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OPIC > Nutrition > Flashcards

Nutrition Flashcards

1
Q

What is Malnutrition?

A
  • A sudden or chronic decrease in the intake of sufficient nutrition to support the body’s requirements for growth, healing and maintenance of life
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2
Q

What is Acute Malnutrition?

A
  • A brief period of inadequate nutrition that is most commonly in relation to an acute illness with a high inflammatory state, such as pneumonia, results in muscle wasting and rapid weight loss
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3
Q

What is Chronic Malnutrition?

A
  • Inadequate nutrition that lasts longer than 3 months. Often secondary to social, behavioural and economic factors in addition to illness-related causes
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4
Q

What is the screening for Malnutrition?

A
  • MUST tool
  • Takes into account BMI, unplanned weight loss and changes to diet
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5
Q

What are the four main reasons that someone might be malnourished?

A
  • Inadequate amounts of nutrients (reduced dietary intake)
  • Difficulty absorbing nutrients (coeliac disease and GI dysfunction)
  • Increased nutritional demands (post-surgery for healing)
  • Energy expenditure
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6
Q

What are the risk factors for Malnutrition?

A
  • Being hospitalised for extended periods of time
  • Problems with dentition, taste or smell
  • Polypharmacy
  • Social isolation and loneliness
  • Mental health issues including grief, anxiety and depression
  • Cognitive issues including confusion
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7
Q

What are some of the typical clinical features of malnutrition?

A
  • High susceptibility or long durations of infections
  • Slow or poor wound healing
  • Altered vital signs including bradycardia, hypotension and hypothermia
  • Depleted subcutaneous fat stores
  • Low skeletal muscle mass
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8
Q

What are some of the causes of Malabsorption?

A
  • Coeliac disease
  • Cystic Fibrosis
  • Crohn’s disease
  • Lactose intolerance
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9
Q

What are some of the causes of increased losses?

A
  • Pancreatitis
  • IBD - diarrhoea
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10
Q

What are some of the causes of loss of appetite?

A
  • vomiting
  • cancer
  • liver disease
  • COPD
  • Eating disorder
  • Dementia
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11
Q

What are some of the causes of increased expenditure?

A
  • Healing after surgery
  • Serious injury - Burns
  • Involuntary movements such as a tremor
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12
Q

What are some of the consequences to malnutrition?

A
  • Impaired immunity
  • Poor wound healing
  • Growth restriction in children
  • Unintentional weight loss, loss of muscle mass
  • Multi-organ failure
  • Death
  • Depression, self-neglect
  • Hypothermia
  • Reduced muscle mass and strength
  • Osteoporosis
  • Rickets
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13
Q

What are some of the consequences of specific micronutrient deficiencies?

A
  • Iron deficiency = anaemia
  • Zinc deficiency = skin rashes and decreased ability to fight infections
  • Vit B12 deficiency = Anaemia and problems with nerves
  • Vit D deficiency = rickets in children and osteomalacia in adults
  • Vit C deficiency = scurvy
  • Vit A deficiency = night blindness
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14
Q

What are the 4 stages of wound healing?

A
  • Hemostasis: activates the blood clotting system and causes platelet aggregation and activation
  • Inflammation: WBC destroy the bacteria and remove the debris
  • Proliferation: granulation tissue is put down with connective tissue and new blood vessels are formed
  • Remodelling: the new tissue matures and remodels and there is an overall increase in tensile strength
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15
Q

What factors affect wound healing?

A
  • Oxygenation
  • Infection
  • Foreign Body
  • Venous Insufficiency
  • Age
  • Gender
  • Stress
  • Ischaemia
  • Obesity
  • Diseases: Diabetes, Fibrosis, Jaundice and Uraemia
  • Medication: Steroids, NSAIDs, Chemotherapy
  • Immunocompromised
  • Nutrition
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16
Q

What are the cardinal signs of inflammation?

A
  • Rubor (redness)
  • Calor (heat)
  • Tumor (swelling)
  • Dolor (pain)
  • Functio laesa (loss of function)
17
Q

What are Pressure Ulcers?

A
  • A pressure ulcer is an area of damaged skin and/ or the tissues below as a result of being placed under pressure
  • Pressure ulcers can cause pain or lead to an extended stay in hospital
  • They can become infected which could lead to sepsis and in extreme cases it can be life threatening
18
Q

What are the causes of Pressure Ulcers?

