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Year 3 - Preparation for Clinical Practise > Nutrition Workshop > Flashcards

Nutrition Workshop Flashcards

1
Q

What is diet

A
  • composition (quantity and quality) of foodstuffs in meals and the way in which these meals are consumed (frequency and pattern)
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2
Q

What is 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
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3
Q

What is the role of the nursing staff in nutritional care

A
  • alongside HCA that assist in feeding

- ensure protected meal time

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4
Q

What is the role of catering staff in nutritional care

A
  • ensure menus available and suitable for the patient

- delivery of correct food orders and cutlery

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5
Q

What is the role of the speech and language therapist in nutritional care

A
  • Safe nutrition - texture modifications via swallow assessments
  • swallow exercises to strengthen mastication/swallow
  • texture/timing/equipment
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6
Q

What is the role of the physiotherapist in nutritional care

A
  • aiding mobility
  • preventing muscle wasting alongside adequate protein delivery
  • improve functional capacity
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7
Q

What is the role of the pharmacist in nutritional care

A
  • Safe prescribing - texture, route of delivery

- TPN - ensuring stable/safe bags to be made up with appropriate electrolyte and micronutrient delivery

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8
Q

What is the role of the nutrition nurse in nutritional care

A
  • specialist assessment of stomas/tube feeding, wound care and tutoring patients of self care of stoma/PEG/PEJ/NGT,
  • nutritional complications
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9
Q

What is the role of the dietitian in nutritional care

A
  • nutritional assessments and implementing appropriate management plans in context of disease status
  • nutritional monitoring training to other staff
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10
Q

What is the role of the doctor in nutritional care

A
  • identifying nutritional deficiencies/malnutrition

- appropriately referring for specialist nutritional input

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11
Q

What are the clinical consequences of malnutrition

A
  • Impaired wound healing
  • sarcopenia - loss of muscle strength
  • impaired gut integrity and immunity
  • poor renal function
  • decreased cardiac output
  • fatty liver
  • ventilation - loss of muscle and hypoxic responses
  • depression and apathy
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12
Q

How much does malnutrition cost

A

19.6 billion

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13
Q

What are the steps to MUST

A
  1. measure height and weight to get a BMI score using chart provided
  2. note percentage unplanned weight loss and score using tables provided
  3. establish acute disease effect and score
  4. add scores from steps 1,2 and 3 together to obtain overall risk of malnutrition
  5. use management guidelines and/or local policy to develop care plan
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14
Q

What type of weight should you consider

A

Dry weight

  • peripheral oedeem
  • ascites - mild, moderate, severe
  • renal/heart failure
  • post op fluid resuscitation
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15
Q 
list the levels for 
- mild 
- moderate 
- severe 
ascites
A
  • mild = 2.2Kg
  • moderate = 6.0 kg
  • severe = 14.0 Kg
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16
Q 
list the levels for 
- mild 
- moderate 
- severe 
Oedema
A
  • mild = 1 Kg
  • moderate = 5 Kg
  • severe = 10 Kg
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17
Q

What do you do if the MUST score is 0

A

0

  • Low risk
  • routine clinical care
  • repeat screening in hospital weekly, care homes Monthly, community annually
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18
Q

What do you do if the MUST score is 1

A

Score Is 1

  • Medium risk
  • Observe
  • document dietary intake for 3 days
  • if adequate - little concern and repeat screening = repeat screening in hospital weekly, care homes Monthly, community every 2 to 3 months
  • If inadequate = clinical concerns - follow local policy, set goals, improve and increase overall nutritional intake, monitor and review care plan regularly
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19
Q

What do you do if the MUST score is 3

A
  • high risk
  • treat
  • refer to a dietitian, nutritional support team or implement local policy
  • set goals, improve and increase overall nutritional intake
    Monitor and review care plan
  • hospital = weeky
  • care home = monthly
  • community monthly
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20
Q

What do you do in all risk categories of MUST

A
  • treat underlying conditions and provide help and advice on food choices, eating drinking when necessary
  • record malnutrition risk category
  • record need for special diets and follow local policy
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21
Q

what does a full assessment of nutritional status consider

A
  • Anthropometry
  • Biochemistry
  • Clinical evaluations dn context
  • dietary assessment
  • extra factors - economic/psychosocial factors
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22
Q

What is anthropometry

A
  • This is the measurement and proportions of the human body e.g. height, weight etc
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23
Q

What do you look at in anthropometry

A
  • BMI/waist circumference
  • weight history
  • hand grip strength
  • mid arm muscle circumference
  • bioelectrical impedance
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24
Q

