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MET 2 > Nutrition in practice > Flashcards

Nutrition in practice Flashcards

1
Q

Define malnutrition

A

State of nutrition in which deficiency or excess of energy/ protein/ other nutrients causes measurable adverse effects on tissue

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2
Q

What is the cost of malnutrition to NHS England?

A

£19.6 billion

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3
Q

Name 4 generic causes of malnutrition

A
  • Low intake due to inadequate availability or quality of food
  • Reduced intake of food when food is available
  • Increased nutritional requirments
  • Lack of recognition and treatment
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4
Q

What can cause reduced intake of food

A
  • Dysphagia
  • Prolonged periods of nil by mouth
  • Side effects of treatment
  • Pain
  • Psychological
  • Social
  • Poor dentition
  • Reflux
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5
Q

What can cause increased nutritional requirments (3)

A
  • Infections
  • Involuntary movements
  • Wound healing
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6
Q

What happens to respiratory and cardiac function during malnutrition

A

They both decrease

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7
Q

Does risk of pressure sores increase or decrease during malnutrition

A

Increase

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8
Q

Does risk of infection and ability to wound heal increase or decrease during malnutrition

A

Infection= increase

Wound heal=decrease

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9
Q

What are the 5 steps of MUST

A

1) BMI
2) Weight loss
3) Acute disease effect
4) Add scores from 1-3
5) Action plan

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10
Q

How much can weight change due to fluid fluctuation

A

Increase by 10-20%

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11
Q

What is meant by MUAC

A

Mid upper arm circumference

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12
Q

BMI=

A

Weight (kg)/ Height (m2)

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13
Q

Name some ways height can be measured in difficult situations (eg bedbound patients)

A

Knee height
Demi span
Ulna length

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14
Q

What is BMI likely to be if MUAC <23.5<20

A

<20

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15
Q

What is BMI likely to be if MUAC is >32

A

> 30

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16
Q

How much weight do the following ascites add

a) Tense ascites
b) Moderate ascites
c) Minimal ascites

A

a) 14 kg
b) 6 kg
c) 2.2 KG

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17
Q

How much weight do the following classifications of peripheral oedema add

a) Severe
b) Moderate
c) Mild

A

a) 10kg
b) 5 kg
c) 1 kg

18
Q

Where is fat mass (skin folds) most commonly measured? What does it estimate?

A

Use the triceps site

Estimates total adiposity

19
Q

How do you calculate fat free mass

A

Arm muscle circumference- mid upper arm circumference- (0.314 x triceps site)

20
Q

What does handgrip dyanomometry measure

A

Muscle strength and endurance

21
Q

What is the most abundant protein in the plasma

A

Albumin

22
Q

What is normal range of albumin

A

35-50g/l

23
Q

Function of albumin

A

Maintaining oncotic pressure

24
Q

Name some causes of hypoalbuminaemia

A
  • Inadequate protein intake

- Inflammation and sepsis

25
Q

How does sepsis lead to hypoalbuminaemia

A

Capillary wall becomes porous and albumin drifts out

26
Q

Why isn’t low albumin always detected in patients with malnutrition

A

Because in some patients who are starving, there is no inflammatory response so no reduction in vascular permeability

27
Q

Define refeeding syndrome

A

Condition characterised by severe fluid and electrolyte shifts and related metabolic implications in malnourished patients undergoing refeeding

28
Q

How do intracellular stores of K+, PO4- and Mg2 change during starvation

A

They deplete

29
Q

During refeeding, what substrate is used for energy

A

Switches from fatty acids to carbohydrates

30
Q

Why does switch from fatty acid metabolism to carbohydrate metabolism cause refeeding syndrome

A

Raised insulin secretion
Insulin stimulates potassium, phosphate and magnesium to return to cells
Intracellular stores replenished at expensive of plasma concentration

31
Q

Describe what biochemistry tests would show in a refeeding syndrome patient

A
  • Hypokalaemia
  • Hypomagesaemia
  • Hypophosphataemia
  • Thiamine deficiency
  • Salt and water retention
32
Q

Describe the clinical consequences hypophosphataemia

A 
Seizures
Weakness
Osteomalacia
Impaired resp muscle function
Cardiac failure
Rhabdomolysis
33
Q

Define rhabdomolysis

A

Results from muscle injury

34
Q

Describe the clinical consequences of hypomagnesaemia

A

Tetancy, paraesthesia, seizures, ataxia
Arrhythmias
Anorexia
Abdo pain

35
Q

Describe the clinical consequences of hypokalaemia

A 
Paralysis
Paraesthesia
Rhabdomyolysis
Resp depression
Arrythmias
Constipation
36
Q

Which patients are at moderate risk of refeeding syndrome

A

Those with very little food intake for >5 days

37
Q

Which patients are at high risk for refeeding syndrome

A

BMI<16
Unintentional weight loss >15% for >10 days
Low levels of K, PO, Mg
OR ANY OF THE 2
Patients BMI<18.5
Unintentional weight loss >10% for last 6 weeks
History of alcohol/ drug use

38
Q

What is meant by enteral route?

A 
Oral
Nasogastric
Orogastric
Nasojejunal
Gastrostomy
Jejunostomy
39
Q

What is meant by parenteral route

A

Peripheral or central (eg not via gastric)

40
Q

When you enteral tube nutrition be advised

A

Insufficient oral intake/ oral intake not possible

But gut is functioning

41
Q

What are the indications for parenteral nutrition

A

GIT unable to digest/ absorb or GIT cannot be assessed

42
Q

Name the disadvantages of parenteral nutrition (6)

A
  • Risk associated with placement
  • Risk of catheter related sepsis
  • Disordered liver function
  • Gut atrophy
  • Physological implications
  • Cost

MET 2 (32 decks)

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