Flashcards in Nutrition Deck (27):
Malnutrition can occur as a result of what?
inadequate dietary supply:
• access to food
• inability to feed
• gastrointestinal failure
• unusual losses
• increased demands
What is REE in terms of nutrition?
Resting energy expenditure
How does REE change in illness?
Increases with illness
What conditions impact on the REE the most?
Electrolyte imbalances in malnutrition? Why?
Reduced total potassium
Due to failures in the NaK ATPase
What is reductive adaptation
Physiological response of the body to under nutrition i.e. Systems slow down and do less in order to allow survival on limited nutrient resources especially calories.
Implications of reductive adaptation on care?
Processes – on the way to system failure:
• Structure no longer adequately marks function
• Represent increasing vulnerability (RISK)
• inability to cope with stressors
• greater susceptibility to homeostatic failure
Refeeding syndrome symptoms?
Profound secretory diarrhoea
Refeeding syndrome causes?
Insulin secretion resumes in response to increased blood sugar; resulting in increased glycogen, fat and protein synthesis. This process requires phosphates, magnesium and potassium which are already depleted and the stores rapidly become used up.
management of malnutrition?
1. Gain metabolic control (Resuscitate and repair) treat underlying condition
treat infection, prevent hypoglycaemia & hypothermia manage reductive adaptation
correct specific deficiencies (intracellular)
energy and protein to maintain function (not excess)
repair cellular damage before replete tissue loss
2. Replete tissue deficit:
added energy: extra protein and nutrients to meet need
for tissue deposition.
Methods of nutritional support?
Encourage & assist with feeding
- Polymeric feeds
- Elemental feeds
- NG, NJ, PEG, PEGJ, PEJ
- Overnight or continuous
Peripheral, midline, PICC, central
R/F for malnutrition?
– Particularly those in hospital or nursing homes
• People with long term health conditions
• People with chronic progressive conditions e.g.
cancer or dementia
• People who abuse drugs or alcohol
Clinical effects of malnutrition
Ventilation - muscle atrophy
Fatty liver disease
Loss of strength
MUST tool definition?
Malnutrition universal screening tool
If you can't measure weight or height what should you measure?
Mid-upper arm circumference
Steps in MUST tool?
1. BMI 5days = 2 points)
4. add these scores together
What do the must scores mean
0 no risk
1 medium risk
2+ high risk
Action plan depending on the MUST score?
Low risk - Routine clinical care
medium risk - Observe and monitor
high risk - Treat & refer
Steps of nutritional assessment?
Blood tests done in a nutritional assessment?
– Renal Function
– Electrolytes such as Mg2+, PO4, K+
– Inflammatory Markers
– Disease specific Markers: HbA1c/anti –tTG antibodies
Clinical assessments done in a nutritional assessment?
E.g. Burns, surgery (Increased Requirements) – GI disorders (Malabsorption)
– Neurological Conditions (Dysphagia)
Dietary assessments as part of a nutritional assessment?
Estimate total dietary intake and dietary adequacy
Environmental assessments as part of a nutritional assessment?
• Ability to shop, cook, mobility, budget, family
support, meal timings (shift work)
Appetite, dentures, dexterity, sight, dysphagia, food intolerances, taste preferences
Management of refeeding syndrome?
Do not withhold nutrition – cannot correct the intracellular electrolyte deficits without low levels of feeding
• Clinical Management
Meet fluid and electrolyte requirements
Vitamin supplementation: IV Pabrinex I & II od for 3/7 → PO Thiamine 100mg bd, Vitamin B Compound strong BD and Sanatogen
A-Z OD for 7/7 (or if lower risk can give 10 days of oral and no IV)
Daily electrolyte monitoring (Mg, PO4, K, Ca) → replacement (PO/IV) if low (pharmacist advice)
Monitor fluid balance
Very high risk: Monitor ECG, BGLs, GI symptoms, observations
Cost associated with malnutrition treatment in the UK?
What IBD has positive effects from enteral nutrition?
crohns not UC