malnutrition Flashcards

Question

respiratory system

Answer 1

o visible wasting, costo-chondral bead (Vit C; sharp and vit D dull), Harrison’s groove and signs of pneumonia.

Answer 2

o Bradycardia, hypotension, reduced cardiac output, small vessel vasculopathy, slow capillary refill>3sec, shock

Answer 3

Distended (port belly), gaseous because of bacteria overgrowth hepatomegaly with fatty liver is only seen in kwashiorkor. fluid thrill and shifting dullness

Answer 4

Edema characterizes as pitting or non-pitting, and grade 1-3. o Muscle wasting (Buttocks giving baggy pant appearance) and thighs o Sign of hypocalcemia Chvostek sign (twitching of the face while striking on jaw angle) and trousseau sign (flexion of metacarpophalangeal joint and extension of inter phalangeal joints. o Skeletal deformities (Vit D, Vit C and calcium deficiencies).

Answer 5

o Skin: cold and clammy skin; shock, loose and wrinkled (marasmus), shiny and edematous (kwashiorkor), dry follicular hyperkeratosis, patchy hypo-and hyper-pigmentation (crazy paving/flaky paint dermatosis), erosion and poor wound healing, Pallor, petechiae. o Hair: brownish discoloration (flag sign), easily pluck-able, dull, sparse, broom stick eyelashes, alopecia. o Nails: koilonychia, thin and soft nail plates, fissure and ridges.

Answer 6

lethargic, apathy, irritable, weak reflexes, impaired memory.

Answer 7

o CBC, RBS, Stool Examination, PICT, Organ Function Tests (OFT) , Serum Electrolyte, Chest X-ray

Answer 8

stabilization and rehabilitation.

Answer 9

repair cellular function, correct fluid and electrolyte imbalance, restore homeostasis, and prevent death from the interlinked triad of hypoglycemia, hypothermia, and infection.

Answer 10

restores wasted tissues (i.e., catch-up growth).

Answer 11

grade 3 edema severe wasting complications appetitie loss if they are < 6 months

Answer 12

phase 1 transitional phase 2

Answer 13

: treatment is always given in an in-patient setting. During this phase, o Life-threatening medical complications are treated o Routine drugs (vitamins, folic acid, antibiotics, de-worming) are given to correct specific deficiencies o Feeding with F-75 milk (low caloric and sodium) is begun

Answer 14

Here the patients are going to be prepared for phase 2 and F75 in phase 1 is changed to F100 or RUTF

Answer 15

can be given both in inpatient and out patient o Phase 2 inpatient: when treating the patient in outpatient is not reasonable; no capable care giver, no enough supply of RUTF o Phase 2 outpatient: when there is capable care giver, enough RUTF, OTP program is near to home. o N: B F100 is never given in outpatient care.

Answer 16

* Definition: RBS<54mg/dl * Prevention: feeding appropriate amount of F 75(check reference card) Q 2hrs especially in the first 24 hrs. * Treatment: 10% glucose o If the child is awake: 50ml of bolus orally or by NGT if the child is unable to drink o If the child is lethargic, unconscious or convulsing: 5ml/kg of 10% glucose by IV then 50ml of 10% bolus by NGT o Continue giving F75 30min after giving glucose solution and every 30min (1/4th of the 2 hr feed) thereafter for the first 2 hrs

Answer 17

* Definition: rectal temperature<35.5°c, or axillary temperature<35°c * Prevention: feeding, avoid heat loss, keep them dry, sleep with the mother(skin to skin), room T° 28°c-32°c o Monitor T° Q 30 min while rewarming

Answer 18

Diagnosis: o Mainly depending on history, watery diarrhea and vomiting with recent change in appearance o Excessive weight loss for edematous SAM; >2% of body weight per day o Look for other sign and symptoms if dehydration o Special rehydration solution: ReSoMal, rehydration solution for malnutrition o Best solution in malnutrition over ORS, with less sodium, more sugar and potassium. o Exception is dehydration caused by cholera; use ORS * Modifying ORS to ReSoMal o MIX WHO standard 1 litter packet ORS in 2 litters of water o Add 50g of sugar o Add 40ml of mineral mix or 1 scoop of CMV (combined mineral mix) - use 5 tablets of 600mg (8MEq) KCL for our setup. * Prevention o Replace loss with: o 50-100ml/loss for non-edematous SAM below age 2yrs o 100-200ml/loss for non-edematous SAM above age 2yrs o 30ml/loss for edematous SAM of all ages

Answer 19

* Diagnosis: cold hands, with slow capillary refill and weak fast feeble or absent pulses * IV fluid: RL or 0.45% NS with 5% dextrose. o NB: RL and 0.45% saline are the preferred fluids for management of shock in malnutrition b/c of their low sodium concentration as compare to NS. * Amount: 15ml/Kg over 1hr, reassess response * If improving repeat 15ml/Kg over 1 hr * If not improving consider septic shock and put on maintenance 4ml/kg/hr and look for cross matched blood, 10 ml/kg slowly over 3 hours or packed RBC in case of heart failure * Evaluate the patient further to identify the cause * Follow patients with V/S, wt, input output, liver size,

Answer 20

* Mild: Hgb9g/dl * Moderate: Hgb≤9g/dl, >7g/dl * Severe: Hgb≤7g/dl * Very severe anemia: Hgb<4g/dl; transfusion threshold for malnutrition * Investigate other possible causes such as malaria and intestinal parasites (for example, hookworm). * Do NOT give iron during stabilization phase as it can damage cell membranes and make infections worse.

