Nutrition

Question 1

What is a balanced diet?

Answer 1

This means eating a wide variety of foods in the right proportions, and consuming the right amount of food and drink to achieve and maintain a healthy body weight.

Question 2

What does a balanced diet consist of?

Answer 2

Question 3

Suggest 3 reasons why a balanced diet important?

Answer 3

1. Nutritional health-It ensures you get all essential nutrients your body needs, including vitamins, minerals, proteins, fats, and carbohydrates. Each of these plays a specific role in maintaining health and supporting bodily functions.

2.Mental Well-being: Nutrition has a significant impact on brain function and mental health. Certain nutrients, like omega-3 fatty acids and B vitamins, play roles in mood regulation and cognitive function.

3. Health Maintenance: It helps prevent chronic diseases such as heart disease, diabetes, and obesity. Nutrients like fiber, antioxidants, and healthy fats can contribute to better overall health and lower disease risk.

Question 4

Suggest 6 causes of nutritional decline?

Answer 4

1-Physical medical Conditions: Certain medical conditions, such as gastrointestinal disorders (e.g., Crohn’s disease, celiac disease), can impair nutrient absorption and lead to deficiencies.

2- Food Insecurity: Limited access due to poverty to affordable, nutritious food can lead to an imbalanced diet and nutritional deficiencies.

**3-Lifestyle Factors: **Addictions e.g excessive alcohol consumption or drugs can negatively impact
nutritional status and overall health.

4- Pyschological well being: mental health conditions such as depression, stress, insomnia can impair or reduce appetitie and thus affect nutritional input.

5- Access to resources: Inability to access healthcare or resources may lead to things such as poor dentition or ill-fitting dentures which will negative impact an individuals nutritional intake.

6-Age-Related Changes: As people age, changes in metabolism, appetite, and digestive efficiency can impact nutritional status. Older adults might also experience changes in taste and smell that affect their food choices.

Question 5

Suggest 4 MDT members that can help with improving nutritional intake?

Answer 5

1-Dieticians e.g. recommend fortified foods

2-SALT e.g. advise safe swallow

3-Occupation therapists e.g adaptable utensils

4-Physiotherapists e.g. improve mobility to sit up and eat meals.

Question 6

How do we identify when someone is at nutritional risk?

Answer 6

Malnutrition universal screening tool

E.G. MUST tool

Question 7

You are unable to obtain a height measurements, how can you estimate height from ulna
length?

Answer 7

-Measure the patients ulnar length from the olecranon process to the styloid process.

-Use the ulnar length/height conversion chart to ascertain a persons height.

Question 8

How can you estimate BMI from mid upper arm circumference (MUAC)?

Answer 8

Question 9

What is malnutrition?

Answer 9

Malnutrition refers to deficiencies, excesses, or imbalances in a person’s intake of energy and/or nutrients.

Question 10

Is obesity a form of malnutrition?

Answer 10

Yes.
As malnutrition is defined as an imbalance in a persons intake of energy/ nutrients.
Obesity is an excess of energy intake.

Question 11

Suggest 4 causes of malnutrition?

Answer 11

1- Inadequete Dietary Intake-Consuming insufficient quantities of food or a diet lacking in essential nutrients (e.g., vitamins, minerals, proteins) can lead to malnutrition.

2-Malabsorption- Chronic illnesses like cancer, diabetes, and chronic kidney disease can affect appetite, metabolism, and nutrient absorption.

3- Psychosocial Factors: Stress, depression, and mental health issues can affect eating behaviors and food choices, potentially leading to inadequate nutrient intake.

4-Natural Disasters and Conflicts: Situations such as war, famine, and natural disasters can disrupt food supplies and access to nutrition, leading to widespread malnutrition in affected populations.

Question 12

What is a pressure sore?

Answer 12

A pressure ulcer is an area of damaged skin and/or the tissues below as a result of being
placed under pressure.

Question 13

How do we grade pressure sores?

Answer 13

Stage 1-Non blanching erythema
Stage 2-Partial thickness
Stage 3-Full thickness
Stage 4-Extends into muscle, fascia & bone
Unstageable-Black/necrosed, cannot see full extent.

Question 14

Suggest 2 causes of pressure sores?

Answer 14

1-Constant pressure on any part of the body can lessen the blood flow to tissues. Blood flow is essential to deliver oxygen and other nutrients to tissues. Without these key nutrients, skin and nearby tissues are damaged and breakdown over time becoming necrotic.

2-Friction. Friction occurs when the skin rubs against clothing or bedding. It can make fragile skin more vulnerable to injury, especially if the skin also is moist.

Question 15

How do we assess pressure areas?

Answer 15

Look at a patients skin on admission, paying particular attention to common sites of breakdown and documenting any sores, redness or skin breaks.

Carry out a risk assessment to see if the individual is at risk of pressure damage and needs other interventions.

Question 16

Suggest 4 risk factors for developing pressure sores?

Answer 16

1-Poor nutrition
2-Immobility
3-Incontinence
4-Loss of sensory perception

Question 17

Suggest 5 preventative measures that can be put in place to reduce the risk of pressure sores?

Answer 17

1-Regular pressure area care (2 hourly turns)
2-Daily skin maps
3-Blower box/pressure cushions
4- Risk assessments to identify those at high risk
5-Adeqeute nutritonal intake

Question 18

Suggest 5 common sites for pressure sores to develop?

