Nutrition Flashcards
What is a healthy diet?
Right balance of nutrients: Minerals Vitamins Carbohydrate Protein Fats Fibre
What are effects of ageing on nutrition?
- Vomiting
- Malabsorption
- Wound/pressure sore
- High temperature
- Being bedbound
- Having intense physiotherapy
Sensory impairment –> reduced appetite, decreased ability to purchase and prepare food
ORal health/dental problems: difficulty chewing, pain
Altered energy need - lacking in essential nutrients
Decreased physical activity - loss of appetites
Muscle loss (sarcopenia) - decreased functional ability in ADLs
Psychosocial isolation - decreased appetite
Environmental/financial - limited access to quality food
What are factors assessed by MUST?
- BMI score (higher for underweight) /2
- Unplanned weight loss in past 3-6 months (higher score for greater weight lost) /2
- Acutely ill and there has been or is likely to be no nutritional intake for >5 days /2
What should you doe for Low risk, medium risk and high risk of malnutrition?
Low risk (0) – Routine Clinical Care • Repeat screening for special groups e.g. over 75: o Hospital – weekly • Care homes – monthly • Community – annually
Medium risk (1) - observe
• Document dietary intake for 3 days
• If adequate – little concern and repeat screening:
o Hospital – weekly
o Care home – monthly
o Community – every 2-3 months
• If inadequate – set goals, improve and increase overall nutritional intake, monitor and review care plan regularly
High risk (2+) – treat • Refer to dietician • Refer to nitrtional support team • Set goals • Improve and increase overall nutritional intake • Monitor and review careplan weekly
For all risk: • Treat underlying condition • Provide help and advice on food choices, earing and drinking • Record malnutrition risk category • Record need for special diets
What patients are likely to be at risk of malnutrition?
Patients with poor eating habits, dementia, communication difficulties
• Patient requiring assistance with feeding
• Patients on pureed diets
• Patients on thickened fluids
• Patients changing from enteral feeding methods to oral eating
• Patients for whom staff have concerns e.g. change in medical status, taking nutritional supplements, or for reasons of professional judgement
Mx for improving nutritional wellbeing?
Patients at risk of under-nutrition identified and supported
Meals served on red tray and water in jug with red lid
Intake recorded on food and fluid charts
Maximise oral intake by having more food Fortify diet by adding additional energy and protein Oral nutritional supplements Enteral Feeding Parenteral feeding
Treat underlying causes and risk factors
MDT for nutrition and hydration? Roles?
Dietician – review diet, nutritional supplements
Speech and Language Therapist – swallow
Occupational Therapist: Functional impairment – modify environment
Physiotherapist: Functional impriament – physical therapy
Psychiatrist/Psychotherapist/Clinical psychologist – Treat depression, psychotherapy, modify environment
Physician – treat oral pathology
What is rationale for enteral feeding?
Enteral feeding is used for people who are unable to meet all of their nutritional requirements orally due to compromised intake or contraindications.
Medical decision to commence NG feed to help meet nutritional requirements as unable to meet demands orally
What are indications for enteral feeding?
• Medical: o IBD o Hepatic Failure o Renal Failure o Respiratory failure
• Neurological: o Cerebrovascualr accident o Motor neurone disease o Acquired brain injury o Brain tumour o Parkinson’s disease
• Surgical: o Preoperative o Postoperative o Fistula o Burns o Sepsis
• Paediatric:
o Cystic fibrosis
• Psychiatric
o Anorexia nervosa
What are advantages and disadvantages of NG tube?
Advantages:
Easy to insert by trained personnel
Disadvantages/Complications: • Unable to pass tube • Malposition into trachea – aspiration and pneumonia • Pneumothorax • Intracranial placement • Blockage • Nasopharyngeal pain
What are advantages and disadvantages of PEG feed?
Advantages • Safer • More cost effective • Less interruption from tube displacement • Less reflux • Less feed aspiration • Overnight feeding safer
Disadvantages/Complications: • Peristomal infection • Peritonitis • Tube blockage • Tube fracture and leakage
What are complications of enteral feeding?
Aspiration – especially if absent gag reflex → aspiration penumonia Overhydration Hypertonic dehydration Refeeding syndrome Infection – contaminated feed GI complications: Diarrhoea/Constipation Nausea Abdominal bloating Cramps Reflux
What is refeeding syndrome?
Metabolic disturbances that occur as a result of reinstitution of nutrition to patients who are starved, severely malnourished or metabolically stressed due to severe illness. When too much food and/or liquid nutrition supplement is consumed during the initial 4 – 7 days of refeeding.
This triggers synthesis of glycogen, fat and protein in cells, to the detriment of serum concentrations of potassium, magnesium, and phosphorus.
• Starvation/Malnutrition
• Glycogenolysis, gluconeogenesis and protein catabolism
• Protein, fat, mineral, electrolyte and vitamin depletion
• Refeeding – switch to anabolism
• Fluid, salt, nutrients
• Insulin secretion
o Increased glucose uptake
o Increased utilisation of thiamine
o Increased uptake of potassium, magnesium and phosphate
o Increased protein and glycogen synthesis
• Results in:
o Hypokalaemia o Hypomagnesaemia o Hypophosphataemia o Thiamine deficiency o Salt and water retention – oedema
Metabolic abnormalities in refeeding syndrome?
o Hypokalaemia o Hypomagnesaemia o Hypophosphataemia o Thiamine deficiency o Salt and water retention – oedema
What are clinical features of refeeding syndrome?
o Convulsions o Delirium o Wernicke’s encephalopathy – nystagmus confusion, ophthalmoplegia, ataxia o Hypotension o Arrhythmias o Heart failure o Renal failure o Hyperglycaemia o Peripheral oedema o Rhabdomyolysis o Fasciculation
