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Integrated Care [9] > [9] Nutrition > Flashcards

[9] Nutrition Flashcards

1
Q

What is a healthy diet?

A

One which provides the body with the right balance of nutrients

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2
Q

What is a healthy diet visually represented by?

A

Eatwell Guide

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3
Q

What does the Eatwell Plate show?

A

The ideal contribution of the different food groups to our diet

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4
Q

Who does the Eatwell Guide apply to?

A

Most people

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5
Q

What specific groups is it important to recognise that the Eatwell Guide applies to?

A
  • Vegetarians
  • Minority ethnic groups
  • Overweight
  • Healthy BMI
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6
Q

When may the proportions of the Eatwell Guide require adjusting?

A

In hospital patients who are elderly and/or at nutritional risk

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7
Q

What are the categories on the Eatwell Guide?

A
  • Fruit and veg
  • Starchy carbohydrates
  • Dairy and alternatives
  • Proteins
  • Oils and spreads
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8
Q

What are some examples of starchy carbohydrates?

A
  • Potatoes
  • Bread
  • Rice
  • Pasta
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9
Q

What are some example of protein sources?

A
  • Beans
  • Pulses
  • Fish
  • Eggs
  • Meat
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10
Q

As well as the food groups, what else forms an important part of nutrition?

A

Hydration

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11
Q

What can good hydration help to prevent?

A
  • Pressure ulcers
  • Constipation
  • Blood clots
  • Kidney and gallstones
  • Heart disease
  • Confusion
  • Falls
  • Memory loss
  • Poor oral health
  • Diabetic complications
  • Dizziness
  • UTI
  • Incontinence
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12
Q

What is the recommended daily intake of fluids?

A

2L per day

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13
Q

Is a patient’s nutritional risk static?

A

No, it can change throughout their admission

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14
Q

How are patients identified as being at nutritional risk?

A

By nutritional screening

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15
Q

Who usually conducts a nutritional screen for patients?

A

Nursing staff - all staff should know the process

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16
Q

What are some examples of screening tools used to assess a patient’s nutritional status?

A
  • Leicestershire NST

- MUST

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17
Q

What is the Leicestershire NST?

A

Leicestershire Nutritional Screening Tool

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18
Q

What is the MUST?

A

Malnutrition Universal Screening Tool

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19
Q

What should happen to the results of a nutritional assessment?

A

Recorded in the patient’s notes

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20
Q

What are the steps of MUST?

A

1 - Measure height and weight to calculate BMI
2 - Note percentage unplanned weight loss
3 - Establish acute disease effect and score
4 - Add scores from steps 1-3
5 - Develop appropriate care plan

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21
Q

What is a high risk score for MUST?

A

2 or more

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22
Q

What is a medium risk score on MUST?

A

1

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23
Q

What should happen to patients with a MUST of 2 or more?

A

Start intervention immediately with dietician input

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24
Q

What should happen to patients with a MUST score of 1?

A

Monitor closely with food charts for 3 days then decide about further intervention

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25
Q

What are the common underlying causes of malnutrition in older people?

A
  • General function
  • Cognitive impairment
  • Swallowing problems
  • Dentition
  • Medication
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26
Q

What aspects of general function can lead to malnutrition?

A
  • Social aspects

- Medical aspects

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27
Q

What social aspects of general function can lead to malnutrition?

A
  • Poverty
  • Social isolation
  • Difficulty shopping
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28
Q

What medical aspects of general function can lead to malnutrition?

A
  • Stroke
  • Arthritis
  • Other conditions making it difficult to feed
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29
Q

What is the main cause of cognitive impairment leading to malnutrition in older people?

A

Dementia

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30
Q

How can dementia lead to malnutrition?

A
  • Difficulty accessing food
  • Reduced appetite
  • Reduced awareness of appetite
31
Q

What is malnutrition considered in dementia?

A

A poor prognostic factor

32
Q

How can swallowing problems develop?

A

Slowly or suddenly

33
Q

What can be a cause of slow developing swallowing problems?

A

Progressive neurological problems

34
Q

What can cause a sudden onset swallowing problem?

A

Vascular event

35
Q

What dental problems can lead to malnutrition?

A
  • Poor oral hygiene
  • Poor or painful dentition
  • Gingivitis
36
Q

How can medication lead to malnutrition?

A

Side-effects can affect a patient’s ability to eat

37
Q

What are some examples of medication leading to impaired eating?

A
  • Candidiasis due to antibiotics or steroids
  • Dry mouth due to anti-cholinergics
  • Altered taste due to some sedatives
38
Q

What is the first step in managing malnutrition?

A

Improving oral nutrition

39
Q

How can oral nutrition be improved?