Answer 18

1-Sacrum/buttocks

2-Heels

3-Elbows

4-Hip

5-Shoulders

Question 19

Name 3 screening tools used to assess pressure sores?

Answer 19

1-Braden scale

2-Waterlow score

3-Norton Risk assessment scale

Question 20

What 6 factors are considered in the Braden scale?

Answer 20

1. Sensory perception
2. Nutrition
3. Friction and shear
4. Mobility
5. Moisture
6. Activity

Question 21

What are the 4 stages of wound healing?
Describe them.

Answer 21

1. Hemostasis: This is the body’s initial response to injury. Blood vessels constrict to reduce blood flow, and platelets aggregate to form a clot. This clot not only stops bleeding but also releases growth factors that signal the next stages of healing.

2. Inflammation: The wound becomes red, swollen, warm, and sometimes painful due to increased blood flow and the arrival of immune cells. White blood cells, particularly neutrophils and macrophages, migrate to the wound site to clean out debris, bacteria, and dead cells. This stage is crucial for preventing infection and setting the stage for tissue repair.

3. Proliferation:New tissue forms to replace the damaged tissue. Key processes in this stage include:
Angiogenesis: Formation of new blood vessels to supply nutrients and oxygen to the healing tissue.
Fibroplasia: Fibroblasts produce collagen and extracellular matrix to provide structural support.
Reepithelialization: New epithelial cells migrate across the wound to cover it.
Wound Contraction: Myofibroblasts pull the edges of the wound together to reduce its size.

4. Remodelling: The newly formed tissue gains strength and flexibility. Collagen fibers are reorganized, remodeled, and aligned along tension lines. The wound gradually gains strength and elasticity, although it may never fully return to its pre-injury state. Scar tissue forms and continues to mature over time.

Question 22

Suggest 4 local factors which influence wound healing?

Answer 22

1. Oxygenation; Oxygen is essential for aerobic metabolism, which produces ATP (adenosine triphosphate), the energy currency of cells. Adequate energy is required for cellular functions such as cell proliferation, migration, and collagen synthesis.

2. Infection; Prolonged Inflammation: Infection triggers an inflammatory response that can become chronic, extending the inflammatory phase of wound healing. Chronic inflammation can prevent the transition to the proliferative phase, where tissue repair and regeneration occur.

3. Foreign Body ; Foreign bodies can serve as a nidus (focal point) for bacterial colonization, leading to infections that complicate healing. Bacteria may adhere to the foreign material, forming biofilms that are difficult to eradicate with standard treatments.

4. Venous Insufficiency ;Venous insufficiency leads to poor blood flow, which reduces the delivery of oxygen and essential nutrients to the wound site. Adequate oxygenation and nutrient supply are critical for cellular functions involved in wound healing.

Question 23

Suggest 9 systemic factors which influence wound healing and give an example why for each?

Answer 23

1. Age; Weakened Immune System: The immune system becomes less efficient with age, leading to a reduced ability to fight infections and manage inflammation effectively. This can increase the risk of wound infections and prolong the healing process.

2. Gender; In women, oestrogen plays a role in wound healing by promoting collagen synthesis and angiogenesis (the formation of new blood vessels).

3. Stress; Chronic Inflammation and chronic stress can lead to prolonged inflammation. While inflammation is a normal part of wound healing, excessive or prolonged inflammation can disrupt the healing process and contribute to complications.

4. Ischemia; Impaired Cellular Function: Oxygen is essential for cellular metabolism and energy production. Ischemia leads to hypoxia (low oxygen levels), which impairs the function of cells involved in wound healing, including fibroblasts, keratinocytes, and endothelial cells.

5. Diseases; Diabetes Mellitus, Poor Glycemic Control: High blood sugar levels can impair the function of immune cells and reduce the body’s ability to fight infections.

6. Uraemia; Uremia often results in fluid retention and oedema, which can complicate wound healing by increasing tissue swelling and affecting blood flow to the wound site.

7. Obesity;Excess body fat can lead to poor circulation, particularly in the extremities. Reduced blood flow can impair the delivery of oxygen and nutrients necessary for wound repair, leading to delayed healing.

8. Medication; NSAIDs can inhibit the production of prostaglandins, which are involved in inflammation and pain. While they help manage pain and inflammation, excessive use may impair the inflammatory response crucial for initial wound healing.

9. Immunocompromise; Reduced Inflammation, An adequate inflammatory response is crucial for cleaning the wound of debris and pathogens and initiating the repair process. Immunocompromised individuals may have a diminished inflammatory response, which can lead to inadequate wound debridement and slower transition to the proliferative phase of healing.

10. Nutrition;Proteins are essential for collagen production, which is crucial for wound strength and tissue repair. Collagen is a major structural protein in the healing tissue.

Question 24

Suggets 5 signs of wound infection?

Answer 24

1-Erythema ; Surrounding skin becomes redder than usual, and the redness may spread from the wound site.
2-Swelling;the area around the wound may become swollen and puffy. This is often due to increased fluid and immune response.
3-Discharge or pus; the wound may produce pus or other types of discharge that can be thick, yellow, green, or cloudy. An unusual or foul odor may also be present.
4-Pain; The wound may become increasingly painful or tender, with pain that can be more severe than what would be expected from the initial injury.
5-Fever; A systemic response to infection can include a fever, which is a sign that the body is fighting off an infection.