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nutrition in practice Flashcards

1
Q

define malnutrition

A

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.

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2
Q

what % of patients are malnourished on hospital admission?

A

40%

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3
Q

what is the annual cost of malnutrition to NHS England?

A

19.6 billion

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4
Q

what are the causes of malnutrition?

A

intake < requirements bc;

  • decreased intake when food is available
  • decreased intake due to inadequate availability, quality or presentation of food
  • increased nutritional requirement
  • lack of recognition and treatment
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5
Q

what can cause decreased intake of food?

A 
Dysphagia
Prolonged periods NBM
Side effects of treatment
Pain/constipation
Psychological e.g. depression
Social e.g. low income, isolation
Poor dentition
Reflux/feeding problems/food intolerance's
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6
Q

what can cause increased requirement of food?

A

Infections
Involuntary movements
Wound healing

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7
Q

what can cause increase loss of nutrition?

A

Malabsorption from gut
Diarrhoea and vomiting
High stoma output

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8
Q

what are the consequences of malnutrition?

A 
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
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9
Q

what is the function of nutritional screening?

A

identifying malnutrition/risk of malnutrition

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10
Q

when should nutritional screening be done?

A

on admission of all adult patients into hospital and then weekly thereafter

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11
Q

what are the 2 main nutritional screening tools?

A

MUST (malnutrition universal screening tool)

STAMP (Screening Tool for the Assessment of Malnutrition in Paediatrics)

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12
Q

what are the 5 steps of MUST?

A 
1 - BMI
2 - weight loss
3 - acute disease effect
4 - add scores for steps 1-3
5 - action plan
repeat weekly
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13
Q

what are the next steps for a patient with a MUST score of 0?

A

just need monitoring and to repeat the score weekly

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14
Q

what are the next steps for a patient with a MUST score of 1?

A

observations (how much are the eating and drinking, are they finishing meals?)

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15
Q

what are the next steps for a patient with a MUST score of 2 or more?

A

refer to a dietician who will suggest a form of nutrition to help the patient

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16
Q

in what people can malnutrition be missed?

A

overweight patients

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17
Q

how do you calculate BMI?

A

weight/height^2

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18
Q

what are the ranges for BMI?

A

<19 - underweight
20-25 - normal
>25 - overweight

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19
Q

what are surrogate measures of height?

A

Knee height
Demispan
Ulna length

20
Q

what is the problem with using surrogate measures?

A

may overestimate height

-underestimate BMI

21
Q

what are surrogate measures for weight?

A

Can measure in supine position
Obtain height or surrogate height
Can then estimate weight from BMI
(Weight (kg) = BMI x Height (m2)

22
Q

what is the BMI likely to be if MUAC is <23.5?

A

<20 (underweight)

23
Q

what is the BMI likely to be if MUAC is >32

A

> 30 (overweight)

24
Q

what are anthropometrics?

A 
weight - dry/oedema/ascites
height
BMI
weight history
other measurements e.g. MUAC
25
Q

how much increase in body weight is needed before visual oedema can be seen?

A

increase of at least 1kg

26
Q

how can fat mass be measured?

A

Skinfolds (SF)
Indirectly estimate total adiposity
Commonly use triceps site (TSF)

27
Q

what does handgrip dynamometry/grip strength measure?

A

measures muscle strength and endurance

28
Q

what is albumin?

A

Large protein synthesised in the liver

Most abundant protein found in plasma and is usually trapped within capillaries

29
Q

what is the normal range of albumin in the body?

A

35-50g/L

30
Q

what is the function of albumin?

A

Maintains oncotic pressure

i.e. albumin molecules have an osmotic effect that helps to stop water leaking out through capillary walls

31
Q

what are the causes of hypoalbuminaemia?

A
  • inadequate protein intake
  • in hospital: inflammation and sepsis associated with infection. capillary walls become more porous and albumin drifts out –> low plasma albumin
32
Q

who does low albumin occur in?

A

sick patients with infection
increased CRP
those with poor nutrition

33
Q

define refeeding syndrome

A

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)

34
Q

what happens to the body in starvation?

A

Glucagon levels rises
Insulin levels fall
Glycogen used up in the first 24-72 hrs of starvation
Shifts to protein for energy
Fatty acids are metabolised to produce ketone bodies – become the major source of energy
Loss of fat and lean body mass, water and minerals.
Intracellular stores of K+, P04-, Mg2 become depleted

35
Q

what happens to the body in refeeding?

A

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.

36
Q

what are the clinical consequences of refeeding syndrome?

A

hypophosphataemia
hypomagnesaemia
hypokalaemia

37
Q

what are the effects on the different body systems of hypophosphataemia?

A

Neurological—Seizures, paraesthesia
Musculoskeletal—Rhabdomyolysis, weakness, osteomalacia
Respiratory—Impaired respiratory muscle function
Cardiac—Cardiac failure
Renal—Rhabdomyolysis, fluid and salt retention

38
Q

what are the effects on the different body systems of hypomagnesaemia?

A

Neurological—Tetany, paraesthesia, seizures, ataxia, tremor
Cardiac—Arrhythmias
Gastrointestinal—Anorexia, abdominal pain

39
Q

what are the effects on the different body systems of hypokalaemia?

A 
Neurological—Paralysis, paraesthesia 
Musculoskeletal—Rhabdomyolysis 
Respiratory—Respiratory depression 
Cardiac—Arrhythmias, cardiac arrest 
Gastrointestinal—Constipation, paralytic ileus
40
Q

who is at risk of refeeding syndrome?

A

any patient with very little food intake for >5 days

41
Q

who is at high risk of refeeding syndrome?

A

Any one the following;
BMI <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

OR Any 2 of the following
BMI <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

42
Q

why provide nutrition support?

A

Increased nutritional requirements are associated with the metabolic response to stress/trauma/sepsis

           Maintain nutritional status and limit catabolism
           Preserve lean body mass (LBM)

Maintain immune function

Preserve organ function and promote wound healing

Enhance recovery and improve patient outcomes

43
Q

what are the routes for nutritional support?

A

enteral: oral, nasogastric, orogastric, nasojejunal, gastrostomy, jejunostomy
paranteral: peripheral and central

44
Q

what type of oral nutritional support can you get?

A

supplement drinks

45
Q

what type of supplement drinks are available?

A

milkshake style - calorie content varies. ready-made
juice based - fat free
powdered - not nutritionally complete and the patient may not be able to mix it

46
Q

what nutritional supplements are given in dysphagia?

A 
Pre-thickened drinks 
Thickening of supplement drinks with a thickener 
Yoghurt style drinks 
Smoothie style drinks 
Yoghurt/dessert pot type supplements

m2 (24 decks)

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