the management if a patient is judged as at risk of developing malnutrition?
- Regular repeat nutritional assessments
- % weight loss recorded if lengthy admission
- Start diet chart and offer supplemental build-up soups + shakes/nutritional supplements
- Offer assistance with eating
- Give option of alternative food when necessary
- Dietician input
- Oral nutrition preferable but some may need enteral/parenteral feeding
What are the modified consistencies of food?
- Category E: fork mashable
- Category D: pre-mashed
- Category C: puree
- Thickened fluids - syrup (1 scoop per 100mls fluid), custard (2 scoops per 100mls fluid), pudding (3 scoops per 100mls fluid)
What are the consequences of malnutrition?
- Increased LOS
- Impaired wound healing
- Impaired immune response
- Inability to mobilise
- Depression/reduced QoL
- Poor digestive function
- Increased costs of care
Describe the features of nasogastric feeding tubes
- Temporary - can last up to 6 weeks
- Can be done on the ward
- Easy to dislodge
- Risks of malpositioning (check on XR)
Describe the features of a nasojejunal tube
- For patients at high risk of pulmonary regurgitation e.g. gastric atony/gastroparesis/altered upper GI anatomy
- More technically difficult compared to NG
- Done endoscopically/fluoroscopically
What is a percutaneous endoscopic gastostromy?
- Provides means for long term enteric feeding
- Easy to use and effective in delivering calories
- Requires specialist involvement
- Done endoscopically/fluoroscopically
