Nutrition In Practice Flashcards
Malnutrition
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
What causes malnutrition
Intake less/more than requirements
What can decrease nutrition intake
Decr food availability or quality
Dysphagia
Nil by mouth
Treatment side effects
Pain
Constipation
Psychological conditions
Low income
Poor dentition
Reflux
Food intolerance
What can increase nutrition requirements
Infections
Movement
Wound healing
What can increase nutrient losses
Malabsorption
Diarrhoea
Vomiting
High stoma output
What can malnutrition lead to
Decr resp function
Decr cardiac function
Decr mobility
Incr pressure sore risk
Decr wound healing
Incr malabsorption risk
Apathy
Depression
When should patients receive nutrition screening
Admission to hospital
Weekly in hospital
What is the most widely used nutrition screening tool
MUST
Which 3 factors are scored in MUST
BMI
Weight loss
Acute disease effect
What group is malnutrition likely to be missed in
Overweight
What is normal BMI
20-25
What BMI is overweight
> 25
What BMI is underweight
<19
Surrogate measures for height
Knee height
Demispan
Ulna length
What is a surrogate measure for weight
Mid upper arm circumference
What can cause significant difference between weight and dry weight
Ascites
Peripheral oedema
Anthropometric measures
Weight
Height
BMI
Weight history
Mid upper arm circumference
Fat mass
Fat free mass
What can skin folds be used to measure
Fat mass
How is fat free mass measured
Arm muscle circumference
How can muscle strength and endurance be measured
Handgrip dynamometry
Normal albumin level
35-50g/l
Albumin function
Maintains oncotic pressure
Causes of hypoalbuminaemia
Inadequate protein intake
Inflammation
Sepsis
Why does inflammation and sepsis cause hypoalbuminaemia
Capillary walls become porous and albumin leaves plasma
Why do anorexia nervous patients often have normal albumin levels
Not acutely unwell w infection
Refeeding syndrome
Potentially fatal condition characterised by severe fluid and electrolyte shifts and related metabolic implications in malnourished patients undergoing refeeding
How do insulin and glucagon levels change in starvation
Glucagon incr
Insulin decr
How soon is glycogen used up in starvation
24-72hrs
What are fatty acids metabolised to in starvation
Ketone bodies
What intracellular stores are depleted in starvation
K+
PO4-
Mg2+
What causes refeeding syndrome
Insulin simulates K PO4 and Mg to move into cells decreasing plasma concentrations
What triggers refeeding syndrome
Insulin secretion from metabolism change from fatty acid to carbohydrates
What does refeeding syndrome cause
Hypophosphataemia
Hypomagnesaemia
Hypokalaemia
Symptoms of Hypophosphataemia
Seizures
Paraesthesia
Rhabdomyolysis
Weakness
Osteomalacia
Impaired resp muscle function
Cardiac failure
Fluid and salt retention
Hypomagnesaemia symptoms
Tetany
Paraesthesia
Seizures
Ataxia
Tremor
Arrhythmia
Anorexia
Abdo pain
Hypokalaemia symptoms
Paralysis
Paraesthesia
Rhabdomyolysis
Resp depression
Arrhythmia
Cardiac arrest
Constipation
Paralytic ileus
What increases risk of refeeding syndrome
Little food intake for 5+ days
Low BMI
Unintentional weight loss
Low electrolyte levels
Alcohol or drug abuse, medications
2 groups of routes for nutrition support
Enteral
Parenteral
Enteral routes for nutrition support
Oral
Nasogastric
Orogastric
Nasojejenal
Gastrostomy
Jejunostomy
Parenteral routes for nutrition support
Peripheral IV
Central IV
Main types of oral nutrition support
Supplement drinks
What aspect of nutrition support is important for patients with dysphagia
Increased thickness of drinks
