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Flashcards in Malnutrition Deck (29)
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What are some consequences of malnutrition?

Impaired immune function
Delayed healing
Pressure sores
Muscle weakness
Cardio-respiratory weakness
Pyschosocial effects
Length of stay
Hospital costs
Prolonged recovery


What are causes of undernutrition?

Decreased intake
Increased requirements
Impaired absorption
Increased losses/utilisation


What should be determined and recorded when assessing a malnutritioned patient?

Determine current nutritional status
Determine nutritional goals
Record baseline to facilitate monitoring.


What should you be careful of when measuring weight and weight loss?

Be careful if oedema is present


What percentage of weight loss is significant?

5-10 %


What BMI signifies a) significant malnutrition, b) possible malnutrition and c) desirable BMI

a) <18.5
b) 18.5 - 20
c) 20-25


Does a normal or high BMI exclude malnutrition?



Why is BMI in the elderly inaccurate?

Because of height and muscle loss


Why is albumin a poor marker of malnourishment?

It has a long half life.
It has a reduced concentration secondary to many things e.g. inflammation, sepsis, IV fluids, nephrotic syndrome and impaired liver synthesis


What tool is used in Scotland for nutritional screening and is a standard of care?

MUST- malnutrition universal screening tool


What factors make up a MUST score?

1. BMI >20 = 0
18.5-20 = 1
10% = 2
3. Acute disease effect
Add a score of 2 is there has been or is likely to be no nutritional intake for >5 days


What MUST scores are a) low risk, b) medium risk and c) high risk?
What actions should be taken for each category of risk?

a) 0 = low risk - normal care
b) 1= medium risk - observe and re-screen
c) 2 or more = high risk - nutritional support


What measures are used to improve nutrition?

Food first
Oral supplements
Enteral Feeding
Parenteral feeding


Describe various methods of enteral tube feeding.

Percutaneous endoscopic gastrostomy
Percutaneous jejunostomy
Surgical jejunostomy


What are contraindications of enteral feeding?

Lower GI Obstruction
Active ulceration
Facial injury
Severe diarrhoea or vomiting
Prolonged intestinal ileus
Intestinal ischaemia


What are complications of enteral feeding?

Patient uncooperative
Metabolic disturbance


What is parenteral feeding?

The administration of nutrient solutions via a central or peripheral vein


What are negative features of parenteral feeding?

It is expensive
The complications are life-threatening
Needs specialist skills
Not physiological
Pyscho-social disturbance


Define malnutrition

A state of nutrition in which a deficiency, excess or imbalance of energy, protein and other nutrients causes measurable adverse affects on tissue, body form, function and clinical outcome.


What is the malnutrition cycle?

Illness--> hospital --> Anorexia and weight loss --> complications --> illness
This becomes a vicious cycle


List some psychosocial causes of malnutrition

inappropriate food provision
Lack of assistance
Poor eating environment
Lack of cooking skills or facilities
Self neglect
Inability to access food


List the biochemical markers commonly used to assess a patients nutritional status and describe their usefulness.

Albumin: A non-specific marker of illness
Transferrin: Synthesis reduced in protein restriction. Affected by APR, iron deficiency and liver disease.
Prealbumin: Reflects recent dietary intake rather than overall nutritional status. Increased in uraemia and dehydration. Decreased by APR, fasting. More useful in measuring response to nutritional support than initial assessment.
Retinol binding protein: Reflects recent dietary intake rather than overall nutritional status. Affected more by energy than protein restriction. Levels increased by increased glomerular filtration rate and alcoholism and decreased by chronic liver disorders and vitamin A and zinc deficiency.
Urinary creatinine: If renal function is normal, excretion rate mirrors muscle mass. Expressed per unit height. 24hr urine collection is required.
IGF1: Reduced in acute and chronic malnutrition and increases with repletion. Levels reduced in liver disease and renal failure.
Micronutrients: Poor correlation between plasma values and intracellular concentrion, especially during illness, therefore measurement of related coenzymes more useful. Usually can only be analysed by a specialised centre.


List some indications for enteral feeding.

Inadequate or unsafe oral intake, and a functional, accessible GI tract (If the gut works, use it).
Unconscious patients
Neuromuscular swallowing disorder
Upper GI obstruction
GI dysfunction
Increased nutritional requirements.


What are indications for parenteral feeding?

Should be considered in patients who are malnourished or at risk of malnutrition and meet either of the following criteria:
inadequate or unsafe oral and/or enteral nutritional intake
a non-functional, inaccessible, or perforated GI tract:
IBD with severe malabsorption
Radiation enteritis
Short bowel syndrome
Motility disorders


What is refeeding synrome?
When can it arise?

Potentially fatal shifts in fluids and electrolytes and disturbances in organ function and metabolic regulation that may result from a rapid initiation of re feeding after a period of under nutrition.
It is less likely to occur with oral feeding as intake is usually limited by a poor appetite, but excessive feeding can be administered by EN or PN.


What are some metabolic signs of refeeding syndrome?

Salt and water retention- fluid overload and oedema
Altered glucose metabolism


What are some physiological features of refeeding syndrome?

Altered level of consciousness
Respiratory failure
Cardiovascular collapse


How should patients who are at moderate risk of refeeding syndrome (i.e. have had more than 5 days of little or no nutrition) be managed?

Nutritional support should be introduced at a maximum of 50% of requirements for the first 48 hours.
Their clinical and biochemical parameters should be monitored.
If monitoring reveals no problem, increase nutrition support to meet full requirements.


How should patients at high risk of refeeding syndrome be managed?

Check phosphate, magnesium, calcium and potassium.
Provide immediately before and during the first 10 days of feeding:
vitamin B compound
multi-vitamin and mineral supplement
Start feeding at 5-10kcal/kg/day and slowly increase feeding over 4-7 days
Rehydrate carefully and supplement/correct levels phosphate, magnesium, potassium and calcium.
Monitor these levels for the first 2 weeks and amend supplementation as appropriate.

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