wk 2 5 Malnutrition

Question 1

define malnutrition

Answer 1

defiency, excess or imbalance of energy, protein and other nutrients

Question 2

causes of malnutrition 4

Answer 2

decreased intake
impaired digestion/absorption increased nutritional requirements
increased nutrient losses

Question 3

what can cause an increased loss of nutrients

Answer 3

vomiting
diarrhoea
stoma losses

Question 4

explain malnutritions impact

Answer 4

increases likelihood of Gi dysfunction, infections and poor wound healing

occur acutely (sepsis,surgery,side effects) causing increased nutritional requirements

Question 5

give some psychosocial causes of malnutrition

Answer 5

inappropriate food provision 
lack of assistance
lack of skill 
deprivation
depression

Question 6

starvation has the opposite effect on the body than

Answer 6

injury

Question 7

explain the effect starvation has on hormones

Answer 7

early smal incr catecholamines (noradrena,adrena,dopamine)
cortisol, GH then slow fall

insulin decreased

Question 8

difference in weight loss observed in starvation and injryq

Answer 8

starve - slow loss, fat stores

injury -rapid loss, 80% fat, 20%protein

Question 9

effects of malnutrition (9)

Answer 9

impaired immune
impaired wound healing 
reduced muscle strength
reduced resp muscle strength
inactivity
water/electrolyte disturbances
impaired thermoregulation 
menstrual irregularities 
impaired psycho-social function

Question 10

menstrual irregularities due to malnutrition may lead to 2

Answer 10

infertility

osteoporosis

Question 11

nutritional assessment

Answer 11

mid-arm muscle circumference

grip strength

Question 12

albumin is a baseline investigation, why

Answer 12

makes up half protein in plasma, low levels suggest reduced AA synthesis/ abdominoretiroerineal resection (APR) , non-specific marker of illness

Question 13

parameter used to check if their is protein restriction, 3 sources of causation

Answer 13

transferrin
APR
iron deficiency
liver disease

Question 14

t/f prealbumin is increased in uraemia and dehydration

and decreased in APR

Answer 14

true

decreased in fasting too

Question 15

when would prealbumin *transthyretin) be checked

Answer 15

monitoring patients response to nutritional support

Question 16

retinol binding protein reflects dietary intake, and affected more by energy than protein restriction. When is it increased/decreased

Answer 16

incr - alcoholism, incr glomerular filtration

dec - chronic liver disorders, VitA/zinc defiency

Question 17

which parameter reflects muscle mass if renal function is normal.

Answer 17

urinary creatinine

Question 18

which parameter is reduced in malnutrition, liver and renal failure, and requires multiple measures to assess status

Answer 18

IGF1

Question 19

nutritional support given if 4

Answer 19

bmi <18.5
unintentional weight loss >10% in last 6months
(if BMI ,20, unintentional = 5%)
reduced recent consumption
poor absorptive capacity/nutritional loss

Question 20

contra-indications of ETF

Answer 20

lower GI obstruction (gut may work but cannot pass)
prolonged intestinal ileus (food build up)
high enterocutaneous fistula
intestinal ischaemia

Question 21

when is parenteral nutrition used

Answer 21

if patient:
inadequate oral/enteral intake
GI tract inaccessible