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YEAR 4 OLDER PEOPLE INTEGRATED CARE > Nutrition > Flashcards

Nutrition Flashcards

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1
Q

Define malnutrition?

A

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

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2
Q

Causes of malnutrition?

A

Reduced dietary intake
Malabsorption
Increased losses or altered requirements
Energy expenditrue

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3
Q

NICE definition of malnutrition?

A

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

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4
Q

What is sarcopenia?

A

Age related loss of skeletal muscle
Major cause for the increased prevalence of frailty and disability
Muscle mass decreases, reducing mobility

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5
Q

Why are older people more at risk of malnutrition complications?

A

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

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6
Q

Feeding hierarchy?

A

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

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7
Q

Use of NG tube?

A

Short to medium term
Used in surgery recovery

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8
Q

Use of PEG feeding?

A

Medium to long term
Used in: Chronic disease, chemo, palliative care

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9
Q

How to insert a PEG tube?

A

Needs to undergo endoscopy, therefore the pt needs to be willing and able to undergo this

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10
Q

Alternative if patient cannot undergo endoscopy for PEG feeding?

A

RIG
Placed with direct puncture of the abdominal wall

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11
Q

What is RIG feeding?

A

Gastrostomy insertion without intubation
Used in: Swallowing issues, upper GI tract not accessible,

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12
Q

Disadvantages/ risk of RIG feeding?

A

Peritonitis due to leakage
Has to be changed regularly
Easily dislodged

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13
Q

Indications for PN/TPN?

A

Intestinal failure
Obstructed/ inaccessible GI tract

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14
Q

What is PN?

A

Paraenteral nutrition- giving nutriton without using the GI tract
TPN is only feeding a patient without using the GI tract

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15
Q

How is PN and TPN adminstered?

A

IV
TPN: PICC line, Central venous catheter, tunnelled venous catheter or hickman line

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16
Q

What do we need to remember when adminstering PN?

A

Degraded by light
Needs to be kept covered

17
Q

What are the complications of PN?

A

Thrombosis
Pneumothorax
Line occlusion
Air embolus

fluid overload
Electrolyte and glucose imbalance
GI atrophy
Gallbladder problems

Infection: septicaemia/bacteraemia

Hunger pangs

18
Q

What is MUST tool?

A

Used to assess for malnutriton

19
Q

Outline the MUST tool?

A

BMI score + Weight loss + acute disease effect score

20
Q

How else do you assess if someone is malnourished?

A

MUST tool
MAC
BMI

21
Q

Triad for refeeding syndrome?

A

Hypophosphataemia
Hypokalaemia
Hypomagnesia

W

22
Q

Who is at risk of refeeding syndrome?

A

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

23
Q

Steps to take for pt with risk of refeeding?

A
  • 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
24
Q

Complications of malnutrition?

A

Impaired wound healing

25
Q

What is primary intention wound healing?

A

When dermal edges are close together
End result is complete return to function with minimal scarring

26
Q

Stages of wound healing?

A

Haemostasis- vasoconstriction, blood clot formation

Inflammation- after blood loss has stopped, digestion of blood clot and removal of any cellular debris- this is more intense in 2ndary intention

Proliferation- angiogenesis, proliferation of fibroblasts, myofibroblasts, extracellular matrix–> granulation tissue.

Granulation tissue fills the gap, capillaries supply oxygen and nutrients and it contracts to close the defect

Remodelling- collagen fibres deposited and fibroblasts undergoing apoptosis, in 2ndary intention myofibroblasts cause wound contraction–> scar

27
Q

What is secondary intention?

A

When sides of wound not opposed, healing must start from the bottom
Myofibroblast are v important

28
Q

What systemic factors affect wound healing?

A

Age
Gender
Stress
Ischaemia
Diabetes
Fibrosis
jaundice
Uraemia
Obesity
Steroids
NSAIDs
Chemo
Immunocomprimised
Nutrition

29
Q

What local factors influence wound healing?

A

Oxygenation
Infection
Foreign body
Venous insufficiency

30
Q

5 signs of wound infection?

A

Hot
Red
Swollen
Discharge
Itchy
Fever

31
Q

Barriers to improved nutrition?

A
32
Q

Describe a management plan for someone identified as high risk on the MUST score (bb)

A
  • follow MUST 1 care pathway (in the guidelines booklet)
  • refer to dietician
  • re-weigh weekly
  • document action taken unless detremential or no benefit is expected from nutritional support e.g. end of life care pathway

YEAR 4 OLDER PEOPLE INTEGRATED CARE (21 decks)

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