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S&P - Nutrition > Nutrtition Screening > Flashcards

Nutrtition Screening Flashcards

1
Q

What are the three criteria for all malnourished people?

A
  • BMI of less than 18.5
  • Unintentional weight loss greater than 10% in the last 3-6 months
  • BMI of <20 coupled with unintentional weight loss >5% within last 3-6 months
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2
Q

What are the causes of malnutrition?

A 
•	Uraemia; nausea, vomiting, anorexia taste changes fatigue
•	Poor appetite
•	early satiety
•	Unpalatable
•	restricted diets
•	Frequent hospital admissions (NBM episodes, hospital smells/food)
•	Infections
•	Increased nutritional requirements
•	Depression
•	anxiety
Drug side effects
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3
Q

Which patients are at increased malnutrition risk?

A

Increased requirements
E.g. Pyrexia, post-operative, cachexia, infection, chronic illness
Over 65s
Those who are bedbound / Pressure sores / Physical disabilities
Patients on modified diets

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4
Q

What is the impact of malnutrition?

A
  • Increases morbidity
  • Delays wound healing
  • Increased risk of pressure sores
  • Prolongs hospital stay
  • Low weight
  • Low energy
  • Falls and fractures
  • Muscle wasting
  • Weight loss
  • Reduced mobility
  • Reduced independence
  • Increased hospital admissions
  • Increased infections
  • Increased confusion
  • Low mood
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5
Q

Describe the malnutrition carousel

A
  • 25-34% of hospital admissions are at risk of malnutrition
  • longer stay more complications
  • More support needed after hospital
  • 70% patients weigh less on hospital discharge
  • More GP visits
  • More prescriptions
  • More hospital admissions
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6
Q

Nutrition screening: what is it?

A 
Uses scores or flow charts to determine nutritional statuses of patients.
o	Well Nourished
o	Mild to Moderately Malnourished
o	Severely Malnourished
o	E.g. MUST tool
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7
Q

How are screening scores graded?

A

Add score from nutritional status and requirements
If 0-2 No action required, re-screen weekly
If 3, start nutrition care plan and rescreen weekly
If 4+ start nutrition care plan and refer to dietitian

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8
Q

Describe the nutrition care plan?

A

http://imgh.us/nutrition_.png

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9
Q

Desribe the MUST

Screening Tool

A

Http://pinnt.com/getattachment/Therapies/Nutrition-Therapies/must.jpg.aspx

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10
Q

What are physical signs of malnutrition?

A
  • Diarrhoea
  • Dermatitis (legs)
  • Pressure sores
  • Anaemia
  • Ascites
  • Mental health changes
  • Hair change
  • Sunken eyes
  • Sore red eyes and lids
  • Poorly fitting dentures
  • Swollen/bleeding gum
  • Dry/cracked lips
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11
Q

What should be noted in a physical exam?

A

Loss of subcutaneous fat
Muscle wasting
Oedema
Ascites (Renal, liver and heart failure patients may have fluid overload)

Remember overweight / obese patients can also have all the above!

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12
Q

Which categories of questions should be asked?

A

Weight changes
Diet
Functionality
Gastrointestinal symptoms

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13
Q

What would you ask re weight?

A

Have you lost weight in the last 3 months?
Was the weight loss intentional?
Have you noticed a change in your clothes sizes?
Has your rings on your fingers got too big?
If you have dentures do they fit?

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14
Q

What would you ask re diet?

A

Do you have a special diet?
Do you follow any dietary restrictions?
If so what?
Are you on any nutritional supplements? Herbal remedies?
If yes, who prescribed them?
Which ones do you take?
Is your appetite less than it used to be? How long for?

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15
Q

What would you ask re functionality?

A

Exercise tolerance/lethargy

Ability to cook /shop / prep food

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16
Q

What would you ask re GI symptoms?

A

Do you have any diarrhoea or constipation?
If yes for how long? Frequency?
Do you experience abdominal pains? If yes how often? What helps it get better?

17
Q

How do electrolytes change in refeeding syndrome?

A

Refeedingsyndromeis a syndrome consisting of metabolic disturbances that occur as a result of reinstitution of nutrition to patients who arestarved or severely malnourished

Glucose enters bloodstream via enteral, parenteral, oral or IV routes
Pancreas secretes insulin
Insulin promotes cellular uptake of: glucose, K, Mg, PO4-. Low serum phosphate levels for K, P and Mg result

18
Q

Describe clinical effects of PO4-, K+ and Mg2+ changes

A

• Phosphate
o Cardiac; altered myocardial function, arythmia, congestive cardiac failure
o Respiratory; Acute ventilatory failure
o Neuromuscular; Lethergy, confusion, weakness, paralysis

• Potassium
o Arthymia, cardiac arrest
o Respiratory distress
o Paralysis, weakness, rhabdomyolysis

• Magnesium
o Arrythmia, tachycardia
o Respiratory distress
o Ataxia, confusion, muscle tremors, tetany

19
Q

Describe the chain of events in starvation and refeeding syndrome

A

• Starvation –> Glycogen stores utilised
• ↓ Insulin production &
• ↑ Glucagon secretion
• Gluconeogenesis
• Protein catabolism & mobilisation of lipid
• Protein, fat, mineral, electrolyte & vitamin depletion – sodium &
water intolerance

•	Refeeding:  
•	Eating (especially with 
•	CHO main source of energy)
•	↑ Insulin secretion
•	Increased uptake of glucose 
•	Increased  utilisation thiamine
•	increased cell uptake potassium, magnesium. phosphate.
REFEEDING SYNDROME
20
Q

Which patients are at high risk of refeeding syndrome?

A

Patient has one or more of the following:
o BMI <16kg/m2
o Unintentional weight loss >15% over 3-6 months
o Little or no nutritional intake for >10 days
o Low levels of potassium, phosphate and magnesium prior to feed

Patient has two or more of the following:
o BMI less than 18.5kg/m2
o Unintentional weight loss >10% over 3-6 months
o Little or no nutritional intake for >5 day
o A history of alcohol abuse or drugs including insulin, chemotherapy, antacids or diuretics

21
Q

How are patients treated?

A

Daily: Check U&Es
Bone Profile
Magnesium

Watch potassium, phosphate and magnesium closely
Provide vitamin preparations

1st 10 days of feeding:
Provide <30mins before start of feed/meal
Vitamin B Co Strong (1 or 2 tablets tds) and Thiamine (200-300mg daily)
Or
Pabrinex I &II (give to patient intravenously)
Multivitamin/trace element supplement once a day

22
Q

Case study: Mrs D: 79 year old lady admitted following fall in shopping centre with #NOF. Coughing on water.
Hx: Repeated chest infections (3 in last 3 months) has high blood pressure

Biochemistry: 
Sodium 157mmol/l Potassium 2.5mmol/l 
Urea 16.8mmol/l 
Phosphate 0.55mmol/l 
Magnesium 1.02mmol/l

What are the nutritional concerns with Mrs D?What do you do next?

A

Low phosphate and potassium - refeeding syndrome?

  • Very dehydrated so give IV fluids
  • Low electrolytes so replace potassium and phosphate
  • Have the patient nutritionally screened
  • Prescribe Vitamins (Pabrinex I & II or oral)
  • Refer to dietitian
  • Keep NBM and Refer to Speech and Language Therapy (SALT) who can assess swallow
  • Provide oral support as 1st line
  • If NBM consider nasogastric feeds rather than parenteral nutrition in this patient

S&P - Nutrition (13 decks)

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