Nutrition & Pressure Ulcers Flashcards
What does a balanced diet consist of?
- “Balanced diet means eating a wide variety of foods in the right proportions, and consuming the right amount of food and drink to achieve and maintain a healthy body weight” NHS Website
Why is a balanced diet important?
- Energy for day
- Maintain healthy weight (being over or underweight can increase risk of illnesses/diseases)
- Help prevent illnesses e.g. T2DM, some cancers, cardiovascular disease, strong bones & teeth (reduce fracture risk), pressure ulcers
Define malnutrition
“Malnutrition is a state in which a deficiency or excess of nutrients such as energy, protein, vitamins and minerals causes measurable adverse effects on body composition, function or clinical outcome.” NICE
NICE didn’t use in context of excess nutrients but remember malnutrition can be undernutrition or overnutrition
Malnutrition is both a a cause and consequence of disease; true or false?
True
Malnutrition is commonly recognised in hospital patients; true or false?
False; it is a common, underrecognised condition
Causes of malnutrition can be broadly classified into 4 categories; state each of the categories and give some examples for each
- Reduced dietary intake: poverty, cognitive impairment, excess alcohol, body dysmorphia, anorexia nervosa
- Malabsorption: IBD, coeliac disease, abdominal surgery/bowel resection, excessive alcohol consumption, chronic pancreatitis, CF
- Increased loss or altered requirements: burns, enterocutaneous fistula, vomiting, persistent diarrhoea
- Increased energy expenditure: excessive exercise, malignancy, CF, pregnancy
Consequences of malnutrition can be broadly grouped into 5 categories; state each of the categories and give some examples for each
- Muscle function: muscle weakness & wasting
- Cardio-respiratory function: reduction in cardiac muscle mass leading to weaker heart which can decrease perfusion to other organs (e.g. kidneys), thiamine has role in cardiac function, weak respiratory muscles lead to decreased cough pressure hence inability to clear secretions predisposing to infections
- Gastrointestinal function: colon loses ability to absorb water & electrolytes which can lead to chronic diarrhoea, changes to pancreatic exocrine function, increased intestinal permeability which can predispose to infections
- Immunity & wound healing: weakened immune system predisposing to infections, impaired wound healing
- Psychosocial effects: depression, anxiety, apathy
What tool can be used to rapidly and easily screen for malnutrition?
MUST (Malnutrition Universal Screening Tool)
Briefly describe the MUST
5 step screening tool to identify adults who are:
- Malnourished
- At risk of malnutrition
- Obese
Steps:
- BMI
- Note percentage unplanned weight loss & score using table provided
- Establish acute disease effect & score (i.e. is pt ill and there has been or is likely to be no nutritional intake for >5days)
- Add scores from steps 1-3 to give overall score
- Use guidelines to develop care plan
Within what time frame should every inpatient have a MUST assessment completed?
Within 24hrs of admission
Discuss ways in which you can encourage oral intake
- Protected meal times & regular routine
- Encouragement
- Ensuring pt has appropriate aids
- Finding foods pt likes
- Nutritional supplements
Which MDT members can help with improving nutritional intake and when should you refer a patient to these members of the MDT?
- Dietician: give guidance on nutritional intake/meal plan, give supplements
- SALT: assess swallowing and advise on thickened fluids or modified diet
If a patient has difficulty swallowing, SALT may advise that they have modified diet and/or thickened fluids to make swallowing easier and safer; briefly outline what is meant by modified diet and thickened fluids
Thickened Fluids
- Stage 1: syrup consistency (pour easily off a spoon)
- Stage 2: custard consistency (drop easily off a spoon)
- Stage 3: pudding consistency (stay on a spoon)
Modified diet
Useful if people have difficulty chewing, chewing takes a long time or they get weary/tired eating so consequently don’t eat much
- Texture B : “thin blended diet” cannot be eaten with a fork (e.g. soup)
- Texture C: “thick blended diet” can be moulded into shapes and can eat with a fork
- Texture D: “mashed diet”
- Texture E: “soft diet” e.g. sponge pudding, fish in sauce, banana, sandwich with soft filling
If a patient is not having adequate nutrition but is struggling to eat, what options are available?
- Ensuring what they eat is high calorie (if poor intake)
- Supplements (e.g. fortisip drinks)
Other more invasive options include parenteral feeding e.g. via NG tube, TPN etc…
Remind yourself of the 4 stages of wound healing
- Haemostasis: blood clot forms to reduce blood loss
- Inflammation: neutrophils and macrophages appear. Causes redness, swelling, pain. Both controls bleeding and prevents infection.
- Proliferation: granulation tissue forms, myofibroblasts contract to pull wound edges together
- Remodelling: wound fully closes, shrinkage/fading of scar and increased strength of skin
**NOTE: may see proliferation & remodelling grouped together as regeneration & repair
State some common sites for pressure ulcers
- Occiput/back of head
- Shoulders
- Elbows
- Sacrum
- Knee
- Ankles
- Heels
Discuss signs & symptoms of pressure ulcers
- Change in colour of skin e.g. erythematous skin (bear in mind may not see erythema in darker skin tones)
- Non-blanching skin
- Unusual skin texture (spongey/boggy feeling)
- Skin feels cooler or warmer than usual
- Open wound (later sign)
- Pain
Discuss the grading/staging of pressure ulcers
Describe the Braden Scale for pressure ulcers in more detail
Looks at 6 factors that contribute to either:
- Higher intensity and duration of pressure
- Or lower tissue tolerance to pressure
… therefore increasing risk of pressure ulcer development. Each factor scored between 1 and 4 as guided by a descriptor. The LOWER the score, the GREATER the risk
Factors:
- Sensory perception
- Nutrition
- Friction & shear
- Mobility
- Moisture
- Activity
Image shows Waterlow Score
Briefly outline the difference between pressure ulcers & moisture lesions
