Nutritional Screening Flashcards
What is the MUST score?
“malnutrition universal screening tool”
used to assess everyone admitted to hospital
What are the 4 steps of the MUST score?
1) BMI
2) Recent weight loss
3) Acute disease effect score
4) Overall risk of malnutrition
5) management guidelines
How is BMI calculated?
What BMI equates what score?
weight (Kg)/height (m2)
>20 = 0
18.5-20 = 1
<18.5 = 2
How is a score for step 2 calculated?
calculate percentage unplanned weight loss over past 3-6 months (change in weight/usual weight X 100)
Less than 5% = 0
5-10% = 1
>10% = 2
unplanned weight loss of 5% is clinically significant, true or false?
false
10% or over is clinically significant
5-10% indicates increased risk
what score would be given if weight loss is intentional?
0
how is acute disease effect score calculated?
is the patient acutely ill AND there been or likely to be nutritional intake for 5 days?
No = 0
Yes = 2
how is overall risk of malnutrition calculated?
add scores from steps 1, 2 and 3
0 = low risk
1 = medium risk
2 or above = high risk
What should be included in step 5 management plan?
frequency of repeat screening
recording of dietary intake
measures to improve dietary intake
referral for specialist advice
in which category are most patients in?
Most are low risk
second = high risk
least = moderate risk
which factors increase malnutrition risk?
care homes
age
female
what must be considered when measuring weight?
measure in lightweight clothing without shoes
account for diurinal variation through the day (up to 2Kg)
account for hydration status
what conditions can cause extra weight?
ascites (2.2-14kg)
oedema (1-10kg)
what 2 methods of surrogate measurement can be used?
use recently documented or self reported (if reliable/realistic)
estimate height from length of ulna (measure from olecranon process and midpoint of styloid process)
what are 2 methods of surrogate weight measurement?
use recently documented or self reported
measure mid-upper arm circumference (useful when weight distorted by fluid overload
describe the triceps skinfold thickness test
Estimates total body fat
Assumes constant relationship between subcutaneous and internal fat but this varies with sex, body weight, ethnicity and age
How is mid-upper arm muscle circumference calculated?
using MUAC and TSF
assesses body muscle mass and PEM (indicator of protein reserves)
how can upper extremity muscle strength be measured?
handgrip dynamometer
what is malnutrition?
where deficiency of nutrients causes adverse outcomes
how many patients entering hospital are malnourished or are at risk?
25%
who is malnutrition more common in and how can it be recognised?
women
MUST
