Nutrition In Practice

Question 1

Malnutrition

Answer 1

A state of nutrition in which a deficiency or excess of energy, protein, and other nutrients causes measurable adverse effects on tissue/body form and function and clinical outcome

Question 2

What causes malnutrition

Answer 2

Intake less/more than requirements

Question 3

What can decrease nutrition intake

Answer 3

Decr food availability or quality
Dysphagia
Nil by mouth
Treatment side effects
Pain
Constipation
Psychological conditions
Low income
Poor dentition
Reflux
Food intolerance

Question 4

What can increase nutrition requirements

Answer 4

Infections
Movement
Wound healing

Question 5

What can increase nutrient losses

Answer 5

Malabsorption
Diarrhoea
Vomiting
High stoma output

Question 6

What can malnutrition lead to

Answer 6

Decr resp function
Decr cardiac function
Decr mobility
Incr pressure sore risk
Decr wound healing
Incr malabsorption risk
Apathy
Depression

Question 7

When should patients receive nutrition screening

Answer 7

Admission to hospital
Weekly in hospital

Question 8

What is the most widely used nutrition screening tool

Answer 8

MUST

Question 9

Which 3 factors are scored in MUST

Answer 9

BMI
Weight loss
Acute disease effect

Question 10

What group is malnutrition likely to be missed in

Answer 10

Overweight

Question 11

What is normal BMI

Answer 11

20-25

Question 12

What BMI is overweight

Answer 12

> 25

Question 13

What BMI is underweight

Answer 13

<19

Question 14

Surrogate measures for height

Answer 14

Knee height
Demispan
Ulna length

Question 15

What is a surrogate measure for weight

Answer 15

Mid upper arm circumference

Question 16

What can cause significant difference between weight and dry weight

Answer 16

Ascites
Peripheral oedema

Question 17

Anthropometric measures

Answer 17

Weight
Height
BMI
Weight history
Mid upper arm circumference
Fat mass
Fat free mass

Question 18

What can skin folds be used to measure

Answer 18

Fat mass

Question 19

How is fat free mass measured

Answer 19

Arm muscle circumference

Question 20

How can muscle strength and endurance be measured

Answer 20

Handgrip dynamometry

Question 21

Normal albumin level

Answer 21

35-50g/l

Question 22

Albumin function

Answer 22

Maintains oncotic pressure

Question 23

Causes of hypoalbuminaemia

Answer 23

Inadequate protein intake
Inflammation
Sepsis

Question 24

Why does inflammation and sepsis cause hypoalbuminaemia

Answer 24

Capillary walls become porous and albumin leaves plasma

Question 25

Why do anorexia nervous patients often have normal albumin levels

Answer 25

Not acutely unwell w infection

Question 26

Refeeding syndrome

Answer 26

Potentially fatal condition characterised by severe fluid and electrolyte shifts and related metabolic implications in malnourished patients undergoing refeeding

Question 27

How do insulin and glucagon levels change in starvation

Answer 27

Glucagon incr Insulin decr

Question 28

How soon is glycogen used up in starvation

Answer 28

24-72hrs

Question 29

What are fatty acids metabolised to in starvation

Answer 29

Ketone bodies

Question 30

What intracellular stores are depleted in starvation

Answer 30

K+ PO4- Mg2+

Question 31

What causes refeeding syndrome

Answer 31

Insulin simulates K PO4 and Mg to move into cells decreasing plasma concentrations

Question 32

What triggers refeeding syndrome

Answer 32

Insulin secretion from metabolism change from fatty acid to carbohydrates

Question 33

What does refeeding syndrome cause

Answer 33

Hypophosphataemia Hypomagnesaemia Hypokalaemia

Question 34

Symptoms of Hypophosphataemia

Answer 34

Seizures Paraesthesia Rhabdomyolysis Weakness Osteomalacia Impaired resp muscle function Cardiac failure Fluid and salt retention

Question 35

Hypomagnesaemia symptoms

Answer 35

Tetany Paraesthesia Seizures Ataxia Tremor Arrhythmia Anorexia Abdo pain

Question 36

Hypokalaemia symptoms

Answer 36

Paralysis Paraesthesia Rhabdomyolysis Resp depression Arrhythmia Cardiac arrest Constipation Paralytic ileus

Question 37

What increases risk of refeeding syndrome

Answer 37

Little food intake for 5+ days Low BMI Unintentional weight loss Low electrolyte levels Alcohol or drug abuse, medications

Question 38

2 groups of routes for nutrition support

Answer 38

Enteral Parenteral

Question 39

Enteral routes for nutrition support

Answer 39

Oral Nasogastric Orogastric Nasojejenal Gastrostomy Jejunostomy

Question 40

Parenteral routes for nutrition support

Answer 40

Peripheral IV Central IV

Question 41

Main types of oral nutrition support

Answer 41

Supplement drinks

Question 42

What aspect of nutrition support is important for patients with dysphagia

Answer 42

Increased thickness of drinks