malnutrition

Question 1

what is malnutrition

Answer 1

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

Question 2

can malnutrition relate to obesity

Answer 2

yes

Question 3

annual cost of under nutrition

Answer 3

£19.6billion

Question 4

how many people in UK are under nourished

Answer 4

3 million

Question 5

describe the conceptual model of malnutrition

Answer 5

basic causes - infrasturucture, political ideology, resources

underlying causes - household food insecurity, poor social care and envirmonment, poor access to healthcare and an unhealthy environment

immediate causes - disease and inadequate food

Question 6

factors contributing to malnutrition - inadequate fodo

Answer 6

poverty 
poor cooking
social isolation
bereavement
limited access to food

Question 7

disease related contributors

Answer 7

increased nutritritional requirements - Crohns/burns/cancer cachexia 
nausea/vomiting/taste changes 
diarrhoea
early satiety 
depression 
mobility 
frequent hospital admissions

Question 8

consequences of malnutrition

Answer 8

lean body mass – massive effect on how live life and the support needed to stay at home

More likely to fall – readmissions
Low mood
More likely to go into care home – require more support

low immune func

muscle weakness

kidneys

brain - apathy, depression, self-neglect

reduced fertility

hypothermia

growth regulation

micronutrient deficiency

Question 9

3 ways to assess malnutrition

Answer 9

nutrition screening
nutrition assessment
nutritional diagnosis

Question 10

describe nutrition screening

Answer 10

quick 
Screen everyone that is admitted
Regular and routine – admission and intervals 
Done by nurses or health care assistant 
with 24hours 
validated screening tool

Question 11

describe nutritional assessment

Answer 11

more detailed
anthropometrics
dietician/specialist nurse

Question 12

purpose of nutritional screening

Answer 12

Categorise people into risk so they can get the right support

Question 13

describe the malnutrition universal screening tool

Answer 13

score for BMI
score for weight loss in 3-6months
score 2 if been acutely ill

add scores together to determine the malnutrition risk

0 - low risk - reassess: In hospital screen week
care homes- month
More community – yearly for in risk gps

1 – keep food charts, red trey scheme so people know they need assistance with food

2 – full dietary assessment and put in plan

Question 14

how do you assess malnutrition and technical difficulties

Answer 14

% loss – see if signifivant – what and in how long- quicker is more significant – impact the care plan
Weighing rely on people being able to get on scales – bed/chair/hoist
Height – cant stand – surrogate markers – each measure wrist to sternal notch (demispan) or wrist to elbow (ulnar length)

Handgrip – measure of functional use, skinfold thickness – measure of biceps, tricep, super iliac?

Muscle circumference and how it changes

Question 15

describe the food chart

Answer 15

Food record chart
24 hour – add food frequency

Macronutrient – 3 day enough
Micronutrient and vitamen – longer – need a lot info to get accurate food – weight/brand

Question 16

assessing nutritional status through biochemistry

Answer 16

Depend on clinical picture of patient 
Albulin – inflamm – trauma and stress so on own doesn’t give whole picture 
Creatine – change in muscle mass
change in cholesterol 
Liver func test

Question 17

practical impact of malnutrition

Answer 17

falls 
muscle wastage 
low mood
increased admissions 
reduced independence 
confusion 
increased infections

Question 18

what is artificial feeding

Answer 18

Nutrition therapy for people unable to get enough nourishment from food and drink

Question 19

forms of nutritional support

Answer 19

Food first – snacks, butter, more fried food, fortified – more calories for less food

Red tray – need to see how much that person has eaten, encourage more

Oral nutritional supplements – on prescription
assistance with feeding 
swallow assessment 
food and fluid charts 
manage nausea/vomiting/bowels

Question 20

What are the enteral access routes

Answer 20

nasogastric tube 
gastrostomy tube 
jejunostomy 
nasojejunal tube 
nasoduodenal tube

Question 21

When would you use a Nasogastric feed?

