OPIC - Nutrition

Question 1

Malnutrition

Causes
Consequences
Malnutrition Universal Screening Tool (MUST)
Management Guidelines in MUST

Answer 1

1. ) Causes
   - reduced dietary intake: ↓appetite, N+V, swallowing issues, ↓ADLs, low income, alcohol, eating disorders
   - malabsorption: diarrhoea, IBD, B12 deficiency, coeliac’s disease, altered GI tract
   - increased losses or ↑energy expenditure: N+V, diarrhoea, post-op, involuntary tremors, pregnancy
2. ) Consequences - affects every system, increasing vulnerability to illness and complications
   - prolonged hospital stays, more visits to the doctor
   - fatigue and lethargy, falls, HF, anxiety and depression
   - difficulty coughing: ↑risk of chest infection
   - ↓immune function, prolonged wound healing
3. ) Malnutrition Universal Screening Tool (MUST)
   - score given based on BMI, unintentional weight loss and presence of an acute illness/no intake for >5days
   - height can be estimated using ulna length
   - BMI can be estimated using MUAC (mid-upper arm circumference)
4. ) Management Guidelines in MUST
   - low risk (0): repeat (weekly in hospital)
   - med risk (1): document dietary intake for 3 days, if inadequate, follow local policy in aim to improve
   - high risk (2+): refer to dietician or nutritional support

Question 2

Pressure Ulcers

Pathophysiology
Consequences
Severities
Braden Scale

Answer 2

1. ) Pathophysiology - area of damaged skin and/or tissues as a result of being placed under pressure
   - extra pressure disrupts blood flow, starving the skin of O2 and nutrients causing it to break down –> ulcer
   - affects those with health conditions that are confined to lying in a bed or sitting for prolonged periods of time
   - reduced blood flow is also a risk factor e.g T2 DM
2. ) Consequences - can be painful or become infected
   - common locations depend on what the patient is on
   - bed: shoulders, elbows, head, ears, knees, ankles, heels or toes, spine, tail bone
   - wheelchair: buttocks, arms and legs, hip bone
3. ) Severities - EPUAP grading system, 4 grades:
   - 1: most superficial, discoloured, skin intact, may be painful or itchy, non-blanching, warm, spongy or hard
   - 2: skin loss due to damage to (epi-)dermis, ulcer looks like an open wound or a blister
   - 3: skin loss through entire skin thickness, damaged underlying tissues, looks like a deep, cavity-like wound
   - 4: severely damaged skin, tissue necrosis, underlying muscle/bone may be damaged, can lead to sepsis
4. ) Braden Scale - assesses the risk of pressure ulcers
   - 6 factors: sensory perception, nutrition, friction and shear, mobility, moisture, activity
   - others: Waterlow scale, Norton risk‑assessment scale

Question 3

Refeeding Syndrome

Answer 3

1,) Risk Factors
- high risk (1+): BMI < 16, little nutritional intake > 10 days, unintentional weight loss >15% over 3-6 months, hypokalaemia, hypophosphataemia or hypomagnesaemia prior to feeding (unless high)
- mod risk (2+): BMI < 18.5, little nutritional intake > 5 days, unintentional weight loss > 10% over 3-6 months, history of: alcohol abuse, drug therapy including insulin, chemotherapy, diuretics and antacids

2.) Clinical Features/Biochemical Abnormalities
- abnormal fluid balance
- hypokalaemia
- hypophosphatemia
- hypomagnesaemia
- hyperglycaemia
- thiamine deficiency

3.) Management
- checking bloods before feeding
- replace B vitamins
- reintroduce food slowly: <50% of energy requirements
- if a patient hasn’t eaten for > 5 days, aim to re-feed at no more than 50% of requirements for the first 2 days.