PRESCRIPTION DIETS FOR SPECIFIC MEDICAL CONDITIONS

Question 1

WHAT IS MALNUTRITION?

Answer 1

A STATE OF NUTRITION IN WHICH A DEFICIENCY OR EXCESS OR IMBALANCE OF ENERGY, PROTEIN AND OTHER NUTRIENTS CAUSES MEASURABLE ADVERSE EFFECTS ON BODY FORM, FUNCTION AND CLINICAL OUTCOME

Question 2

BMI THAT INDICATES OBESITY?

Answer 2

30 kg/m2 or more

Question 3

BMI THAT INDICATES UNDERNUTRITION/MALNOURSIHMENT?

Answer 3

LESS THAN 18.5 kg/m2

Question 4

ANNUAL COST OF MALNUTRITION IN ENGLAND?

Answer 4

23.5 BILLION

Question 5

HEALTH AND SOCIAL CARE COST IS HOW MUCH GREATER FOR MALNOURISHED INDIVIDUALS COMPARED TO NON-MALNOURISHED?

Answer 5

3-4x

Question 6

WHAT PERCENTAGE OF PEOPLE ADMITTED TO HOSPITALS ARE UNDERNOURISHED?

Answer 6

10-40%

Question 7

CAN PEOPLE WITH NORMAL BMI BE MALNOURSIHED?

Answer 7

YES

Question 8

1/ HOW MANY ADULTS ARE AFFECTED BY OVERNUTRITION?

Answer 8

1/5

Question 9

ESTIMATED ANNUAL COST OF OVERNUTRITION?

Answer 9

> 2 BILLION

Question 10

POPULATIONS AT GREATEST RISK OF UNDERNUTRITION?

Answer 10

• 65+ Y.O., ESP IF LIVING IN CARE HOMES OR ADMITTED TO HOSPITALS
• POEOPLE WITH CHRONIC CONDITIONS, E.G. DIABETES, KIDNEY DISEASE, LUNG DISEASE
• PEOPLE WITH CHRONIC PROGRESSIVE CONDITIONS, E.G. DEMENTIA AND CANCER
• PEOPLE WHO ABUSE DRUGS AND ALCOHOL

Question 11

SOCIAL FACTORS ATTRIBUTING TO UNDERNUTRITION?

Answer 11

POVERTY, SOCIAL ISOLATION, CULTURAL/RELIGIOUS BARRIERS IN INSTITUTIONALIZED SETTINGS (E.G. HOSPITALS, CARE HOMES), LACK OF HEALTH LITERACY

Question 12

PHYSICAL FACTORS CONTRIBUTING TO UNDERNUTRITION?

Answer 12

PAINFUL MOUTH, DENTAL PROBLEMS, PROBLEMS SWALLOWING (E.G. AFTER A STROKE), LOSS OF TASTE OR SMELL, DIFFICULTY COOKING, DIFFICULTY IN MOBILITY..

Question 13

PERCENTAGE OF PATIENTS WHO LOSE WEIGHT DURING HOSPITAL STAYS?

Answer 13

70%

Question 14

SYMPTOMS AND SIGNS OF UNDERNUTRITION?

Answer 14

LOSS OF APPETITE, WEIGHT LOSS, TIREDNESS, REDUCED ABILITY TO PERFORM NORMAL TASKS, REDUCED PHYSICAL PERFORMANCE, ALTERED MOOD, POOR CONCENTRATION, POOR GROWTH IN CHILDREN

Question 15

CONSEQUENCES OF UNDERNUTRITION?

Answer 15

INCREASED SUSCEPTIBILITY TO INFECTIONS, MUSCLE WASTING, IMPAIRED WOUND HEALING, DEHYDRATION AND KIDNEY INJURY, APATHY, DEPRESSION, SELF NEGLECT

Question 16

WHAT IS ‘MUST’?

Answer 16

MALNUTRITION UNIVERSAL SCREENING TOOL, DEVELOPED BY THE BRITISH ASSOCIATION FOR PARENTERAL AND ENTERAL NUTRITION, RELIABLE AND VALID TOOL, EVALUATES PATIENT OUTCOMES FOR HOSPITALS AND COMMUNITY

Question 17

BMI CAN BE ESTIMATED BY MEASURING WHAT?

Answer 17

MID UPPER ARM CIRCUMFERENCE

Question 18

HEIGHT CAN BE ESTIMATED BY MEASURING WHAT?

