Nutrition in medicine Flashcards
Define malnutrition
Deficiences, excesses or imbalances in bodies macro and micronutrients
Define undernutrition
Form of malnutrition resulting from reduced supply of food or inability to digest, assimilate or utilise necessary nutrients
What % of the following types of patients are undernourished
a) on admission
b) in patients
c) out patients
a) 28-40%
b) 66%
c) 45-100%
Which groups are most vulnerable to under nutrition in the UK
Chronic diseases Elderly Recently discharged Low income Socially isolated
Name 4 consequences of under-nutrition in the community
Falls, depression, increased infection risk, dependency
Name 5 consequences of under-nutrition in the hospital
Increased morbitity Increased length of stay Increased dependency Increased mortality Increased costs of care
Name some causes of disease related under nutrition that relate to reduced nutritional intake
- Anorexia
- Side effects of treatment
- Pain
- Dysphagia
- Physical disablity
- Nil by mouth
Name some causes of disease related under nutrition that relates to increased nutritional losses
Malabsorption
Wound exudate/ burns
Name some causes of disease related under nutrition that relates to increased nutritional requirement
Inflammation/ infection
Pyrexia
Tissue healing
Metabolic effects
How long does it take undernourished catabolic patients to reach death
5 weeks
How long does it take undernourished patients in an otherwise normal metabolic state to reach death
10 weeks
Describe the changes that occur during undernutrition that lead to nitrogen death
- Decreased muscle mass
- Decreased visceral proteins
- Impaired immune response
- Impaired wound healing/ response to truama
- Multiple organ failure
Describe the changes that occur during undernutrition that lead to energy death
-Lack of initiative
- Bedridden
- Apathy
- Depression
- Personality changes
- Total apathy
0 Complete exhaustion
At what % of original body weight does nitrogen death usually occur
60
What screening tool is used to detect malnutrition
MUST (malnutrition universal screening tool)
What 2 areas does subjective global assesment
History
Physical
What needs to be examined when taking history as part of subjective glocal assesment
Weight changes Appetite Taste changes Diet history GI symptoms
What needs to be physically examined as part of subjective global assessment
Muscle wasting
Fat
Ascites
Oedema
What nutritional investigations can be done in the lab to assess nutrion
Anaemia
Plasma proteins
Vit. and mineral
Immune response
What makes up total energy expenditure (TEE)
Basal metabolic rate
Thermic effect of food
Physical activity
Stress factors
How is BMR measured
Subject lying down in comfortably heated room not digesting food
What % of TEE does BMR account for
60-70
Define basic metabolic rate
Energy used in involuntary msucle contraction and cellular action
When is BMR high
Young people
Tall, thin people
Pregnant women
Stress
What makes up nutriton support team
Dieticians
Doctor
Nurse
Pharmacist
What are some indications for gastrostomy feeding
Reduced conciousness
Unsafe swallow
Pre head and neck cancer
Special situations liek cystic fibrosis
What are some indications for parenteral nutritino
Prolonged postoperative ileus Intestinal obstruction Short bowel Small bowel fistula Acute pancreatitis GI motility disorders