A
  • Manage symptoms preventing eating
  • Give adequate feeding time
  • Modify food to patient needs
  • Increasing intake
40
Q

How can symptoms preventing eating be managed?

A
  • Anti-emetics

- Analgesia

41
Q

How can food be modified for patient needs?

A
  • Softened or liquid meals

- Thickeners added to liquids

42
Q

What is the second line for managing malnutrition?

A

Oral nutritional supplements (ONS)

43
Q

How can different ONS vary?

A
  • Taste
  • Texture
  • Nutrient profile
44
Q

Who should be involved in determining the appropriate ONS for a patient?

A

Dietician

45
Q

What are some examples of ONS used in Leicester?

A
  • Fortisip compact
  • Fortisip compact fibre
  • Fortijuice
  • Forticreme complete
46
Q

What members of the MDT are involved in managing malnutrition?

A
  • Dietician
  • SALT
  • OT
  • PT
47
Q

When should enteral feeding be considered early?

A

If there is dysphagia and an intact GI tract

48
Q

What can cause dysphagia?

A
  • Stroke
  • MND
  • PD
49
Q

What are the most common forms of enteral feeding?

A
  • Fine-bore NG
  • PEG feeding
  • Percutaneous jejunostomy tube
50
Q

When is a fine-bore NG tube preferred?

A

For short-term feeding

51
Q

What are the advantages of an NG tube?

A
  • Simple
  • Quick
  • Inexpensive
52
Q

What are the disadvantages of NG tubes?

A
  • Can be pulled out by confused patients

- Can risk aspiration

53
Q

How is a PEG tube inserted?

A

Directly through the stomach wall endoscopically or surgically under antibiotic cover

54
Q

What are the risks of PEG insertion?

A
  • Perforation
  • Bleeding
  • Infection
55
Q

What are the problems of PEG feeding?

A
  • Risks of insertion
  • Patient has to be fit enough to undergo surgery
  • Problems gaining consent
  • Some contraindications
56
Q

What are the contraindications of PEG feeding?

A
  • Reflux
  • Previous gastric surgery
  • Gastric ulceration or malignancy
  • Gastric outlet obstruction
57
Q

What are the advantages of PEG feeding?

A
  • Better tolerated than NG

- More discreet than NG

58
Q

When is PEG feeding preferred?

A

Medium/long-term feeding

59
Q

How is a percutaneous jejunostomy tube inserted?

A

Through the skin into the jejunum using surgery or endoscopy

60
Q

What are the advantages of jejunostomy tubes?

A
  • Permit early post-op feeding

- Useful in patients at risk of reflux

61
Q

What are the disadvantages of jejunostomy tubes?

A

Difficult to insert and more complications

62
Q

What are the main complications of all types of enteral feeding?

A
  • Aspiration pneumonia
  • Re-feeding syndrome
  • Fluid overload and heart failure
  • Diarrhoea
63
Q

Why is aspiration pneumonia a complication of enteral feeding?

A
  • Reflux of feed is common
  • Salivary secretions
  • Covert oral intake
64
Q

If a patient shows signs of aspiration pneumonia what should be checked?

A

Position of tubes

65
Q

How can aspiration be managed despite tube in the right place?

A
  • Slow the feed
  • Feed upright
  • Add promobility drugs e.g. metoclopramide
66
Q

When does re-feeding syndrome occur in enteral feeding?

A

If the patient has been malnourished for a long time

67
Q

How should fluid overload be managed in enteral feeding?

A
  • Reduce feed volume

- Add diuretics

68
Q

How can diarrhoea due to enteral feeding be managed?

A
  • Reduce rate

- Reduce fibre content

69
Q

What are the options for enteral feed preparations?

A
  • Standard enteral feeds

- Pre-digested feeds

70
Q

What is a pre-digested feed?

A

Contains nitrogen as short peptides or free amino acids

71
Q

Who are pre-digested feeds for?

A

Improving nutrient absorption in presence of pancreatic insufficiency or IBD

72
Q

What are the indications for parenteral nutrition?

A
  • Complete mechanical intestinal obstruction
  • Ileus or intestinal hypomobility
  • Severe uncontrollable diarrhoea
  • Severe acute pancreatitis
  • High-output fistulae
  • Shock
73
Q

When can parenteral nutrition be given by standard IV lines?

A

In patients who are expected to improve within 1-2 weeks

74
Q

What are the complications of parenteral nutrition?

A
  • Malposition of central venous catheter
  • Possible pneumothorax
  • Infection
  • Catheter blockage from reflux
    Fluid and electrolyte abnormalities

Integrated Care [9] (14 decks)

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