What are the things you look for in biochemistry

A
  • U and Es
  • serum proteins - albumin, pre-albumin
  • calcium, albumin, vitamin D, PTH, CRP, WCC, ESR
  • haematological parameters - LFTs
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25
Q

What do you look for in dietary

A
  • assess intake - quality/quantity
  • diet history, 24 hour recall, FFQ
  • consider energy/protein intake
  • micronutrients and electrolytes
  • cultural/social considerations
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26
Q

What do you look for in clinical

A
  • nutritional requirements and stress factor
  • sepsis/infection
  • metabolic response
  • nutrient losses - D&V, fistulas, surgical drains
  • impaired ingestion, digestion or absorption
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27
Q

What are the high risk groups for malnutrition

A
  • long term conditions such as diabetes, kidney disease and chronic lung disease
  • social isolation
  • elderly
  • sheltered housing
  • low income
  • IV drug users

physical factors

  • eating may be difficult because of a painful mouth or teeth
  • swallowing may be more difficult or painful
  • losing your sense of smell or taste may affect your appetite
  • being unable to cook for yourself may result in a reduced food intake
  • limited mobility or lack of transport
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28
Q

What are the high risk groups for vitamin deficiencies

A
  • elderly
  • alcohol excess
  • cultural/ethnic groups
  • restricted diets such as vegans and coeliacs
  • conditions of malabsorption such as cystic fibrosis
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29
Q

What are the high risk groups for mineral deficiencies

A
  • renal failure
  • weight loss/GI surgery
  • dietary restriction such as anorexia, veganism, vegetarians, fad diets
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30
Q

what can cause osteoporosis

A
  • sub-optimal levels of calcium and vitamin D

- accelerated by increased alcohol consumption

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31
Q

What is scurvy associated with

A

vitamin C deficiency

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32
Q

what happens with scurvy

A
  • haemorrhages
  • receding gums
  • abnormal bone and dentine formation
33
Q

What is dermatitis herpetitformis

A
  • this is an immunobullous disease linekd to coeliac disease
  • gluten sensitive enteropathy
  • due to intolerance to the gliadin fraction of gluten found in wheat, rye and barley
34
Q

What are the factors for protein requirements

A
  • inadequate intake of protein - anorexia or ageing
  • reduced ability to use available protein e.g. insulin resistance, protein anabolic resistance
  • greater need for protein
35
Q

What are colonic polyps

A
  • these are small non cancerous growth of cells which form on the inside lining of the colon or rectum
  • often consisting of a short stalk and a head likened to a mushroom in shape which protrudes from the internal lining of the bowel
36
Q

What are the signs of left sided colon carcinoma

A
  • colicky pain and early change in bowel habit
  • rectal bleeding
  • tenesmus
  • mass in left iliac fossa
  • Bowel obstruction more common
37
Q

What are the signs of right sided colon carcinoma

A
  • weight loss
  • anaemia - decrease in haemoglobin
  • occult bleeding
  • mass in right iliac fossa
  • obstruction less likely
38
Q

What should you aims be in colon cancer

A
  • Commence B12 injections
  • aim for weight gain
  • aim to prevent further weight loss
  • low fibre diet
  • high fibre diet
  • monitor weight and BMI
  • start nutritional supplements
  • dietary salt restriction
  • iron supplementation
  • high protein
39
Q

What is referring syndrome

A
  • This relates to the physiological and biochemical changes which occur when re-introducing a source of carbohydrate/glucose as an energy source
40
Q

What measurements should you look at and monitor when being aware of refeeding syndrome

A
  • calcium
  • potassium
  • magnesium
  • phosphate
41
Q

What are the risks of referring syndrome

A

One of the following:

  • BMI < 16
  • unintentional weight loss >15% in 3 months
  • little/no intake for >10 days
  • low levels of K, Mg, P prior to feeding

Two of the following

  • BMI <18.5
  • unintentional weight loss >10% within the last 3-6 months
  • little/no intake for more than 5 days
  • history alcohol abuse
42
Q

Who is likely to be at risk of refeeding syndrome

A
  • malnourished elderly particularly those living alone in which a very poor intake in the acute term may go unnoticed
  • patients with prolonged nil by mouth or fasting times
  • alcoholics with poor intake and thiamine deficiency
  • drug abusers
  • patients with anorexia nervosa
43
Q

