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Metabolism 2 > Nutrition and diet > Flashcards

Nutrition and diet Flashcards

1
Q

what is the definition of malnutrition

A
  • this is a state of nurtion in which a deficiency or excess of energy, protein, and other nutrients causes adverse effects on tissue form and function
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2
Q

what is the annual cost of malnutrition

A

19.6bn increase in obesity and malnutrition

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3
Q

what are the causes of malnutrition

A
  • Decreased intake when food available
  • Increased intake due to inadequate availability quality or presentation of food
  • Lack of recognition and treatment
  • Increase in nutritional requirements e.g. if you are pregnant
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4
Q

what can cause decreased intake of food

A

 Dysphagia – tend to be in elderly – after stroke, or brain damage
 Prolonged periods NBM – patients fast and then there procedure gets cancelled
 Side effects of treatment
 Pain/constipation
 Psychological e.g. depression
 Social e.g. low income, isolation
 Poor dentition – in children and adults, older people will loose there teeth and end up with dentures – effect the ability to chew food and the consistency of the food that they can have
 Reflux/feeding problems/food intolerance’s – this can effect there intake –

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5
Q

what requires you to increase nutritional requirements

A
  • Infection
  • Involuntary movements
  • Wound healing
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6
Q

what causes increase losses of nutrition

A
  • Malabsorption from gut
  • Diarrhoea and vomiting
  • High stoma output
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7
Q

what are the consequences of malnutrition

A 
	 Respiratory function
	 Cardiac function
	 Mobility
	 risk of pressure sores
	 risk of infection
	 wound healing
	 risk of malabsorption
	Apathy and depression
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8
Q

what two things can identify the risk of malnutrition

A

MUST

STAMP

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9
Q

what are the 5 steps of MUST

A
  1. Body mass index BMI
  2. Weight loss
  3. Acute disease effect
  4. Add scores for steps 1-3
  5. Action plan
  • 0 – low risk
  • 1 medium risk
  • 2 or more is high risk
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10
Q

how do you assess malnutrition in terms of ABCDE

A 
A - anthropometrics
B - biochemistry 
C - clinical status 
D - dietary intake 
E - stilted requirements
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11
Q

describe anthropometrics of the ABCDE assessment tool

A
  • Weight (Dry/Oedema/Ascites)
  • Height (ulna, knee length, full body length),
  • BMI (Actual or estimate)
  • Weight history (?recent weight loss)
  • Other measurements – MUAC, MUAMC
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12
Q

describe biochemistry of the ABCDE assessment tool

A

• Pre-existing malnutrition consider evidence of depletion/risk of RFS

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13
Q

what is the clinical status of the ABCDE assessment tool

A

• Diagnosis, medications, PMH will impact on nutritional intervention

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14
Q

what is the dietary intake of the ABCDE assessment tool

A
  • Routes available for feeding
  • Pre-admission nutritional intake
  • Allergies
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15
Q

what are the BMI levels for

  • underweight
  • normal
  • overweight
A
  • Less than 19 is underweight
  • 20-24.9 normal
  • Over 25 is overweight
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16
Q

how can you measure height

A

 Can be difficult to measure for example if they are bedbound
 Surrogate measures;
-Knee height
-Demispan
-Ulna length
- reported height form the patient is a better measure than this

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17
Q

how can you measure weight

A
  • Difficult to obtain unless chair scales or hoist scales

- instead of measuring there weight you can use a mid upper arm circumference as a surrogate

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18
Q

what can you use as a surrogate measure instead of weight

A

Mid upper arm circumference (MUAC)

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19
Q

how do you measure mid upper arm circumference

A

o Can measure in supine position
o Obtain height or surrogate height
o Can then estimate weight from BMI
o (Weight (kg) = BMI x Height (m2)

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20
Q

name some mid arm circumference numbers and how they link to BMI

A
  • If MUAC is less than 23.5 BMI is likely to be less than 20 likley to be underweight
  • If MUAC is greater than 32 BMI is likely to be greater than 30 so overweight
21
Q

what are the different levels of ascites

A

tense 14Kg,
moderate 6Kg
minimal 2.2Kg

22
Q

what are the different levels of peripheral oedema

A 
Severe 10kg(up to sacrum), 
moderate 5kg(up to knee), 
mild 1kg (ankle)
23
Q

you need an increase in body water off at least….

A

increase in body water of at least 1kg before can see visual oedema

24
Q

how much unintentional weight loss do you have to have before you have predicted death

A

34% weight loss

25
Q

what can you use to measure fat mass

A
  • skinfolds, commonly use triceps sit
26
Q

how do you measure fat free mass (ie protein synthesis)

A

Arm Muscle Circumference (AMC)
Derive from MUAC & TSF
AMC = MUAC (cm) – (0.314 x TSF

27
Q

what does handgrip dynamometry (HGD) measure

A
  • measures muscle strength and endurance

- t has a positive correlation with functional ability

28
Q

how can you measure handgrip dynamometry

A
  • supine or sitting position
  • dominant or non-dominant side
  • repeated measures to mirror original position
29
Q

what is albumin

A
  • Large protein synthesised in the liver

* Most abundant protein found in plasma and is usually trapped within capillaries

