Nutrition Flashcards
(32 cards)
1
Q
What is Malnutrition?
A
- A sudden or chronic decrease in the intake of sufficient nutrition to support the body’s requirements for growth, healing and maintenance of life
2
Q
What is Acute Malnutrition?
A
- A brief period of inadequate nutrition that is most commonly in relation to an acute illness with a high inflammatory state, such as pneumonia, results in muscle wasting and rapid weight loss
3
Q
What is Chronic Malnutrition?
A
- Inadequate nutrition that lasts longer than 3 months. Often secondary to social, behavioural and economic factors in addition to illness-related causes
4
Q
What is the screening for Malnutrition?
A
- MUST tool
- Takes into account BMI, unplanned weight loss and changes to diet
5
Q
What are the four main reasons that someone might be malnourished?
A
- Inadequate amounts of nutrients (reduced dietary intake)
- Difficulty absorbing nutrients (coeliac disease and GI dysfunction)
- Increased nutritional demands (post-surgery for healing)
- Energy expenditure
6
Q
What are the risk factors for Malnutrition?
A
- Being hospitalised for extended periods of time
- Problems with dentition, taste or smell
- Polypharmacy
- Social isolation and loneliness
- Mental health issues including grief, anxiety and depression
- Cognitive issues including confusion
7
Q
What are some of the typical clinical features of malnutrition?
A
- High susceptibility or long durations of infections
- Slow or poor wound healing
- Altered vital signs including bradycardia, hypotension and hypothermia
- Depleted subcutaneous fat stores
- Low skeletal muscle mass
8
Q
What are some of the causes of Malabsorption?
A
- Coeliac disease
- Cystic Fibrosis
- Crohn’s disease
- Lactose intolerance
9
Q
What are some of the causes of increased losses?
A
- Pancreatitis
- IBD - diarrhoea
10
Q
What are some of the causes of loss of appetite?
A
- vomiting
- cancer
- liver disease
- COPD
- Eating disorder
- Dementia
11
Q
What are some of the causes of increased expenditure?
A
- Healing after surgery
- Serious injury - Burns
- Involuntary movements such as a tremor
12
Q
What are some of the consequences to malnutrition?
A
- Impaired immunity
- Poor wound healing
- Growth restriction in children
- Unintentional weight loss, loss of muscle mass
- Multi-organ failure
- Death
- Depression, self-neglect
- Hypothermia
- Reduced muscle mass and strength
- Osteoporosis
- Rickets
13
Q
What are some of the consequences of specific micronutrient deficiencies?
A
- Iron deficiency = anaemia
- Zinc deficiency = skin rashes and decreased ability to fight infections
- Vit B12 deficiency = Anaemia and problems with nerves
- Vit D deficiency = rickets in children and osteomalacia in adults
- Vit C deficiency = scurvy
- Vit A deficiency = night blindness
14
Q
What are the 4 stages of wound healing?
A
- Hemostasis: activates the blood clotting system and causes platelet aggregation and activation
- Inflammation: WBC destroy the bacteria and remove the debris
- Proliferation: granulation tissue is put down with connective tissue and new blood vessels are formed
- Remodelling: the new tissue matures and remodels and there is an overall increase in tensile strength
15
Q
What factors affect wound healing?
A
- Oxygenation
- Infection
- Foreign Body
- Venous Insufficiency
- Age
- Gender
- Stress
- Ischaemia
- Obesity
- Diseases: Diabetes, Fibrosis, Jaundice and Uraemia
- Medication: Steroids, NSAIDs, Chemotherapy
- Immunocompromised
- Nutrition
16
Q
What are the cardinal signs of inflammation?
A
- Rubor (redness)
- Calor (heat)
- Tumor (swelling)
- Dolor (pain)
- Functio laesa (loss of function)
17
Q
What are Pressure Ulcers?
A
- A pressure ulcer is an area of damaged skin and/ or the tissues below as a result of being placed under pressure
- Pressure ulcers can cause pain or lead to an extended stay in hospital
- They can become infected which could lead to sepsis and in extreme cases it can be life threatening
18
Q
What are the causes of Pressure Ulcers?
