Nutritional Screening

Question 1

What is the MUST score?

Answer 1

“malnutrition universal screening tool”

used to assess everyone admitted to hospital

Question 2

What are the 4 steps of the MUST score?

Answer 2

1) BMI
2) Recent weight loss
3) Acute disease effect score
4) Overall risk of malnutrition
5) management guidelines

Question 3

How is BMI calculated?

What BMI equates what score?

Answer 3

weight (Kg)/height (m2)
>20 = 0
18.5-20 = 1
<18.5 = 2

Question 4

How is a score for step 2 calculated?

Answer 4

calculate percentage unplanned weight loss over past 3-6 months (change in weight/usual weight X 100)
Less than 5% = 0
5-10% = 1
>10% = 2

Question 5

unplanned weight loss of 5% is clinically significant, true or false?

Answer 5

false
10% or over is clinically significant
5-10% indicates increased risk

Question 6

what score would be given if weight loss is intentional?

Answer 6

0

Question 7

how is acute disease effect score calculated?

Answer 7

is the patient acutely ill AND there been or likely to be nutritional intake for 5 days?
No = 0
Yes = 2

Question 8

how is overall risk of malnutrition calculated?

Answer 8

add scores from steps 1, 2 and 3
0 = low risk
1 = medium risk
2 or above = high risk

Question 9

What should be included in step 5 management plan?

Answer 9

frequency of repeat screening
recording of dietary intake
measures to improve dietary intake
referral for specialist advice

Question 10

in which category are most patients in?

Answer 10

Most are low risk
second = high risk
least = moderate risk

Question 11

which factors increase malnutrition risk?

Answer 11

care homes
age
female

Question 12

what must be considered when measuring weight?

Answer 12

measure in lightweight clothing without shoes
account for diurinal variation through the day (up to 2Kg)
account for hydration status

Question 13

what conditions can cause extra weight?

Answer 13

ascites (2.2-14kg)

oedema (1-10kg)

Question 14

what 2 methods of surrogate measurement can be used?

Answer 14

use recently documented or self reported (if reliable/realistic)
estimate height from length of ulna (measure from olecranon process and midpoint of styloid process)

Question 15

what are 2 methods of surrogate weight measurement?

Answer 15

use recently documented or self reported

measure mid-upper arm circumference (useful when weight distorted by fluid overload

Question 16

describe the triceps skinfold thickness test

Answer 16

Estimates total body fat
Assumes constant relationship between subcutaneous and internal fat but this varies with sex, body weight, ethnicity and age

Question 17

How is mid-upper arm muscle circumference calculated?

Answer 17

using MUAC and TSF

assesses body muscle mass and PEM (indicator of protein reserves)

Question 18

how can upper extremity muscle strength be measured?

Answer 18

handgrip dynamometer

Question 19

what is malnutrition?

Answer 19

where deficiency of nutrients causes adverse outcomes

Question 20

how many patients entering hospital are malnourished or are at risk?

Answer 20

25%

Question 21

who is malnutrition more common in and how can it be recognised?

Answer 21

women

MUST