Answer 21

Need nutritional support for less than a month
Poor appetite - For people not meeting nutritional requirement – might be full feediung or just a top up
Stroke – cant swallow/not safe – liquid goes into lung if not swallowing properly
ICU- sedated and on a ventilator
After surgery – weak – might not eat well

Question 22

pathway to decide which nutritional support

Answer 22

func GI tract - Yes -> oral diet/supplement or enteral feeding 
No -> parenteral feeding

Question 23

who do you know how much to feed

Answer 23

For people not meeting nutritional requirement – might be full feeding or just a top up - research

predictive equations

Question 24

when use a gastrostomy

Answer 24

long term
neurological swallowing problems
mechanical obstruction

low morbidity associated - but when done incorrectly - high post insertion mprtaity

Question 25

when use a jujunostomy tube

Answer 25

upper GI obstruction (oesophagus/stomach) early post op feeding management of long term delayed gastric emptying

Question 26

complications of enteral feeding

Answer 26

nausea and vom, tube issue - pain/ulcer tube block If not flushed properly/aspiration diarrhoea (intestinal infection/medications/malabsorption), constipation metabolic complications (over/under feeding)

Question 27

what is parenteral feeding

Answer 27

The administration of nutrients, either centrally or peripherally, where the gastrointestinal tract is inaccessible OR there is insufficient gastrointestinal function.

Question 28

when do you use PN

Answer 28

``` ONLY when the gut isn't working prolongued obstruction/pseudoobstruction ilueus prolongued intestinal failure -radiation enteritis, short bowel syndrome, ischemic/necrotic bowel severe acute pancreatitis inadequate EN complex GI surgery onchology patients with GVHD ```

Question 29

how is PN administered

Answer 29

PICC line put into large arms of the vein, above or below the elbow

Question 30

complications with PN

Answer 30

``` pneumothorax bleeding misplacement line sepsis thrombosis phlebitis occlusion - kinking/clogging dislodgement/fracture/leaking refeeding synsdorm hyper/oglucaemia electrolyte diusturbances hypertriglkyceridaemia liver disease cholelithiasis metabolic bone disease micronutrient imbalances liver disease ```

Question 31

what is refeeding syndrome

Answer 31

syndrome consisting of metabolic disturbances that occur as a result of reinstitution of nutrition to patients who are starved or severely malnourished when starved for 5 days or more

Question 32

describe the process involved in re-feeding syndrome

Answer 32

fast reduced insulin, raised glucagon and cortisol glycogenolysis, gluconeogenesis, protein catabolism depletion of electrolytes, proteins, minerals and vitamins feed insulin increase protein and glycogen synthesis increase glucose uptake, uptake pf phosphorus, mg and K, thiamine use = hypophosphtaemia, hypokalaemia, hypomagnesaemia, thiamine deficiency, sodium retention and water retention

Question 33

consequences of re-feeding syndrome - phos

Answer 33

``` altered myocardial func arrhythmia congestibve heart failure vent fauilure lethargy seizures confusion paralysis, Rhabdomyolysis ```

Question 34

consequences of RFS - K

Answer 34

``` arrhythmia cardiac arrest resp destress paralysis weakness Rhabdomyolysis ```

Question 35

consequences of RFS - Mg

Answer 35

``` arrhythmia tachycardia rresp depression ataxia weakness confusion muscle tremors tetany ```

Question 36

management of RFS

Answer 36

replace electrolytes vitamin supplements - start nutrition at 10kca/kg/day

Question 37

nutritional supplements

Answer 37

but experts agree that most people can get enough of these nutrients from eating a balanced diet and, in the case of vitamin D, from getting enough sunlight. On the other hand, there is good evidence that certain vitamin supplements may be beneficial to the health of certain groups of people, such as the elderly, pregnant women and children between six months and five years old. The study found no reduction in mortality in people who took antioxidant supplements, either in healthy people or in those with diseases.