Answer 18

DEMI SPAN

Question 19

SPECIAL CONSIDERATIONS WHEN MEASURING BMI?

Answer 19

• FLUID DISTURBANCES (E.G. OEDEMA)
• PREGNANCY )MID UPPER ARM CIRCUMFERENCE CAN CHANGE)
• PLASTER CASTS; CAN ADD 1-4KG
• AMPUTATIONS (USE KNOWLEDGE OF THE WEIGHT OF MISSING LIMB SEGMENTS)
• VERY MUSCULAR INDIVIDUALS

Question 20

WHAT ARE ORAL NUTRITIONAL SUPPLEMENTS (ONS)?

Answer 20

STERILE LIQUIDS, SEMI-SOLIDS OR POWDERS WHICH PROVIDE MACRO AND MICRO NUTRIENTS, USED FOR INDIVIDUALS WHO CANNOT MEET THEIR NUTRITIONAL REQUIREMENTS THROUGH ORAL DIET ALONE

Question 21

WHAT DO MOST ONS CONTAIN?

Answer 21

300kcal, 12g of protein and a full range of vitamins and minerals per serving

Question 22

POSSIBLE SPECIAL PROPERTIES OF ONS AND THEIR INDIVIDUAL USES?

Answer 22

HIGH PROTEIN (WOUNDS, POST OP, FRAIL ELDERLY, ICU PATIENTS, SARCOPENIA, SOME CANCERS)
HIGH FIBRE (CERTAIN GI DISEASES)
PRE THICKENED (DYSPHAGIA OR IMPAIRED SWALLOW)
LOW VOLUME, HIGH ENERGY (INDIVIDUALS WHO HAVE DIFFICULTIES COMPLYING WITH ONS)

Question 23

WHAT IS ENTERAL FEEDING?

Answer 23

ADMINISTRATION OF FOOD VIA THE GI TRACT

Question 24

WHEN IS ENTERAL FEEDING USED?

Answer 24

PATIENT UNABLE TO SWALLOW FOOD SAFELY ( POST STROKE, IN PARKINSON’S..)
TO SUPPLEMENT ORAL INTAKE IN PATIENTS WITH HIGH METABOLIC DEMANDS (CYSTIC FIBROSIS…)
CONDITIONS WITH DELAYED GASTRIC EMPTYING
CONDITIONS WITH HIGH RISK OF ASPIRATION (FOOD ENTERING THE AIRWAY) OF STOMACH CONTENTS

Question 25

METHODS OF ENTERAL FEEDING?

Answer 25

• NASOGASTRIC
• NASOJEJUNAL
• GASTROSOMY (DIRECTLY INTO STOMACH)

Question 26

CONTRADICTIONS TO ENTERAL FEEDING?

Answer 26

ACTIVE GI BLEEDING, COMPLETE INTESTINAL OBSTRUCTION, INABILITY TO ACCESS THE GUT, ABSENCE OF INTESTINAL FUNCTION

Question 27

WHAT IS PARENTERAL FEEDING?

Answer 27

INTRAVENOUS ADMINISTRATION OF NUTRIENTS FOR PATIENTS WHO CANNOT ABSORB THROUGH THE GI TRACT (E.G. INSTESTINAL FAILURE)

Question 28

WHAT ARE THE METHODS OF PARENTERAL FEEDING?

Answer 28

PERIPHERAL ROUTE; LIPID RICH FORMULATIONS PREFERABLE
OR
CENTRAL ROUTE; IF FEEDING IS DONE FOR MORE THAN 28 DAYS, AND FOR HYPEROSMOTIC SOLUTIONS

Question 29

CONTRADICTIONS TO PARENTERAL FEEDING?

Answer 29

SEVERE HYPERGLYCEMIA, SEVERE ELECTROLYTE ABNORMALITIES, VOLUME OVERLOAD, INADEQUATE IV ACCESS, SEPSIS…

Question 30

IN WHICH CASES IS THE NUTRITIONAL SUPPORT STOPPED?

Answer 30

WHEN THE PROBLEM IS SOLVED, WHEN THE PATIENT IS APPROACHING END OF LIFE AND WANTS TO STOP, AT PATIENT’S REQUEST AT ANY POINT, IF THERE ARE BIG PROBLEMS WITH COMPLIANCE