Nutrition in practice Flashcards
What is the annual cost of malnutrition to NHS England?
14.7 million
4.3 billion
23.5 billion
What is the annual cost of malnutrition to NHS England?
14.7 million
4.3 billion
23.5 billion
Name 5 reasons why someone might have reduced intake of food [5]
Dysphagia
Prolonged periods NBM
Side effects of treatment
Pain/constipation
Psychological e.g. depression
Social e.g. low income, isolation, cost of living
Poor dentition
Reflux/feeding problems/food intolerance’s
Name 3 reasons why someone might have increased requirement of food that causes malnutrition? [3]
Infections
Involuntary movements
Wound healing
Name 3 reasons why someone might have increased losses of food that causes malnutrition? [3]
Malabsorption from gut
Diarrhoea and vomiting
High stoma output
Name 5 consequences of malnutrition
decreased respiratory function
decreased Cardiac function
decreased Mobility
increased risk of pressure sores
increased risk of infection
decreased wound healing
increased risk of malabsorption
Apathy and depression
CAUSES FURTHER MALNUTRITION
Name 2 sreening methods used (by Bart’s Health Trust) for nutritional screening for adults [1] and children [1]?
MUST (adults) and STAMP (paedatrics)
How would you calculate a MUST score? [3]
How do you work out an Action Plan for MUST? [1]
MUST:
1. BMI
2. Weight Loss
3. Acute disease effect
4. Add scores for 1-3
5. Action Plan
How often should you repeat MUST assessment? [1]
weekly
How do you calculate BMI? [1] Unit? [1]
What score would indicate underweight? [1]
normal? [1]
overweight? [1]
Weight (kg)
BMI = ——————
Height (m2)
less than 19 underweight
20 – 25 Normal
more than 25 overweight
Whats important to think when assessing malnutrition? [1]
Often missed in overweight patient (high BMI would be scored agaisnt in MUST)
ABCDE of dietary screening? [5]
Anthropometrics
* Weight (Dry/Oedema/Ascites)
* Height (ulna, knee length, full body length),
* BMI (Actual or estimate)
* Weight history (?recent weight loss)
* Other measurements – MUAC, MUAMC
Biochemistry
* Pre-existing malnutrition consider evidence of depletion/risk of RFS
Clinical status
* Diagnosis, medications, PMH will impact on nutritional intervention
Dietary intake
* Routes available for feeding
* Pre-admission nutritional intake
* Allergies
Estimated Requirements
Name 3 surrogate measures for height [3]
What is a superior meaurement than ^ ? [1]
-Knee height
-Demispan
-Ulna length
Reported height is superior
What is a surrogate measure for measuring weight? [1]
Mid upper arm circumference (MUAC) [1] (can measure in supine position)
If MUAC is over [], BMI is likely to be over []
If MUAC IS over [], BMI is likely to be >[]
If MUAC is over 23.5, BMI is likely to be over 20 (underweight)
If MUAC IS >32, BMI is likely to be >30 (overweight)
How do you estimate dry weight for ascites and peripheral oedema?
Subtract the following
Other Anthropometric Measures
What does Handgrip Dynamometry (HGD) or Grip Strength measure? [1]
How do you take? [3]
Measures muscle strength & endurance: predictor of mortatility
Can be measured
* -supine or sitting position
* -dominant or non-dominant side
* -repeated measures to mirror original position
It is a widely held belief that low albumin arises because of inadequate protein intake.
Explain what causes Hypoalbuminaemia in hospital? [2]
Cause in hospital: is inflammation and sepsis:
- increased C-Reactive Protein
- White Cell Count
- pyrexia
- infection
In these patients capillary walls become more ‘porous’ and albumin drifts out –> low plasma albumin
Low albumin often occurs in sick, malnourished patients, but it is not caused by poor intake
Does albumin level reflect nutritional status? [2]
Low albumin often occurs in sick, malnourished patients, but it is not caused by poor intake.
Patients with anorexia nervosa often have normal albumin levels on admission
Define refeeding syndrome
A potentially fatal condition characterized by severe fluid and electrolyte shifts and related metabolic implications in malnourished patients undergoing refeeding (via the oral, enteral or parenteral routes)
Describe changes that occur when refeeding occurs in refeeding sydrome
What do you become reduced in? [4]
Metabolism changes from fatty acids to carbohydrates
Raised insulin secretion
Insulin stimulates K+, P04-, Mg2+ to return to cells
∴ intracellular stores are replenished but at the expense of plasma concentrations.
See:
* Hypokalaemia
* Hypomagenesiumia
* Hypopohopshataemia
* Thiamine deficiency
Refeeding syndrome: clinical consequences of
Hypophosphataemia [5]
Hypomagnesaemia [3]
Hypokalaemia [5]
Hypophosphataemia
Neurological—Seizures, paraesthesia
Musculoskeletal—Rhabdomyolysis, weakness, osteomalacia
Respiratory—Impaired respiratory muscle function
Cardiac—Cardiac failure
Renal—Rhabdomyolysis, fluid and salt retention
Hypomagnesaemia
Neurological—Tetany, paraesthesia, seizures, ataxia, tremor
Cardiac—Arrhythmias
Gastrointestinal—Anorexia, abdominal pain
Hypokalaemia
Neurological—Paralysis, paraesthesia
Musculoskeletal—Rhabdomyolysis
Respiratory—Respiratory depression
Cardiac—Arrhythmias, cardiac arrest
Gastrointestinal—Constipation, paralytic ileus
Which Ptx are at risk of refeeding syndrome? [1]
Which Ptx are at high risk of refeeding syndrome? [4]
Which Ptx are at very high risk of refeeding syndrome? [4]
Risk
* Any ptx with very little food for more than 5 days
High risk
ONE OF:
Any one the following;
* BMI less than 16
* Unintentional weight loss >15% in last 3-6 months
* Little or no nutritional intake for more than 10 days
* Low levels of K, PO, Mg prior to feeding
Very high risk
TWO OF THE FOLLOWING:
* BMI less than 18.5
* Unintentional weight loss >10% in last 3-6 months
* Little or no nutrition for more than 5 days
* A history of alcohol abuse or drug use including chemotherapy, antacids or diuretics
How can you provide nutritional support from supplemental drinks? [3]
Milkshake style
* Calorie content varies
* Ready made
Juice based
* Fat free
Powdered
* Not nutritionally complete
* Is the patient able to mix it
What nutritonal supplements could you provide for ptx with dysphagia? [5]
- Pre-thickened drinks
- Thickening of supplement drinks with a thickener
- Yoghurt style drinks
- Smoothie style drinks
- Yoghurt/dessert pot type supplements
What is Gastrotomy / enteral feeding?
Give 4 different examples of entreal access
Tube Inserted through skin into stomach so is inside digestive tract has a tube on phalange on the inside to stop it
coming out. Can be in for years.
Oral
Nasogastric
Orogastric
Nasojejunal
Gastrostomy
Jejunostomy
What is parental feeding? [2]
Parenteral feeding is the intravenous administration of nutrients: outside of GI tract, instead straight into veins
Central (ideally) tunnelled subclavian vein central lines,
Peripheral :veins
