Malnutrition and Nutritional Assesement (Complete) Flashcards
Define malnutration
State in which lack of uptake or intake of nutrition leads to a altered body compisiton and cell body mass which results in impaired physical and mental function.
Malnutrtition tends to be highest in which age groups?
The young and elderly (more common in females)
Which 2 hospital specialty wards has the highest prevalence of mulnutrition in patients?
Oncology
Care of the elderly
Malnutrition is most common in patients with what group of diseases?
Gastrointestinal diseases
N.B. Also prevalent in patients with chronic diseases such as cancers, diabetes ect
70% of patients who have stayed in hospital end up losing weight (muscle mass vs fat). Suggest some hospital related factors that can lead to malnutrition in hospitals.
Malnutrition can lead to poorer physical and functional decline, leading to poorer clinical outcomes. List examples of the impact of malnutrition in terms of clinical outcomes.
Increases the risk of:
Mortality
Septic and post surgical complications
Length of hospital-stay
Pressure sores
Re-admissions, dependency
Reduces:
Wound healing
Response to treatment
Rehabilitation potential
Quality of life
What is the economic consequence of malnutrition?
Costs the economy £19.6 billion on public health expenditure due to patients requiring more care
What is the most common screening tool in the UK for malnutrition?
Malnutrition Universal Screening Tool (MUST)
N.B. It is not a assesment or diagnostic for malnutrition. It only helps to identify risk.
What 3 components are assessed in MUST to determine the risk of malnutrition?
BMI
Weight loss (unexplained weight loss)
Acute disease effect score (looks at whether acute disease is reducing or will reduce food intake)
What is the next step of action if a MUST score shows a patient is at high risk of malnutrition and may benefit from treatment (e.g. are not at imminent death)?
Refer to a dietician
What is the role of a dietician when dealing with malnourished patients?
Able to carry of an extensive nutritional assesment and diagnose malnutrition.
List the 3 components of a systematically approached nutritional assesement
Anthropology (to measure different compartments of the body and how they have been affected by malnutrition)
Biochemistry (Tests can be used to estimate nutritent availability in fluids and tissues)
Clinical history (provide insight into nutrient related problems) [E.g. clinical conditions, dietary constrictions, socioeconomic statuses]
What is the most reliable way to estimate energy expenditure and guide energy prescriptions in a nutritional assesment?
Indirect caliometry
N.B. However has many restrictions which limits its use in clincal setting. Therefore predictive equations are done instead.
According to NICE guidelines, providing nutrition support should be considered in people who are either? (2)
Malnourished
At risk of malnourishment
List 3 ways a patient can be considered malnourished according to NICE guidelines
BMI < 18.5 kg/m2 or
Unintentional weight loss >10 % past 3 - 6 / 12 months
BMI < 20 kg/m2 + unintentional weight loss > 5 % past 3 – 6 months
List 2 ways a patient can be considered at risk of being malnourished according to NICE guidelines
Have eaten little or nothing for > 5 days and / or are likely to eat little or nothing for the next 5 days or longer
or
Have a poor absorptive capacity, and / or have high nutrient losses and/or have increased nutritional needs from causes such as catabolism.
Define artificial nutritional support
The provision of enteral or parenteral nutrients to treat or prevent malnutrition.
According to the algorithm by Stratton and Elia for malnutrition support, when should a patient be considered for enteral tube feeding?
Oral nutrition is not possible and GI tract is functional and accesible
Or oral nutrition is possible but regularly monitored intake shows inadequate nutrition after receiving oral nutritional support
What are the different types of enteral feeding methods depending on access points?
Put a tube down the nose and the tube can end up in different access points:
Nasogastric tube (Stomach) [NGT]
Nasoduodenal tube [NDT]
Naso-jejunal tube [NJT]
Or for long term (>3 months) of enteral nutrition is required, may require a gastrostomy or jejunostomy (Directly into stomach or jejunum)
For a patient requiring long-term enteral nutrition (> 3 months), what type of enteral nutrition method would be most suitable?
A gastrostomy (if gastric feeding possible)
Jejunstomy (If gastric feeding not possible)
Give an example of a condition which can prevent gastric feeding as a possibility for enteral nutrition and suggest what the next step of action should be in these patients.
Gastric outlet obstruction
NGT is contraindicted in these cases so should give patient a NJT
What is a serious complication associated with enteral feeding and how can this be avoided?
Misplaced NG tube
Must take an aspirate sample from the NG tube and measure the pH
Aspirate should be pH < 5.5 (indicates GI acidic content)
if aspirate pH > 5.5 then they need an X-ray interpreted by trained professional following NPSA guidelines
Define parental nutrition
The delivery of nutrients, electrolytes and fluid directly into venous blood.
What is the most common access point for parenteral nutrition?
•Central venous catheter (CVC): tip at superior vena cava and right atrium.
N.B. Different centra venous catheters for short/long-term use
How is parenteral nutrition composition determined for individual patients?
Can administer ready made or ‘scratch’ bags
The dietician also liases with the MDT to determine the electrolyte/fluid targets for the day
List some complications associated with parenteral feeding
Catheter related infections
Mechancal complications:
Pneumothorax
Haemothorax
Thrombosis
Cardiac arrythmias
Metabolic:
Deranged electrolyttes
Hyperglycaemia
Hypertriglycerideamia
Explain the acute phase resposne which results in lower albumin levels
When there is an inflammatory stimulus (e.g. muscle breakdown), it triggers the activation of macrophages and monocytes which release cytokines such as IL-6 and TNF.
Cytokines then act on the liver and upregulate some proteins whilst downregulating others such as albumin
Summarise the pathogenesis of refreeding syndrome
When malnourished, the body switches to a catabolic state (gluconeogeneis, glycogenolysis, increased glucagon, proteinolysis)
Protein, fat, mineral and elctrolyte depeltion results in salt and water intolerance (low concentration in plasma)
Refeeding then triggers a anabolic state resulting in insulin secretion
This promotes increased protein and glycogen synthesis, increased electrolyte uptake, glucose uptake and utilization of thiamine.
This consequently depletes plasma stores as they are already low, resulting in many complications such as hypokalaemia, thiamine deficiency, hypomagnesia, salt and water retention (e.g. oedema).
These depletions can result in the clinical manifestations of refeeding syndrome (e.g. arrythmia, werknickes encephalopathy due ti thiamine deficiency)
