Nutrition

Question 1

Malnutrition can occur as a result of what?

Answer 1

inadequate dietary supply:
• access to food
• appetite
• inability to feed

• gastrointestinal failure
• unusual losses
• increased demands

Question 2

What is REE in terms of nutrition?

Answer 2

Resting energy expenditure

Question 3

How does REE change in illness?

Answer 3

Increases with illness

Question 4

What conditions impact on the REE the most?

Answer 4

Burns, sepsis

Question 5

Electrolyte imbalances in malnutrition? Why?

Answer 5

Reduced total potassium

Incraesed sodium

Due to failures in the NaK ATPase

Question 6

What is reductive adaptation

Answer 6

Physiological response of the body to under nutrition i.e. Systems slow down and do less in order to allow survival on limited nutrient resources especially calories.

Question 7

Implications of reductive adaptation on care?

Answer 7

Processes – on the way to system failure:

• Structure no longer adequately marks function
• Represent increasing vulnerability (RISK)
• inability to cope with stressors
• greater susceptibility to homeostatic failure

Question 8

Refeeding syndrome symptoms?

Answer 8

Overloaded circulation
Heart failure
Abdominal distension
Profound secretory diarrhoea
Cardiac arrhythmias

Question 9

Refeeding syndrome causes?

Answer 9

Insulin secretion resumes in response to increased blood sugar; resulting in increased glycogen, fat and protein synthesis. This process requires phosphates, magnesium and potassium which are already depleted and the stores rapidly become used up.

Question 10

management of malnutrition?

Answer 10

1. Gain metabolic control (Resuscitate and repair) treat underlying condition

treat infection, prevent hypoglycaemia & hypothermia manage reductive adaptation

correct specific deficiencies (intracellular)

energy and protein to maintain function (not excess)

repair cellular damage before replete tissue loss

2. Replete tissue deficit:

added energy: extra protein and nutrients to meet need
for tissue deposition.

Question 11

Methods of nutritional support?

Answer 11

Encourage & assist with feeding

Food supplements

Promote Digestion:

• Polymeric feeds
• Elemental feeds

Enteral feeding:

• NG, NJ, PEG, PEGJ, PEJ
• Overnight or continuous

Parenteral:

Peripheral, midline, PICC, central

Question 12

R/F for malnutrition?

Answer 12

Olderpeopleaged>65years
– Particularly those in hospital or nursing homes

• People with long term health conditions

• People with chronic progressive conditions e.g.
cancer or dementia

• People who abuse drugs or alcohol

Question 13

Clinical effects of malnutrition

Answer 13

Ventilation - muscle atrophy

Depression

Immune vulnerability

Fatty liver disease

Hypothermia

Loss of strength

Question 14

MUST tool definition?

Answer 14

Malnutrition universal screening tool

Question 15

If you can’t measure weight or height what should you measure?

Answer 15

Mid-upper arm circumference

Question 16

Steps in MUST tool?

Answer 16

1. BMI 5days = 2 points)

4. add these scores together

Question 17

What do the must scores mean

Answer 17

0 no risk
1 medium risk
2+ high risk

Question 18

Action plan depending on the MUST score?

Answer 18

Low risk - Routine clinical care
medium risk - Observe and monitor
high risk - Treat & refer

Question 19

Steps of nutritional assessment?

Answer 19

ABCDE

Anthropometry
Biochemistry
Clinical
Dietary
Environment

Question 20

Blood tests done in a nutritional assessment?

Answer 20

Micronutrients
– Renal Function
– Electrolytes such as Mg2+, PO4, K+
– Inflammatory Markers
– Disease specific Markers: HbA1c/anti –tTG antibodies

Question 21

Clinical assessments done in a nutritional assessment?

Answer 21

E.g. Burns, surgery (Increased Requirements) – GI disorders (Malabsorption)
– Neurological Conditions (Dysphagia)

Question 22

Dietary assessments as part of a nutritional assessment?

Answer 22

Estimate total dietary intake and dietary adequacy

Question 23

Environmental assessments as part of a nutritional assessment?

Answer 23

Social
• Ability to shop, cook, mobility, budget, family
support, meal timings (shift work)

Physical
Appetite, dentures, dexterity, sight, dysphagia, food intolerances, taste preferences

Question 24

Management of refeeding syndrome?

Answer 24

Do not withhold nutrition – cannot correct the intracellular electrolyte deficits without low levels of feeding

• Clinical Management

 Meet fluid and electrolyte requirements

 Vitamin supplementation: IV Pabrinex I & II od for 3/7 → PO Thiamine 100mg bd, Vitamin B Compound strong BD and Sanatogen
A-Z OD for 7/7 (or if lower risk can give 10 days of oral and no IV)

 Daily electrolyte monitoring (Mg, PO4, K, Ca) → replacement (PO/IV) if low (pharmacist advice)

 Monitor fluid balance

 Very high risk: Monitor ECG, BGLs, GI symptoms, observations

Question 25

Cost associated with malnutrition treatment in the UK?

Answer 25

£20 million

Question 26

What IBD has positive effects from enteral nutrition?

Answer 26

crohns not UC

Question 27

Three aims of nutrition support?

Answer 27

• Resuscitate
• Repair
• Replete