30
Q

what is the normal range of albumin

A

35-50g/l

31
Q

what is the function of albumin

A

maintains oncotic pressure

32
Q

what are the causes of hypalbuminaemia

A
  • arises because inadequate protein intake
  • can also be due it inflammation and sepsis associated with infection
  • this would result in an increase in C reactive protein, white cell count, pyrexia
  • then axillary walls become more porous and albumin moves out leading to a low plasma albumin
33
Q

what is a good prognostic indicator of mortality risk

A

albumin

34
Q

define referring syndrome

A

A potentially fatal condition characterized by severe fluid and electrolyte shifts and related metabolic implications in malnourished patients undergoing refeeding (via the oral, enteral or parenteral routes

35
Q

what happens in starvation to

  • glucagon
  • insulin
  • glycogen
  • protein
  • fatty acids
  • intracellular stores of potassium, phosphate, magnesium
A
  • Glucagon levels rises
  • Insulin levels fall
  • Glycogen used up in the first 24-72 hrs of starvation
  • Shifts to protein for energy
  • Fatty acids are metabolised to produce ketone bodies – become the major source of energy
  • Loss of fat and lean body mass, water and minerals.
  • Intracellular stores of K+, P04-, Mg2 become depleted
36
Q

what source is used in the brain

A
  • ketone bodies are used in the brain, they can diffuse into the CSF whereas the others cannot be used in the brain
  • it is still 50;50 with glucose in the brain in starvation
37
Q

what happens in refeeding syndrome

A

• Metabolism changes from fatty acids to carbohydrates
• Raised insulin secretion
• Insulin stimulates K+, P04-, Mg2+ to return to cells
- intracellular stores are replenished but at the expense of plasma concentrations this leads to hypokalamia, hypomagnesaemia, hypophosphataemia, thiamine deficiency, salt and water rentention

38
Q

what are the three clinical consequences of refeeding syndrome

A

hypophosphataemia
hypomagnesaemia
hypokalameia

39
Q 
what are the 
- neurological 
- musculoskeletal 
- respiratory 
- cardiac 
- renal 
signs of the three clinical consequences of refeeding syndrome
A

Hypophosphataemia
Neurological—Seizures, paraesthesia
Musculoskeletal—Rhabdomyolysis, weakness, osteomalacia
Respiratory—Impaired respiratory muscle function
Cardiac—Cardiac failure
Renal—Rhabdomyolysis, fluid and salt retention

Hypomagnesaemia
Neurological—Tetany, paraesthesia, seizures, ataxia, tremor
Cardiac—Arrhythmias
Gastrointestinal—Anorexia, abdominal pain

Hypokalaemia
Neurological—Paralysis, paraesthesia 
Musculoskeletal—Rhabdomyolysis 
Respiratory—Respiratory depression 
Cardiac—Arrhythmias, cardiac arrest
40
Q

who is at risk of refeeding syndrome

A
  • any patient with very little food intake for greater than 5 days
41
Q

who is at high risk of refeeding syndrome

A

Any one the following;
– BMI <16
– Unintentional weight loss >15% in last 3-6 months
– Little or no nutritional intake for more than 10 days
– Low levels of K, PO, Mg prior to feeding

OR Any 2 of the following
– BMI <18.5
– Unintentional weight loss >10% in last 3-6 months
– Little or no nutrition for more than 5 days
– A history of alcohol abuse or drug use including chemotherapy, antacids or diuretics

42
Q

why do we provide nutrition support

A

• Increased nutritional requirements are associated with the metabolic response to stress/trauma/sepsis
Maintain nutritional status and limit catabolism
Preserve lean body mass (LBM)
• Maintain immune function
• Preserve organ function and promote wound healing
• Enhance recovery and improve patient outcomes

43
Q

what are enteral routes for nutrition support

A
  • Oral
  • Nasogastric
  • Orogastric
  • Nasojejunal
  • Gastrostomy
  • Jejunostomy
44
Q

what are parenteral routes for nutrition support

A

Peripheral

Central

45
Q

name some oral nutritional support supplement drinks

A 
Milkshake style
•	Calorie content varies  
•	Ready made 
Juice based 
•	Fat free 
Powdered
•	Not nutritionally complete
•	Is the patient able to mix it
46
Q

what are the nutritional supplements in dysphagia

A
  • Pre-thickened drinks
  • Thickening of supplement drinks with a thickener
  • Yoghurt style drinks
  • Smoothie style drinks
  • Yoghurt/dessert pot type supplements
47
Q

when do you use enternal tube nutrition

A

Insufficient oral intake
-options exhausted
Oral intake is not possible
If Gut is functioning – Use it

48
Q

when do you use parental nutrition

A

GIT unable to digest or absorb adequate amount of nutrients (e.g. short bowel syndrome, ileus, motility disorders, gastrointestinal ischaemia, bowel perforation, radiation enteritis, pancreatitis)

GIT cannot be accessed (e.g. obstruction, enterocutaneous fistulae, severe inflammatory bowel disease)

49
Q

what are the disadvantages of parental nutrition

A 
Risk associated with placement
Risk of catheter related sepsis
Disordered liver function (long term)
Risk of gut atrophy
Psychological
Cost

Metabolism 2 (40 decks)

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