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Ama - Part 4 PM4B > Nutrition > Flashcards

Nutrition Flashcards

1
Q

Malnutrition

A

State where deficiency, excess or imbalance of nutrients causes measurable adverse effects on:
- Tissue or body form (shape, size and composition).
- Function and clinical outcome.

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2
Q

Symptoms of malnutrition

A
  • Weight loss/loss of appetite
  • Tiredness, lack of energy, lethargy
  • Depression
  • Poor concentration
  • Poor growth in children
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3
Q

Cost of malnutrition: primary care

A
  • GP visits
  • Rx costs
  • Hospital referrals
  • Care packages
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4
Q

Cost of malnutrition: secondary care

A
  • Medical and surgical complications
  • Length of hospital stay
  • Readmissions
  • Death
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5
Q

Causes of malnutrition

A
  • Altered nutrient processing
  • Excess losses
  • Impaired intake
  • Impaired digestion and absorption
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6
Q

Altered nutrient processing

A
  • Increased metabolic demand
  • Liver dysfunction
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7
Q

Impaired intake

A
  • Dysphagia
  • Depression/psychological stress
  • Mucositis
  • Poor diet
  • Poor appetite
  • Pain/nausea with food
  • Unconsciousness
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8
Q

Impaired digestion and absorption

A
  • Problems with the stomach, small intestine, pancreas and liver.
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9
Q

Excess losses

A
  • Diarrhoea/vomiting
  • Fistulae
  • NG tube drainage
  • Surgical drains
  • Stoma
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10
Q

Consequences of malnutrition

A
  • Decreased immunity
  • Decreased CO
  • Decreased renal function (loss of ability to excrete sodium and water)
  • Decrease liver function
  • Hypothermia
  • Loss of strength
  • Depression
  • Secondary anorexia
  • Impaired gut integrity and immunity
  • Impaired wound healing
  • Loss of muscle and hypoxic responses (ventilation)
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11
Q

Malnutrition Universal Screening Tool (MUST)

A
  1. Calculate BMI using height and weight
  2. Score % unplanned weight loss
  3. Score acute disease effect
  4. Add scores from steps 1-3 for complete score
  5. Refer to local management guidelines/policies to create an action plan.
  6. Score >2 is high risk (0=no risk, 1=low risk)
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12
Q

Nutritional Assessment

A
  • Anthropometry
  • Biochemistry
  • Clinical
  • Dietary
  • Environment
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13
Q

Anthropometry

A

Assessment of the different component parts of the human body (bone, muscle, water and fat)

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14
Q

Anthropometry - what is assessed

A
  • Bodyweight
  • Height
  • BMI
  • Skin fold thickness
  • Mid upper arm circumference (MUAC)
  • Mid arm muscle circumference (MAMC)
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15
Q

Biochemistry

A

Blood tests interpreted in conjunction with a clinical examination, previous medical history, and current medications.

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16
Q

Biochemistry - what is measured

A
  • U&E’s (Na, K, Ca, Mg, PO4)
  • FBC (Hb, RBC, WCC, Plts)
  • Liver function tests (Alb, liver enzymes)
  • CRP
  • Micronutrients
  • Glycated haemoglobin (HBA1c)
17
Q

Clinical

A

Diseases may increase the risk of malnutrition through:
- Reduced intake
- Increased GI losses
- Increased demands.

18
Q

Dietary

A
  1. Estimating energy requirements
  2. Fluid requirements
  3. Dietary assessment
19
Q

Estimating energy requirements

A

Resting energy expenditure (REE) + Physical activity and diet-induced thermogenesis (PAL)

20
Q

Resting energy expenditure (REE)

A
  • Disease specific - varies between 20-25 kcal/kg
  • BMI <18 (REE = 25-30 kcal/kg)
21
Q

Fluid requirements - general

A

3L/day max for most patients

22
Q

Fluid requirements - over 60

A

30ml/kg body weight

23
Q

Fluid requirements - under 6

A

35ml/kg body weight

24
Q

Fluid requirements - obese

A
  • Use ideal body weight requirements
25
Q

Fluid requirements - renal/cardiac failure

A
  • Fluid requirements are lower
26
Q

Other requirements

A
  • 0.8-1.5g protein kg/day (0.13 - 0.24g nitrogen)
  • Electrolytes (sodium, potassium, magnesium, calcium, phosphate)
  • Carbohydrate vs lipid (fat)
  • Vitamins and trace elements (micronutrients)
27
Q

Dietary assessment

A
  • Dietician
  • Estimation of calorie intake
  • No. of meals and snacks
  • Balanced diet?
  • Oral fluid intake
  • Any additional nutrition supplements?
  • Special diets, intolerances, food allergies
28
Q

NICE CG32 (2006) - Definition of malnourished

A
  • A BMI <18.5 kg/m2
  • Unintentional weight loss >10% within last 3-6 months
  • A BMI >20 kg/m2 and unintentional weight loss >5% within the last 3-6 months
29
Q

NICE CG32 (2006) - Those at risk of malnutrition

A
  • Have eaten little or nothing for more than 5 days and/or are likely to eat little or nothing for the next 5 days or longer
  • Have a poor absorptive capacity and/or have high nutrient losses and/or have increased nutritional needs from causes such as catabolism
30
Q

Refeeding syndrome

A
  • Occurs when a person in a state of prolonged starvation is given nutrition.
  • During refeeding, there is a sudden shift in fluid/electrolytes.
  • Leads to potentially fatal shifts in fluids and electrolytes within the body
  • Can be life threatening condition if not correctly managed
31
Q

Shift in fluid/electrolytes results in:

A
  • Insulin secretion
  • Glycogen, fat and protein synthesis for which phosphate, magnesium and thiamine are required
  • Increased uptake of potassium and magnesium into cells
32
Q

High risk of refeeding (1)

A

One or more:
- BMI <16 kg/m2
- Unintentional weight loss >15% in last 3-6 months
- Little or no nutritional intake for > 10 days
- Low levels of potassium, phosphate or magnesium prior to feeding

33
Q

High risk of refeeding (2)

A

Two or more:
- BMI <18.5 kg/m2
- Unintentional weight loss >10% in the last 3-6 months
- Little or no nutritional intake for > 5 days
- History of alcohol abuse or drugs including insulin, chemotherapy, antacids or diuretics

Ama - Part 4 PM4B (69 decks)

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