Nutrition Flashcards
Define malnutrition?
When diet does not contain the right amount of nutrients.
Common, under-recognised condition in hospital patients
Cause and consequence of disease
Prevalent in care home, communities and hospitals
Causes of malnutrition?
Reduced dietary intake
Malabsorption
Increased losses or altered requirements
Energy expenditrue
NICE definition of malnutrition?
a Body Mass Index (BMI) of less than 18.5; or
unintentional weight loss greater than 10% within the last 3-6 months; or
a BMI of less than 20 and unintentional weight loss greater than 5% within the last 3-6 months
What is sarcopenia?
Age related loss of skeletal muscle
Major cause for the increased prevalence of frailty and disability
Muscle mass decreases, reducing mobility
Why are older people more at risk of malnutrition complications?
less physiological reserve
you lose what muscle you have left so you are more likely to become bed bound
respiratory function decreases and being bed bound leads to increased risk of chest infections
Lying in bed all day leads to pressure sores too
Feeding hierarchy?
Normal oral feeding
Oral nutritional supplements → fortisips
NG feed
PEG (percutaneous endoscopic gastrostomy →a feeding tube fitted during endoscopy)/ RIG (radiologically inserted gastrotomy (no endoscopy required)
PEG-J (percutaneous endoscopic gastrostomy with jejunal extension) / NJT (naso-jejunal tube)
PN- parenteral nutrition
TPN- total parenteral nutrition
Use of NG tube?
Short to medium term
Used in surgery recovery
Use of PEG feeding?
Medium to long term
Used in: Chronic disease, chemo, palliative care
How to insert a PEG tube?
Needs to undergo endoscopy, therefore the pt needs to be willing and able to undergo this
Alternative if patient cannot undergo endoscopy for PEG feeding?
RIG
Placed with direct puncture of the abdominal wall
What is RIG feeding?
Gastrostomy insertion without intubation
Used in: Swallowing issues, upper GI tract not accessible,
Disadvantages/ risk of RIG feeding?
Peritonitis due to leakage
Has to be changed regularly
Easily dislodged
Indications for PN/TPN?
Intestinal failure
Obstructed/ inaccessible GI tract
What is PN?
Paraenteral nutrition- giving nutriton without using the GI tract
TPN is only feeding a patient without using the GI tract
How is PN and TPN adminstered?
IV
TPN: PICC line, Central venous catheter, tunnelled venous catheter or hickman line
What do we need to remember when adminstering PN?
Degraded by light
Needs to be kept covered
What are the complications of PN?
Thrombosis
Pneumothorax
Line occlusion
Air embolus
fluid overload
Electrolyte and glucose imbalance
GI atrophy
Gallbladder problems
Infection: septicaemia/bacteraemia
Hunger pangs
What is MUST tool?
Used to assess for malnutriton
Outline the MUST tool?
BMI score + Weight loss + acute disease effect score
How else do you assess if someone is malnourished?
MUST tool
MAC
BMI
Triad for refeeding syndrome?
Hypophosphataemia
Hypokalaemia
Hypomagnesia
W
Who is at risk of refeeding syndrome?
One of:
BMI < 16kg/m2
Unintentional weight loss> 15% in the past 3-6 months
Little or no nutritional intake for >10 days
Low levels of potassium, phosphate or magnesium before feeding
Two of:
BMI < 18.5 kg/m2
Unintentional weight loss > 10% in past 3-6mnths
Little of no nutritional intake for >5 days
Hx of alcohol/ drug misuse icnl insulin, chemo, antacids or diuretics
Steps to take for pt with risk of refeeding?
- Start nutrition support maximum of 10kcal//kg/day and slowly increase to meet/exceed needs by 4-7 days
- Restore circulatory volume and monitor fluid balance/ overall status
- Before and during first 10 days of feeding: oral thiamine 200-300 mg daily, cit b co strong and balanced multivits/trace elements
- Provide oral, eneteral or IV supplements of potassium, phosphate and magnesium unless pre-feeding plasma levels are high
Complications of malnutrition?
Impaired wound healing
