Malnutrition and Nutritional Management for Patients Flashcards Preview

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Flashcards in Malnutrition and Nutritional Management for Patients Deck (18):
1

Define malnutrition

Malnutrition is a state of nutrition in which a deficiency, excess or imbalnce of enrgy, protein and other nutrients causes measureable adverse effects on tissue,m body form (body shape, size and composition), function and clinical outcome. 

2

List the disease related causes of malnutrition

 

  1. Decreased intake​​
    • poor appetite, pain on eating, medicaiton side effects, dysphagia, sore mouth
  2. Impaired digestion and/or absorption
    • ​​problems affecting stomach, intestine, pancreas and liver
  3. Increased nutritional requirements
    • ​​catabolism infection, trauma, burns, surgery
  4. Increased nutritional losses 
    • ​vomiting, diarrhoea, stoma losses 

3

What are some of the impacts of malnutrition?

  • GI dysfunction
  • increased infection rate
  • decreased wound healing
  • physical weakness

this all leads to an increased lenght of stay 

4

List the psychosocial causes of malnutrition

  • inappropriate food provision
  • lack of assistance
  • poor eating environment
  • lack of cooking skills or facilities 
  • self neglect
  • bereavement 
  • inability to access food
  • deprivation
  • loneliness

5

What are the effects of 

a) starvation

b) injury

on metabolic rate, weight, nitrogen losses, hormones, water & sodium

See image attached

 

6

What are some of the effects and consequences of malnutrition?

A image thumb
7

How does NHS Tayside monitor nutrional status of patients?

ACTUALLY IMPORTANT

  • all patients must be nutrionally screened within 1 day of admission and at regular intervals throughout stay
  • NHS Tayside uses MUST Score

 

A image thumb
8

What biochemical tests are done for nutrional status?

 

  • Albumin
  • Transferrin
  • Transthyretin (prealbumin); never see this on normal hospital request
  • Retinol binding protein; never see this on normal hospital request
  • urinary creatine
  • IGF1
  • Micronutrients; usually can only be analysed in specialist centre 

all only 1 tiny sort of useless part of management 

 

9

Who needs nutrional support?

 

  1. BMI <18.5
  2. Unintentional weight loss >10% within last 3-6 months
  3. BMI <20 & unintentional weight loss >5% within last 3-6 months
  4. Eaten or are likely to eat little or nothing for 5/> days 
  5. Poor absorptive capacity and/or high nutrient losses and/or increased nutrional needs from causes such as catabolism 

10

What are the nutritional support options?

 

  • ONS: Oral Nutritional Support
  • ETF: Enteral Tube Feeding
  • Parenteral Nutrition

11

What is enteral tube feeding?

Delivery of a nutrionally complete feed via a tube into the stomach, duodenum or jejunum

  • nasogastric (NG)
  • nasojejunal (NJ) 
    • is stomach isnt empyting properly :. needs bypassed
  • percutaneous jejunostomy 
    • still physiological because still using gut, may be used if had stroke 
  • surgical jejunostomy 

 

A image thumb
12

Why would you use ETF?

  • inadequate or unsafe oral intake
  • functinoal, accessible GI tract
  • 'if the gut works, use it'
    • unconscious patient
    • neuromuscular swallowing disorder
    • upper GI obstruction
    • GI dysfunction
    • increased nutrional requirements 

13

Why wouldn't you use ETF?

  • lower GI obstructions
  • prolonged intestinal ileus
  • severe diarrhoea or vomiting
  • high enterocutaneous fistula
    • abnormal connection in bowel that goes to skin
    • pour food into mouth and it comes out into skin without properly being absorbed 
  • intestinal ischaemia 

14

What are some of the possible complications of enteral tube feeding?

A image thumb
15

What is parenteral nutrition?

 

The administration of nutrient solutions via a central or peripheral vein

  • expensive
  • complications are life-threatening
  • needs specialist skills
  • not physiological
  • psycho-social disturbance 

NB: this is NOT PHYSIOLOGICAL. It doesnt reach gut or go to liver via portal vein it goes straight to systemic circulation and gets to the liver that way

MDTM is required 

Prefer to use a central line

16

Why would you use parenteral nutrition?

Healthcare professionals should consider parenteral nutrition in people who are malnourished or at risk of malnutrition and meet either of the following criteria:

  1. Inadequate or unsafe oral and/or enteral nutrional intake
  2. Non-functional, inaccessible or perforated GI tract
    • IBD with severe malabsorption
    • radiation enteritis 
    • short bowel syndrome 
    • motility disorders 

17

Common indications for parenteral feeding?

 

  • severe malnutrition pre-op
  • post-op feeding: ileus/organ failure/ 5 day rule
  • intestinal fistulae 
  • multi-organ failure
  • post chemo mucositis 

For most of these patients this is just a bridge and they'll soon be fine. 

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