What happens in referring syndrome

A

starvation mode - switches to fat metabolism

  • refeeding
  • conversion to glucose as major energy source
  • insulin spike
  • cellular glucose uptake
  • intracellular shifts and extracellular depletion of phosphate, potassium and magnesium
  • clinical syndromes of referring syndromes
44
Q

What are the metabolic consequences of refeeding syndrome

A
  • hypokalaemia
  • hypomagnesaemia
  • hypophosphataemia
  • thiamine deficiency
  • salt and water retention - oedema
45
Q

What are the pathophysiological consequences of refeeding syndrome

A
  • cardiac failure
  • respiratory failure
  • neuromuscular failure
  • renal failure
  • haematological failure
  • hepatic failure
  • gastrointestinal system failure
46
Q

How do you prevent refeeding syndrome

A
  • determine level of refeeding risk
  • check baseline - potassium, magnesium, calcium and phosphate levels
  • replete thiamine - essential co-factor for carbohydrate metabolism
  • start feeding at 20kcal/kg moderate risk
  • start feeding at 10/5/Kcals/kg for high/very high risk
  • repeat potassium, magnesium, calcium and phosphate levels 6-12 hours after initiation of feeding
  • replacement of electrolytes as required
  • if patients require more than 2 electrolyte replacements check urinary
  • monitor potassium, magnesium, calcium and phosphate levels for 1st 3 days or until level within normal ranges then 3 times a week for 2 weeks
47
Q

How do you manage refeeding syndrome

A
  • IV phosphates polyfusor infusion (PPF) = 500ml PPF = 50mmol Phosphate, +81 mmol Na+, 9.5mmol K+
  • 1 PPF infusion via a dedicated peripheral IV line in 24 hours
  • measure serum phosphate, magnesium, sodium, potassium, calcium and creatine daily over 3 days
  • if the patient is eating then no interruption of oral feeding, 2nd PPF infusion over another 24 hours if phosphate = <0.5mmol/L
48
Q

What is irritable bowel syndrome

A

This is a chronic functional disorder of the GI tract in the absence of organic disease

  • defined as recurrent abdominal pain or discomfort of at least 3 days per month in the last 3 months with 2 or more of the following
  • improvement with defecation
  • onset associated with a change in frequency of stool
  • onset associated with a change in form (appearance) of stool
49
Q

What should you exclude when diagnosing irritable bowel syndrome

A
  • sought and rapid exclusion of IBD or coeliac disease to minimise further psychological implication to the patient
50
Q

What are the types of IBS

A
  • IBS with constipation (IBS-C)
  • IBS with diarrhoea (IBS-D)
  • Mixed IBS (IBS-M)
51
Q

What is IBS with constipation (IBS-C)

A
  • patient reports that abnormal bowel movements are usually constipation
52
Q

What is IBS with diarrhoea (IBS-D)

A
  • patient reports that abnormal bowel movements are usually diarrhoea
53
Q

What is Mixed IBS (IBS-M)

A

Patient reports that abnormal bowel movements are usually both constipation and diarrhoea

54
Q

What can trigger IBS

A
  • food and dietary substances = foods high in insoluble fibre, caffeine, high sugar/fatty foods, alcohol, dairy foods
  • medications = Diarrhoea = laxatives, antacids, caffeine, Constipation = opiates, calcium channel blockers, anticholinergics, 5-HT3 antagonists
  • psychological issues = anxiety, events that increase stress levels, depression, alcohol abuse, eating disorders
  • hormones = alteration in sex hormones
  • inflammation or infection = post gastritis, IBS symptoms, post C diff, lactose intolerance
55
Q

What does FODMAP stand for

A
  • fermentable
  • olligosaccharides
  • disaccharides
  • monosaccharides
  • and
  • polyols
56
Q

What is FODMAP

A
  • this is a collection of short chain carbohydrates and sugar alcohols found in foods naturally or as food additives
  • FODMAPs include fructose (when in excess of glucose), fructans, galacto-olgiosaccharides, lactose, polyps (e.g. sorbitol and mannitol)
57
Q

What is coeliac disease

A
  • Coeliac disease is an autoimmune disease caused by sensitivity to the protein gluten
  • individuals affected by coeliac disease are intolerant to specific gluten proteins found in wheat, barley, rye and oats
58
Q

what conditions are associated with coeliac disease

A
  • dermatitis herpetiformis
  • autoimmune disorder such as type 1 diabetes
  • strongly associated with HLA-DQ2 and HLA-B8
59
Q

