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Flashcards in Malnutrition Deck (50):
1

Define malnutrition

A state of nutrition in which a deficiency, excess or imbalance of energy, protein and other nutrients causes measurable adverse effects on tissue, body form (body shape, size and composition), function and clinical outcome

2

Name some effects of disease related causes of malnutrition

Decreased intake
impaired digestion / absorption
Increased nutritional requirements
Increased nutrient losses

3

How many hospital admissions are identified as malnourished?

30-40%

4

What happens to the majority of patients who are treated for malnutition

They improve their nutritional status

5

Name some economic consequences of malnutrition in the over 65s

More hospital admissions
Longer length of stay
more GP visits
More OP visits

6

What is the main difference between short term and long term malnutrition?

Short term is adaptive and they usually return to normal
Long term is a gradual decline and harmful

7

Describe the malnutrition cycle

Anorexia and weight loss result in complications, contributing to illness which results in a hospital admission

8

What do chronic conditions often result in

Poor food intake leading to malnutrition

9

What is an effect of malnutrition in the GI system

Dysfunction - increased infection rate, decreased wound healing and physical weakness. These all result in a poor food intake

10

Describe some acute events which can lead to poor food intake

Sepsis, pneumonia, fever, surgery, trauma, radiotherapy, chemotherapy

11

Name some psychosocial causes of malnutrition

Inappropriate food provision
self neglect
lack of assistance
bereavement
inability to access food
poor eating environment
deprivation
loneliness
lack of cooking skills/ facilities

12

What happens to the metabolic rate in starvation

Reduced

13

What happens to the weight in starvation

slow loss, almost all from fat stores

14

What happens to the water and sodium in starvation

Initial loss but then late retention

15

What happens to the metabolic rate in injury

Increased

16

What happens to the weight in injury

Rapid loss 80% from fat stores, remainder from protein

17

What happens to water and sodium

Retained

18

Name some adverse effects of malnutrition

Impaired immune responses
Impaired wound healing
reduced muscle strength and fatigue
reduced respiratory muscle strength
inacrtivity, especially in bed bound patient
water and electrolyte disturbances
impaired thermoregulation
menstrual irregularities. amenorrhoea
impaired psycho-social function

19

What can weight loss be an indicator for?

Impaired GI motility
Acute liver disease
Intra- abdominal infection
acute liver disease
coeliac disease
oesophageal cancer
gastric cancer
colorectal cancer
crohn's disease

20

Name some consequences of malnutrition

Impaired immune function
Delayed healing
pressure sores
Immobility
Muscle weakness
Cardio-respiratory weakness
Psychosocial effects
Length of stay
Hospital costs
Prolonged recovery

21

When do we screen for risk of under nutrition?

On admission and at regular intervals thereafter

22

What screening tool do we use in Tayside?

MUST (Malnutrition Universal Screening Tool)

23

What is the usefulness of albumin in nutritional assessment?

Constitutes around 50% of total protein in plasma
Low levels therefore could indicate malnutrition although this can be affected by various other factors

24

Generally speaking, what is the trend in biochemical assessment of nutritional status

Most tests are reduced or poor in malnourished individuals

25

What type of person requires nutritional support?

BMI <10% within the last 3-6 months
No nutritional intake for 5 days
Poor absorptive capacity or high nutrient losses

26

Name some types of nutrition support

Food fortification and dietery counselling
Oral nutrition support (additional snacks)
Enternal tube feeding (PEG)
Parenteral nutrition (IV)

27

Name some oral nutritional supplements

Ready made drinks (sip feeds)
Powders to reconstitue with milk (Build up, ensure)
Pudding with forticreme

28

Name some fat supplements

Calogen

29

Proc-Cal is used for what?

Fat and protein supplements

30

What does ETF stand for

Enteral Tube feeding

31

How does ETF work

Delivers nutritional complete feed via a tube into the stomach (NG, NJ, PEG)
The feed is nutritionally complete

32

What are the indications for ETF

Inadequate or unsafe oral intake (SALT)
A functional, accessible GI tract

33

What are some contra-indications for ETF

Lower GI obstruction
Prolonged intestinal ileus
Severe diarrhoea or vomiting
High enterocutaneous fistula
Intestinal ischaemia

34

What are some complications of ETF

Nasal damage
Tube falls ut
Oesophagitis
Aspiration
Nausea
Hyperglycaemia
Fluid overload
Electrolyte disturbance

35

What is parenteral Nutrition

The administration of nutrient solutions via a central or peripheral vein

36

What are the problems with Parenteral nutrition

Expensive
Complications are life threatening
Needs specialist skills
Psycho-social disturbance

37

What is the main indicator for parenteral nutrition?

A non-functional, inaccessible or perforated (leaking) GI tract

38

What are some reasons for a perforated GI tract?

IBD with severe malabsorption
Radiation enteritis
Short bowel syndrome
Motility disorders

39

How do you estimate energy requirements

calculate basal metabolic rate
May need to add factor to account for increased requirements caused by metabolic stress of disease
Add factors for activity and thermomgenesis
May add/ subtract energy to allow weight gain/ loss

40

What is refeeding syndrome?

Potentially fatal shifts in fluids and electrolytes and disturbances in organ function and metabolic regulation that may result from rapid initiation of re feeding after a period of under nutrition

41

How can excessive feeding be administered?

By PN or EN

42

What are some of the metabolic features of refeeding syndrome?

Hypokalaemia
Hypophosphataemia
Hypomagnesaemia
Altered glucose metabolism
Fluid overload

43

What are some of the physiological features of refeeding syndrome?

Arrhythmias
Altered level of consciousness
Seizure
Respiratory failure
Cardiovascular collapse
Death

44

Who is at moderate risk of refeeding syndrome?

Patients who have had little or no nutritional intake for >5days

45

Who is at extremely high risk of refeeding syndrome?

BMI 15days

46

What is the prevention and management of refeeding syndrome in moderate risk patients?

Introduce a nutrition support at a maximum of 50% of requirement for the first 48hours
Monitor clinical and biochemical parameters
Increase nutrition support to meet full requirements if monitoring reveals no problems

47

What 4 things do we need to check in high risk refeeding syndrome patients?

PO4, Mg2+, K+ and Ca2+

48

What rate of feed do we start high risk patients on?

10kcal/kg/day

49

What is the rate of feed that we start extremely high risk patients on?

5kcal/kg/day

50

What can with-holding nutrition be perceived as?

Neglect

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