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Y4 OPIC > Nutrition, Carers and Health Inequality > Flashcards

Nutrition, Carers and Health Inequality Flashcards

1
Q

What are the four common causes of malnutrition?

A
  • Reduced Dietary Intake (e.g. N/V, depression, sz, autism, dementia, eating disorders, oral pain)
  • Malabsorption (e.g. Crohn’s, UC, bowel surgery, chronic pancreatitis, celiac, CF, lactose intolerance)
  • Increased losses or altered requirements (e.g. pregnancy, parasitic diseases, cancer, burns)
  • Energy expenditure (e.g. hyperthyroidism, burns)
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2
Q

How does malnutrition affect muscle function?

A

Loss of mass + downregulation of energy dependent membrane functions causes rapid loss of strength

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3
Q

How does malnutrition affect Cardio-Resp function?

A
  • Reduction in cardiac muscle mass
  • Causes reduction in CO
  • Subsequently reducing eGFR
  • Poor diaphragmatic and resp muscle function causes reduced cough pressure and excretion of secretions, increasing risk of RTIS
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4
Q

How does malnutrition affect GI function?

A

Chronic malnutrition results in changes in pancreatic exocrine function, intestinal blood flow, villous architecture and intestinal permeability. The colon loses its ability to reabsorb water and electrolytes, and secretion of ions and fluid occurs in the small and large bowel. This may result in diarrhoea

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5
Q

How does malnutrition affect immunity and wound healing?

A

Imapired cell mediated immunity and cytokine, complement and phagocyte function causes significant reduction in immune function

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6
Q

What is the MUST?

A

Malnutrition Universal Screening Tool. 5 step screening tool used to identify adults who are malnourished or at risk of malnutrition (termed undernurished)

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7
Q

What are the steps in calculating the MUST score?

A

Step 1: BMI
Step 2: Unplanned weight loss in last 3-6 months
Step 3: Based on acute illness, patient scores if they have been unwell and are likely to have not eaten in 5+ days

Step 4: Add 1-3 together, gives overall MUST score

Step 5: 3 different management pathways based on score

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8
Q

What are the 3 management pathways outlined by the MUST tool?

A

0 = Low risk of malnutrition: Routine clinical care

1 = Medium risk of malnutrition: Observe intake

2+ = High risk of malnutrition: Treat

  • Refer to dietician, nutritional support team
  • Set goals
  • Monitor and review
  • Treatment can be withheld if no benefit is likely (e.g. end of life)
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9
Q

What factors can affect wound healing?

A

Local:

  • Oxygenation
  • Infection
  • Foreign body
  • Venous insufficiency

Systemic:

  • Age
  • Gender
  • Stress
  • Ischaemia
  • Diabetes
  • Fibrosis
  • Jaundice
  • Uraemia
  • Obesity
  • Meds; NSAIDs, Steroids, Chemotherapy
  • Immunocompromised
  • Nutrition
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10
Q

What pathological processes cause pressure ulcers?

A
  • Unrelieved pressure cutting off blood flow/venous drainage to the pressured areas.
  • Shearing effect; as the patient moves around the skin is pulled away from the tissue, breaking blood vessels
  • Friction between bedclothes and skin causes loss of stratum corneum, accelerating skin breakdown.
  • Moisture from sweat or urine builds up causing maceration of the skin surface
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11
Q

Why are pressure ulcers such a concern?

A
  • Obvious pain and discomfort
  • Tend to significantly increase stays in hospital
  • High risk for infection and sepsis, therefore death
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12
Q

What are the most common sites for pressure ulcers?

A 
Back of head
Shoulder
Elbow
Sacrum
Ankle
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13
Q

What screening tools are used to assess pressure ulcers?

A

Braden scale = Generic tool

Waterlow = Orthopaedic and Geriatric tool

Cubin and Jackson scale = ITU tool

TIME can be used for existing chronic wounds

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14
Q

How does the Braden scale score pressure ulcer risk?

A

Posits that six factors contribute to either higher intensity or duration of tissue pressure, or lower tissue tolerance, or increased risk of pressure ulcer development.

  1. Sensory perception
  2. Nutrition
  3. Friction/shearing
  4. Mobility
  5. Moisture
  6. Activity

Each item scored 1-4 on scale, lower score = higher risk.

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15
Q

If a patient is bedbound, how can you go about calculating their BMI (i.e. if they can’t get onto a scale or stand up to be measured).

A

MUST tool has tables comparing…

  • Ulna length (medial styloid process –> Olecranon process) to Height
  • Mid Upper Arm Circumference (MUAC) to BMI
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16
Q

How does MUAC compare to BMI?

A

MUAC less than 23.5cm, BMI is likely below 20

MUAC greater than 32cm, BMI is likely above 30

17
Q

What is a limitation of the MUST score?

A

Doesn’t really pick up malnutrition in obese people.

18
Q

What is a better option than Fortisip for older patients struggling to get adequate nourishment?