What is T cells a reaction to

A
  • T cell mediated autoimmune diseased caused by a reaction to protein in gluten (gliadin)
60
Q

how does coeliac disease present

A
  • Most common in infancy = faltering growth, diarrhoea and ongoing fatigue and signs of anaemia
  • bowel changes - often mistaken for IBS, malabsorption and anaemic symptoms - most common in 50-60 years age group
  • smelly stools and steatorrhoea
  • abdominal symptoms - bloating, cramping with nausea and vomitting
  • signs of nutritional deficiencies - calcium - osteomalacia, and B vitamins = anaemia and angular stomatitis
61
Q

What investigations do you do in coeliac disease

A

Blood tests - FBC and haemoglobin

  • Anaemia screen - vit B12, folate, ferritin levels
  • Antibodies - tissue transglutaminase, anti-endomysial
  • endoscopy - for duodenal or jejunal biopsy to assess for = villous atrophy, crypt hyperplasia
62
Q

How quickly does it take for symptoms to show up in a coeliac patient once they eat gluten

A

2 hours

63
Q

what is the management of a patient with coeliac

A
  • avoid gluten

- use their own utensils, toaster, toaster bags to minimise contamination from gluten containing foods

64
Q

when testing for someone to see if they have coeliac disease what is important to do

A
  • advise the patient to sustain a normal diet with gluten in at least one meal for 6 weeks
  • primary reason to have gluten in the diet as the antibodies will only be present when a gluten containing diet is followed
65
Q

What doesn’t contain gluten

A
  • rice
  • lentils
  • potato
66
Q

What are the symptoms of malnutrition

A
  • Loss of appetite
  • weight loss
  • tiredness and loss of energy
  • reduced ability to perform normal tasks
  • reduced physical performance
  • altered mood
  • poor concentration
  • poor growth in children
67
Q

what are the consequences of malnutrition

A

Immune system
- reduced ability to fight infection

Muscles

  • inactivity and reduced ability to work, shop, cook and self care
  • inactivity may lead to pressure ulcers and blood clots
  • falls
  • reduced ability to cough and may predispose to chest infections and pneumonia
  • heart failure

Impaired wound healing

Kidneys - inability to regulate salt and fluid can lead to over-hydration or dehydration

Brain - malnutrition causes apathy, depression, introversion, self-neglect

reproduction - reduces fertility

Impaired temperature regulation - lead to hypothermia

68
Q

What are the consequences of malnutrition in children and adolescents

A
  • growth failure and stunting
  • delayed sexual development
  • reduced muscle mass and strength
  • impaired intellectual development
  • rickets
  • increased lifetime risk fo osteoporsi s
69
Q

what can zinc deficiency cause

A
  • skin rashes and decreased ability to fight infection
70
Q

What can vitamin A deficiency cause

A

night blindness

71
Q

What is the commonest type of enteral tube feeding

A
  • tube that is passed through the nose and down into the stomach (a nasogastric tube)
  • short term feeding (less than 4 weeks) to provide nutritional support as a patient recovers from illness
72
Q

what enteral tube feeding is used for longer term

A
  • PEG tube
  • Percutaneous gastrostomy tube
  • jejunsostomy or nasojejunal tubes when it is not possible to use the stomach
73
Q

When is parenteral nutrition used

A
  • used if it is not possible to use your gut for nutrition

- goes directly into the blood stream

74
Q

Describe each stage of the BMI score

A

Step 1 - BMI score

  • > 20 kg/m2 = 0
  • 18.5-20 = 1
  • <18.5 = 2

Step 2 - weight loss score, unplanned weight loss in past 3-6 months

  • <5% = 0
  • 5-10% = 1
  • > 10% = 2

Step 3 - acute disease effect score
- if the patient is acutely ill and there has been or is likely to be no nutritional intake for >5 days - score =2

Step 4

  • Score 0 = low risk
  • Score 1 = medium risk
  • Score 2 = high risk
75
Q

What do you do if you cannot measure height and weight for BMI in MUST

A
  • use recently documented or self-reported height
  • if they don’t know use ulna, knee height or demispan

If height and weight cannot be obtained - use mid upper arm circumference

76
Q

What is nutritional assessment

A

Nutritional assessment is the systematic process of collecting and interpreting information in order to make decisions about the nature and cause of nutrition related health issues that affect an individual

77
Q

How do you work out weight percentage change

A

current weight - previous weight/ current weight x 100

78
Q

what measurements are used for anthropometric measurements

A
  • percentage weight change
  • BMI
  • mid upper circumference
  • skin fold thickness
  • mid arm muscle circumference

Year 3 - Preparation for Clinical Practise (33 decks)

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