malnutrition Flashcards
(46 cards)
when is oral feeding not advised
cognitive impairment
Dysphasia
Types of oral feeeing
By mouth
Normal food, softened food, thickened foods, puréed, fluids etc
What is first line enteral feeding
nasogastric tube
Complications of NG tubes
Tube misplacement Obstruction Electrolyte imbalance Hyperglycaemia Aspiration pneumonia! Larynx ulceration, pharyngeal pain Vomiting and diarrhoea Line infections Refeeding syndrome
How is parenteral nutrition done
Via central venous catheter
Difference between feeding or parenteral and enteral
Enteral made for patients needs
Parenteral from scratch bag
Indications for parenteral feeding
Where oral enteral unsafe
Or GI inaccessible or cannot function
How to testif enteral feed misplaced
pH shouldn’t be over 5.5
If over, immediate imaging to find it
What is refeeding syndrome
starvation for long time
if reintroduced to nutrients, surge in insulin
Encourages cells to take up potassium magnesium and phosphate which are already low in serum (and get lower) causing electrolyte imbalances
A causes arrhythmias, respiratory arrest, multi organ failure
definition of malnutrition
state resulting from lack of uptake/intake of nutrition leading to diminished physical and mental function and impaired clinical outcome from disease
rate of malnourishment upon admission to hospital
1 in 3 are manourished
what % of patients have lost weight at discharge
70%
factors that lead to malnutrition in hospitals
co-morbidities e.g. dementia inflexible mealtimes quality of food dysphagia, stomatitis, anaemia, poor dentition, ill fitting dentures inactivity low mood/depression polypharmacy excess nutritional losses repeated NBM status metabolic response to disease/injury
loss of what % of bodyweight preoperatively leads to 10x greater postop mortality?
> =20%
what increases with malnutrition?
mortality septic and post surgical complications length of hospital stay pressure sores readmissions dependency
what decreases with malnutrition?
wound healing
response to treatment
rehabilitation
QoL
CT advantages in formal nutrition assessment
provide info about body composition
-> however involves exposing patient to radiation
Why is BMI not used to assess malnutrition?
not representative of difference between fat and fat free mass
skin fold thicknesses used for malnutrition assessment
- triceps skinfold thickness
- mid upper arm circumference use similarly to determine lean body mass (positive association)
anthropometric analysis multifrequency bioelectrical impedance analysis used in which patients?
renal and haematology patients
what type of fat can CT scans distinguish between?
visceral and subcutaneous fat
-> highly accurate for evaluating levels of fat and fat free mass
problems with CT for nutritional assessment
expensive, expose individuals to small amounts of radiation
-> use for body comp restricted to research normally
-> being used more frequently in specialities where CTs are already part of the clinical treatment pathway
why are micronutrient and trace elements tests not undertaken easily?
time consuming
expensive
results skewed as a result of the acute inflammatory response
best way of obtaining dietary intake information
dietary history