Nutritional asessment

Question 1

What is the prevalence of hospital malnutrition?

Answer 1

28-50% prevalence of malnutrition in hospital

Costs- 13bn

Question 2

What is the malnutrition carousel?

Answer 2

25-34% of hospital admissions at risk of malnutrition
Causes longer stay, more complications, more support needed after discharge from hospital and more likely to need care
70% of patients weigh less on discharge
Leads to more GP visits, more prescriptions and more hospital admissions

Question 3

Which patients are at increased risk of malnutrition?

Answer 3

Increased requirements
Age (over 65)
Bedbound/pressure sores, physical disabilities
Modified diet
Poorly controlled diabetes/ on insulin
Poor GI function
Heavy alcohol consumption
Poor social situation

Question 4

What is nutritional screening used for?

Answer 4

Assess a patient’s nutritional status by using scores or flowcharts to work out if patient is:
Well nourished
Mild to moderately malnourished
Severely malnourished

Question 5

What is the impact of malnutrition?

Answer 5

Low weight
Falls and fractures
Muscle wasting
Increases morbidity and mortality
Delays wound healing
Reduces immune function
Increased risk of pressure sores
Reduces quality of life- energy levels
Prolongs hospital stay

Question 6

What questions are useful to identify malnutrition?

Answer 6

Weight change- intentional?
Dietary intake
Nutritional supplements?
Gastrointestinal symptoms?
Functional impairment

Question 7

What are the physical signs of malnutrition?

Answer 7

Hair changes
Mental health changes
Anaemia
Ascites
Dermatitis
Pressure sores
Diarrhoea
Sunken eyes
Sore red eyes and lids
Poorly fitted dentures
Swollen/bleeding gums
Dry/cracked lips
Muscle wasting
Oedema

Question 8

Who should be treated for malnutrition?

Answer 8

All malnourished people with:
BMI<18.5
Or unintentional weight loss greater than 10% in last 3-6 months
Or BMI <20 coupled with unintentional weight loss >5% within last 3-6 months

Question 9

What is refeeding syndrome?

Answer 9

Metabolic disturbances that occur as a result of reinstitution of nutrition to patients who are starved or severely malnourished

Question 10

What are the consequences of refeeding syndrome?

Answer 10

Phosphate:
Cardiac- altered myocardial function, arrhythmia, congestive cardiac failure
Respiratory- acute ventilator failure
Neuromuscular- lethargy confusion, weakness and paralysis

Potassium:
Arrhythmia, cardiac arrest
Respiratory distress
Paralysis, weakness

Magnesium:
Arrhythmia, cardiac arrest
Resp distress
Ataxia, confusion

Question 11

Which patients are at high risk of refeeding syndrome?

Answer 11

Patient has one or more of:
BMI <16kg/m2
Unintentional weight loss>15% over 3-6 months
Little or no nutritional intake for >10 days
Low levels of potassium, phosphate and magnesium prior to feeding
Or
Patient has two more of the following:
BMI less than 18.5
Unintentional weight loss >10% over 3-6 months
Little or no nutritional intake for >5 days
History of alchol abuse or drugs

Question 12

What is the doctors role in regards to refeeding syndrome?

Answer 12

Check U and Es, bone profile and magnesium till stable daily- watch K, P and Mg closely
Provide vit preparations

Question 13

What provides a decision tree to help with management of refeeding syndrome?

Answer 13

BAPEN

Question 14

Brief summary of how to carry out nutritional screening?

Answer 14

Ask right questions:
Have you lost weight? How much?
Appetite?
GI symptoms?
Diabetes?
Functional impairment?
Physical exam- fat loss, muscle wasting and oedema
Assess biochemistry
Refer to team member