A
  • Prolonged pressure on the skin
  • Moisture on the skin which can break down the epidermis
19
Q

What are the common sites for pressure ulcers?

A
  • Heels
  • Elbows
  • Hips
  • Base of the Spine
  • Buttocks
20
Q

What are three screening tools used to assess pressure ulcers?

A
  • Braden Scale
  • Norton Scale
  • Waterlow Scale
21
Q

What is the Braden Scale ?

A
  • It is used to predict pressure score risks
  • Six factors that contribute to either higher intensity and duration of pressure or lower tissue tolerance to pressure therefore increasing the risk of pressure ulcer development
  • Each item is scored between 1 and 4 guided by a descriptor
  • The lower the score the greater the risk
  1. Sensory Perception
  2. Nutrition
  3. Friction and shear
  4. Mobility
  5. Moisture
  6. Activity
22
Q

What is the Waterlow Score?

A
  • Used to assess the risk of pressure scores
  • BMI
  • Age
  • Nutritional Status
  • Organ Failure
  • Anaemia
  • Smoking
  • Medical Co-morbidites
  • Drug History
  • Duration and type of surgery
23
Q

What is Refeeding Syndrome?

A
  • A condition caused by rapid re-introduction of normal nutrition in patients who are chronically malnourished
  • A patients intracellular stores of potassium and phosphate are depleted
  • If a patient is suddenly provided with normal levels of nutrition, there is a large insulin response and there is a sudden shift of these electrolytes from the extracellular to the intracellular compartment
  • This causes a hypokalaemia and hypophosphataemia and a hypomagneseamia with abnormal fluid balance
  • This leads to cardiac complications such as arrhythmias and seizures
24
Q

How do you prevent re-feeding syndrome?

A
  • Nutrition is re-introduced more gradually under the guidance of a dietician
  • The patient’s electrolytes are monitored closely, allowing deficiencies to be identified early and replaced appropriately
25
Q

Patients are considered high-risk if one of more of the following occur:

A
  • BMI <16 kg/m2
  • Unintentional weight loss >15 % over 3-6 months
  • little nutritional intake > 10 days
  • Hypokalaemia, Hypophosphataemia or Hypomagnesaemia prior to feeding
26
Q

What is the management of Malnutrition?

A
  • A healthier, more balanced diet
  • Fortified foods that contain extra nutrients
  • Snacking between meals
  • having dinks that contain lots of calories (fortisip)
  • Feeding tubes: NG tube, PEG tube, Parenteral nutrition)
  • food-first approach = add full fat cream to mashed potato rather than prescribing oral nutritional supplements
27
Q

What is the managment for Low risk MUST score?

A
  • Repeat the score: hospital = weekly, care homes = monthly and community = annually
28
Q

What is the managment for Medium risk MUST score?

A

Document dietary intake for 3 days:
1. If adequate - little concern and repeat screening (hospital = weekly, care home = monthly and community = 2/3 months)
2. If inadequate - set goals, improve and increase overall nutritional intake, monitor and review care plan regularly

29
Q

What is the managment for a High Risk MUST score?

A
  • Refer to a Dietitian and Nutritional support team
  • Set goals to help improve and increase overall nutritional intake
  • Monitor and review care plan ( hospital = weekly, care home = monthly and community = monthly)
30
Q

How is the Braden Scale broken down?

A
  • Lower the scale = Higher the risk of pressure sores

Sensory Perception: ( 4- No impairment, 3- slightly limited, 2- Very Limited, 1 - Completely Limited)

Moisture ( 4- Rarely Moist, 3- Occasionally Moist, 2- Very Moist, 1- Constantly Moist)

Activity ( 4- Walks Frequently, 3- Walks Occasionally, 2- Chair Bound, 1- Bed bound)

Mobility ( 4- No limitations, 3- Slightly Limited, 2- Very limited, 1- Completely Immobile)

Nutrition (4- Excellent, 3- Adequate, 2- Probably Inadequate, 1 - Very Poor)

Friction and Shear ( 3- No Apparent Problem, 2- Potential Problem, 1 - Problem)

31
Q

What are the score breakdowns for the Braden Scale?

A
  • 15+ = low risk
  • 13-14 = moderate risk
  • 12 or less = high risk
  • Below 9 = severe risk
32
Q

What factors predispose for Pressure Ulcers?

A
  • Immobility
  • Malnutrition
  • Incontinence
  • Pain (reduced mobility)

OPIC (18 decks)

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