E10 Undernutrition Flashcards
(37 cards)
define undernutrition
‘a state of nutrition in which a deficiency of energy, protein and other nutrients causes measurable adverse effects on tissue / body structure and function and clinical outcome’
risk groups of undernutrition and reasons why for each
children
- poor diet
- growth
elderly
- mobility
- dentition
- reduced appetite
- poverty
disabled
- mobility
- swallowing
mental health
- intake
- anorexia nervosa
disease
- infection
- GI disease
- swallowing
- cancer
describe cancer-induced cachexia
- generally haematological cancers and breast cancer patients don’t suffer weight loss
- most solid tumours associated with weight loss (eg. upper GIT cancer, lung cancer)
describe degree of thinness using BMI values
> 20 normal
18.5-20 marginal
17-18.5 mild malnutrition
16-17 moderate malnutrition
< 16 severe malnutrition
what are the 4 classifications of undernutrition?
- nutrient-specific
- generalised
- primary
- secondary
describe nutrient-specific undernutrition
- eg. vitamins, protein, minerals
- unbalanced diet leading to deficiencies of vitamins or minerals
describe generalised undernutrition
- food
- lacking all food from starvation
describe primary undernutrition
inadequate intake
describe secondary undernutrition
disease, infection, increased requirements
describe the body adaptation to starvation
- early starvation: liver glycogen used to provide energy
- stores used up within 24 hours
- glucose synthesised from protein
- fat metabolised to release FAs
- long term: lipolysis is preferred, sparing protein
state 5 things affected by undernutrition
- muscle function
- cardiovascular function
- GIT
- immune system
- increased risk of hypothermia
explain how undernutrition affects muscle function
- muscle wasting (sarcopenia)
- increased muscle fatiguability
- leads to deterioration in respiratory function
- exacerbates pre-existing respiratory disease (eg. COPD)
explain how undernutrition affects cardiovascular function
- loss of cardiac muscle with reduced cardiac output
- poor tissue perfusion
- hypotension
explain how undernutrition affects GIT
- impaired gastric and pancreatic exocrine function (reduced digestion)
- mucosal cell atrophy - reduced absorption
- increased intestinal permeability to bacteria
explain how undernutrition affects the immune system
- impaired immune response, poor healing, increased sickness
- reduced survival from surgery
- increased requirements for repair
- longer hospital stays
- postoperative complications more common in those who had lost more then 10% body weight
- potentially increased risk of readmission
explain how undernutrition increases risk of hypothermia
- loss of subcutaneous fat
- thermoregulation is impaired, reduced thermogenic response to cooling
psychological consequences of undernutrition in the brain
progression through:
- fatigue / weakness
- deterioration in intellectual function
- lack of initiative
- bedridden
- apathy
- depression (vicious cycle of undernutrition and depression)
- changes in behaviour and personality
- exhaustion
why is not as much energy required in those with undernutrition?
- no thermic response to food
- reduced cell mass
- reduced energy expenditure per unit cell mass
- lethargy / reduced activity
treatment of undernutrition
increase nutrient intake to reverse effects of undernutrition
- vitamins
- minerals
- macronutrients
- fluid
but, reintroduction of nutrient needs to be done with care, or referring syndrome occurs
what is refeeding syndrome? what are its symptoms?
sudden administration of high glucose loads in undernourished patients can lead to:
- hypokalaemia
- hypophosphataemia
- hyperglycaemia
- respiratory failure (raised carbon dioxide production)
- cardiac failure
how can referring syndrome be prevented?
- initiate feeding carefully (slowly)
- better to provide too little than too much initially
treatment of undernutrition patient
- initially give enough food to prevent further weight loss (stabilisation)
- increase energy to make positive energy balance
- enteral feeding
- monitoring
explain enteral feeding for the treatment of undernutrition
- nasogastric tube
- for severe anorexia
- initiated slowly to prevent refeeding syndrome
describe what must be monitored in patients suffering from undernutrition
- electrolytes, fluid, glucose
- ECG
- oedema