Answer 21

dilutional anemia on 2-14 days of treatment due to movement of fluids from to tissue to vascular space transient and normally resolves spontaneously after 2 or 3 days when kidney function recovers, and excess fluids can be eliminated. * For these reasons, transfusion is not recommended between 48 hours and day 14 days unless there is heart failure and the cause is other than dilution anemia.

Answer 22

* Give blood transfusion in the first 48 hours if: o Hgb is < 4 g/dl, (Hct is < 12 %), or o Hgb 4 to 6 g/dl (Hct 12 to 18%) and respiratory distress o Stop all oral intake and IV fluids during the transfusion. * Look for signs of congestive heart failure such as fast breathing, respiratory distress, rapid pulse, engorgement of the jugular vein, cold hands and feet, cyanosis of the fingertips and under the tongue. o Furosemide (1 mg/kg, given by IV) * If no signs of congestive heart failure, transfuse whole fresh blood at 10 ml/kg slowly over 3 hours. * If signs of heart failure, give 5-7 ml/kg packed cells over 3 hours instead of whole blood. * Diuretics should never be used to reduce edema in children with Severe Malnutrition. The purpose of giving a diuretic before a blood transfusion is to prevent congestive heart failure from overloading the circulation with the transfusion.

Answer 23

* Give vitamin A and atropine eye drops immediately for corneal ulceration

Answer 24

* Physical deterioration with weight gain, * Sudden increase in liver size, * Tenderness of the liver, * Crackles in lungs, * Prominent superficial and neck veins, * Engorgement of the neck veins when the abdomen (right upper quadrant) is pressed, (hepatojugular reflex) * Heart failure and pneumonia may be difficult to tell apart as they can be clinically similar. When weight gain precedes or is associated with signs of respiratory distress, heart failure should be the first diagnosis. If there is loss of weight, consider pneumonia instead. * Note: Children with edema do not necessarily present with weight gain during heart failure if the expanded circulation is due to mobilization of edema fluid from the tissues to vascular space. * Stop all intakes of oral or IV fluids. No fluid or therapeutic feeds should be given until heart failure has improved (even if this takes 24 to 48 hours). Small amounts of sugar-water can be given orally to prevent hypoglycemia. * Give Furosemide (1 mg/kg) single dose, repeat if necessary. * If it is due to severe anemia, manage the anemia as above.

Answer 25

BMR decrease by 30% low total body potassium low ATP results in loss of intracellular K and increased intracellular sodium if iron, folic acid, Vitim B12 are not in sufficient amounts, “functional anemia” tissue hypoxia will develop.

Answer 26

increased fatigue decreased strength of skeletal muscle

Answer 27

reduction in Hb concentration and red cell mass decease in dietary amino acids results in reduced hematopoietic activity these cases functional anemia with tissue hypoxia will develop

Answer 28

CO and SV are reduced in proportion to the loss of lean body mass In severe SAM peripheral circulatory failure comparable to hypovolemic shock

Answer 29

RPF and GFR may be reduced UTI are common Water clearance and the ability to concentrate and acidify urine appear impaired

Answer 30

Thin atrophic wall with a reduction in villous height Reduction in functional capacity of the digestive system

Answer 31

the decreased food intake cases reduction in plasma concentration of glucose and free amino acids interns reduce insulin secretion and increase glucagon and epinephrine release which will further reduce insulin secretion

Answer 32

grade I: start in axilla and groin grade II: thigh and buttocks grade III: chest and abdomen grade IV: facial muscle

Answer 33

Is defined as the potentially fatal shift in fluids and electrolytes that may occur in malnourished patients receiving artificial refeeding.

Answer 34

Infection Hypoglycemia Hypothermia Electrolyte imbalance Severe anemia Dehydration Corneal ulceration Shock Skin lesion CHF(secondary to treatment)

Answer 35

begins when stores of phosphate are depleted during episodes of аոοrехia nervosa and ѕtаrvаtioո. Subsequently, when nutritional replenishment starts and patients are fed carbohydrates, glucose causes release of insulin, which triggers cellular uptake of phosphate (and potassium and mаgneѕium) and a decrease in serum phosphorous levels. Insulin also causes cells to produce a variety of molecules that require phosphate (eg, adenosine triphosphate and 2,3-diphosphoglycerate), which further depletes the body’s stores of phosphate

Answer 36

Ηурοрhοѕphаtеmia ●Ηурokаlemiа ●Congestive heart failure ●Peripheral еԁеma ●Rhabdomyolysis ●Seizures ●Hemolysis ●Respiratory insufficiency

Answer 37

The rapid increase in nutrient intake results in a switch from a catabolic state to an anabolic state. The ensuing surge in insulin secretion can result in hурοglусеmia and influx of extracellular electrolytes into the intracellular space, which can lead to dangerously low extracellular concentrations of potassium, phosphate, and magnesium.

Answer 38

patients who weigh less than 70 percent of their ideal body weight, or have a BMI (calculator 2) <14 kg/m2, generally require hospitalization for the initial stage of nutritional replenishment and medical stabilization. Other risk factors for the refeeding syndrome include low baseline levels of phosphate, potassium, or magոеsiսm prior to refeeding the patient; and little or no nutritional intake for the previous 5 to 10 days.

malnutrition Flashcards

(63 cards)