A

Hand feeding with blended normal food.

Many people are quick to give fortisip to older patients struggling to get enough calories in, but the taste is often so off-putting it can often have the inverse effect. If the patient can safely handle it, blended food is the better option.

19
Q

What is the TIME scoring system and what are it’s components?

A 
Scoring system for chronic wounds. Looks at
Tissue
Inflammation and infection
Moisture
Edge and epithelization
20
Q

What are the pressure sore grades (1-4)?

A 
1 = Non-blanching erythema
2 = Partial thickness skin loss
3 = Full thickness skin loss
4 = Full thickness tissue loss
21
Q

How should a pressure sore be managed?

A
  • Friction reduction
  • Optimise nutrition
  • Pressure reduction/ Weight redistribution
  • Air flow boots
  • Swab for cultures
  • Antibiotics as required
  • Contact tissue viability nurse (TVN)
22
Q

What is caregiver burden?

A

The stress which is perceived by caregivers due to the home care situation.

23
Q

Why is caregiver burden so important?

A

This subjective burden is one of the most important predictors for negative outcomes of the care situation – for the caregivers themselves as well as for the one who requires care

24
Q

How is caregiver burden measured?

A

Using the Burden Scale for Family Caregivers (BSFC)

25
Q

What are the key aspects of caregiver burden? Aspects of their life which might be negatively influenced by the caregiving experience?

A
  • Physical (burden is associated with negative health outcomes).
  • Psychiatric (burden is associated with increased rates of depression, anxiety, substance abuse…)
  • Financial (burden often reduces a person’s economic status)
  • Occupational (caregiving can impede a person’s opportunity for career growth)
  • Social (caregiving can reduce a person’s opportunity to maintain social support networks)
26
Q

What are the central aspects of interventions seeking to unburden carers?

A
  1. Information and training
  2. Professional support
  3. Effective communication
  4. Public and financial support
27
Q

What are the 4 explanations of healthcare inequality given by the Black Report?

A

Artefact explanations

Natural/Social selection

Materialist explanations

Cultural/Behavioural explanations

28
Q

Summarise the Artefactual explanations of healthcare inequalities?

A

Both health and class are artefacts of the measurement process and it is implied that their observed relationship may itself be an artefact of little casual significance

29
Q

Summarise the Social Selection explanations of healthcare inequalities?

A

Argues that health level leads to social status, not social status leads to health level, i.e. healthier people rise up the social ladder, unhealthy people fall down it.

30
Q

Summarise the Materialist explanations of healthcare inequalities?

A

Poverty exposes people to health hazards. Disadvantaged people are more likely to live in areas where they are exposed to harm such as air-pollution and damp housing.

The Black report found this to be the most important factor in explaining health inequalities in the UK, however it cannot explain the totality of health inequality.

31
Q

Summarise the Cultural and Behavioural explanations of healthcare inequalities?

A

There are social class differences in health damaging or health promoting behaviours such as dietary choices, consumption of drugs, alcohol and tobacco, active leisure time pursuits, and use of immunisation, contraception and antenatal services.

However the Whitehall study found that this only explains 1/3rd of differences in healthcare amongst people of different classes.

32
Q

What are the most significant health issues faced by the UK’s homeless population?

A
  • Unintentional injuries (bruises, cuts, burns)
  • MSK disorders and joint pain
  • Hunger and malnutrition
  • Skin and foot problems (ulcers, corns, bunions)
  • Infectious diseases (IVDU and otherwise
  • Dental problems
  • Respiratory illnesses (COPD, emphysema, bronchitis)
  • Sexual and reproductive diseases
  • Mental health issues
33
Q

Apart from the direct effect of their condition, what are some reasons people with learning disabilities tend to have worse overall health than those without?

A
  • Reduced health promotion and disease prevention work, e.g. women with LDs receive less breast cancer screening
  • Higher rates of secondary conditions (epilepsy in Down’s), co-morbid conditions, age related conditions
  • More likely to engage in health risk behaviour, more likely to die young
  • Barriers to healthcare e.g. inadequate skill of healthcare workers, physical barriers (e.g. wheelchair access), prohibitive costs, limited availability of resources.
34
Q

What are the most important sociological determinants of health?

A

According to the National Research Council:

  • income
  • accumulated wealth
  • education
  • occupational characteristics (e.g. exposure to certain compounds, risk of depression, risk of injury)
  • social inequality based on race and ethnic group membership
35
Q

How do you interpret a MUST score?

A

0 = Routine Clinical Care
- Repeat screenings throughout hospital stay

1 = Observe

  • Document intake every 3 days
  • If adequate go back to routine monitoring
  • If inadequate; set goals, IMPROVE and INCREASE intake
  • Monitor and review care plan

2 = Treat

  • Refer to dietician or Nutritional Support Team
  • Set goals IMPROVE and INCREASE intake
  • Monitor and review care plan

Y4 OPIC (5 decks)

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