Nutrition

Question 1

Name the brief risk assessment for nutrition used commonly in hospitals? [1]

Answer 1

MUST

Question 2

How do you perform a full nutritional asessment? [5]

Answer 2

A: Anthropometery (Weight, % weight change, BMI, MUAC, skin fold thickness)

B: Biochemistry (FBC, U&E, Ca, B12 & Folate, CRP & HbA1c)

C: Clinical (disease states or symptoms)

D: Dietary (energy and fluid requirements)

E: Environment (social and physiological factors)

Question 3

What are vegans at risk of being malnourished in? [3]

Answer 3

• B12
• Iron
• Ca
• Iodine
• Omega-3 fatty acids

Question 4

What is a BMI that is defined as malnutrition? [1]

What % weight loss, in what time period is classified as malnutrition? [1]

Combination of the two?

Answer 4

Malnutrition:
a Body Mass Index (BMI) of less than 18.5; or

unintentional weight loss greater than 10% within the last 3-6 months; or

a BMI of less than 20 and unintentional weight loss greater than 5% within the last 3-6 months

Question 5

Describe how nutrional feeds can be administerd

Answer 5

• Sip feeds
• Nasogastric (NG tube): narrow feeding tube is placed through your nose down into your stomach.
• Gastrostomy:
  a) Percutaneous endoscopic gastromy (PEG) - tube into stomach
  b) ‘Buttons’

Question 6

What is the name of the criteria used to diagnose a patient with anorexia nervosa? [1]

State the 3 key features of the criteria [3]

Answer 6

DSM 5 criteria:

1. Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
2. Intense fear of gaining weight or becoming fat, even though underweight.
3. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.

Question 7

Common feature of anorexia nervosa? [5]

Answer 7

• Features of anorexia nervosa:
• Excessive weight loss
• Amenorrhoea
• Lanugo hair is fine, soft hair across most of the body
• Hypokalaemia
• Hypotension
• Hypothermia
• Changes in mood, anxiety and depression
• Solitude

Question 8

Describe what is meant by short bowel syndrome? [2]

Answer 8

Small / large intestine becomes physcially shorter when a portion is removed by surgery OR if becomes damaged in way that makes non-functional

Leads to poor absorption of water and nutrients

Question 9

Which investigations are used to investigate SBS? [4]

Answer 9

FBC:
- anaemia caused by iron, copper, folate or b12 deficiences (all common in SBS)
- thrombocytopenia (indicates volume depletion)
- haemoconcentration (indicates volume depletion)

U&Es:
- Hypo/hypernatraemia: reflects hydration status
- Hypomagnesaemia: common due to diarrhoea
- Hypokalemia: common

Low serum albumin

INR: used to detect vitamin K deficiency

Question 10

Name a disease common to have SBS in [1]

Answer 10

Crohns Disease

Question 11

What does management of SBS depend upon? [1]

Describe treatment of SBS [5]

Answer 11

Treatment depends upon the extent and anatomy of bowel resection.

Management:
- Nutrient and fluid supplementation
- Parenteral nutrition: is slowly pumped into the blood stream through a drip;
- ORS
- Increase calorie intake (2-3x prior to SBS)

• Medicines to minimise fluid losses and to control diarrhoea
• Surgical interventions to aid intestinal adaptation
• PPI

Question 12

State 4 physiologal mechanims that are reduced because of protein-calories malnutrition [4]

Answer 12

• Muscle function
• Delayed hypersensitivity (common immune response that occurs through direct action of sensitized T cells when stimulated by contact with antigen)
• Wound healing: increases infection rates
• Gonadal function: decreases fertility

Question 13

Define parenteral nutrition [1]

Describe the different types of parenteral lines (2_
- Time [1]
- Location [1]
- Other nutrition [1]

Answer 13

PN feeding: IV administration of nutrition outside of the gastrointestinal tract.

Peripheral PN:
- smaller vein: neck or limbs
- partial parenteral nutrition
- Short term ( < 14 days)

Central / Total PN:
- Given over longer periods ( > 28 days)
- When IV is the only nutrition provided
- usually SVC

Question 14

State 4 risks of peripheral and central PN feeding [4]

Answer 14

• thrombophlebitis (inflammatory process that causes a blood clot to form and block one or more veins, usually in the legs)
• sepsis
• hyperglycaemia
• sodium overload

Question 15

State how central or peripheral PN can cause [2]

• thrombophlebitis
• hyperglycaemia

Answer 15

thrombophlebitis
- Peripheral PN demands careful surveillance for thrombophlebitis as parenteral feed is very irritant to veins
- caused by hyperosmality of nutrients as they irritate veins

hyperglycaemia
- glucose enters the peripheral circulation, reaching high serum levels and producing sustained hyperglycemia and hyperinsulinemia
- (can be avoided by monitoring plasma glucose often, adjusting the insulin dose in the TPN solution, and giving subcutaneous insulin as needed)