A
- Prolonged pressure on the skin
- Moisture on the skin which can break down the epidermis
19
Q
What are the common sites for pressure ulcers?
A
- Heels
- Elbows
- Hips
- Base of the Spine
- Buttocks
20
Q
What are three screening tools used to assess pressure ulcers?
A
- Braden Scale
- Norton Scale
- Waterlow Scale
21
Q
What is the Braden Scale ?
A
- It is used to predict pressure score risks
- Six factors that contribute to either higher intensity and duration of pressure or lower tissue tolerance to pressure therefore increasing the risk of pressure ulcer development
- Each item is scored between 1 and 4 guided by a descriptor
- The lower the score the greater the risk
- Sensory Perception
- Nutrition
- Friction and shear
- Mobility
- Moisture
- Activity
22
Q
What is the Waterlow Score?
A
- Used to assess the risk of pressure scores
- BMI
- Age
- Nutritional Status
- Organ Failure
- Anaemia
- Smoking
- Medical Co-morbidites
- Drug History
- Duration and type of surgery
23
Q
What is Refeeding Syndrome?
A
- A condition caused by rapid re-introduction of normal nutrition in patients who are chronically malnourished
- A patients intracellular stores of potassium and phosphate are depleted
- If a patient is suddenly provided with normal levels of nutrition, there is a large insulin response and there is a sudden shift of these electrolytes from the extracellular to the intracellular compartment
- This causes a hypokalaemia and hypophosphataemia and a hypomagneseamia with abnormal fluid balance
- This leads to cardiac complications such as arrhythmias and seizures
24
Q
How do you prevent re-feeding syndrome?
A
- Nutrition is re-introduced more gradually under the guidance of a dietician
- The patient’s electrolytes are monitored closely, allowing deficiencies to be identified early and replaced appropriately
25
Patients are considered high-risk if one of more of the following occur:
- BMI <16 kg/m2
- Unintentional weight loss >15 % over 3-6 months
- little nutritional intake > 10 days
- Hypokalaemia, Hypophosphataemia or Hypomagnesaemia prior to feeding
26
What is the management of Malnutrition?
- A healthier, more balanced diet
- Fortified foods that contain extra nutrients
- Snacking between meals
- having dinks that contain lots of calories (fortisip)
- Feeding tubes: NG tube, PEG tube, Parenteral nutrition)
- food-first approach = add full fat cream to mashed potato rather than prescribing oral nutritional supplements
27
What is the managment for Low risk MUST score?
- Repeat the score: hospital = weekly, care homes = monthly and community = annually
28
What is the managment for Medium risk MUST score?
Document dietary intake for 3 days:
1. If adequate - little concern and repeat screening (hospital = weekly, care home = monthly and community = 2/3 months)
2. If inadequate - set goals, improve and increase overall nutritional intake, monitor and review care plan regularly
29
What is the managment for a High Risk MUST score?
- Refer to a Dietitian and Nutritional support team
- Set goals to help improve and increase overall nutritional intake
- Monitor and review care plan ( hospital = weekly, care home = monthly and community = monthly)
30
How is the Braden Scale broken down?
- Lower the scale = Higher the risk of pressure sores
Sensory Perception: ( 4- No impairment, 3- slightly limited, 2- Very Limited, 1 - Completely Limited)
Moisture ( 4- Rarely Moist, 3- Occasionally Moist, 2- Very Moist, 1- Constantly Moist)
Activity ( 4- Walks Frequently, 3- Walks Occasionally, 2- Chair Bound, 1- Bed bound)
Mobility ( 4- No limitations, 3- Slightly Limited, 2- Very limited, 1- Completely Immobile)
Nutrition (4- Excellent, 3- Adequate, 2- Probably Inadequate, 1 - Very Poor)
Friction and Shear ( 3- No Apparent Problem, 2- Potential Problem, 1 - Problem)
31
What are the score breakdowns for the Braden Scale?
- 15+ = low risk
- 13-14 = moderate risk
- 12 or less = high risk
- Below 9 = severe risk
32
What factors predispose for Pressure Ulcers?
- Immobility
- Malnutrition
- Incontinence
- Pain (reduced mobility)
