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Flashcards in Nutrition Deck (27):
1

Malnutrition can occur as a result of what?

inadequate dietary supply:
• access to food
• appetite
• inability to feed

• gastrointestinal failure
• unusual losses
• increased demands

2

What is REE in terms of nutrition?

Resting energy expenditure

3

How does REE change in illness?

Increases with illness

4

What conditions impact on the REE the most?

Burns, sepsis

5

Electrolyte imbalances in malnutrition? Why?

Reduced total potassium

Incraesed sodium

Due to failures in the NaK ATPase

6

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.

7

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

8

Refeeding syndrome symptoms?

Overloaded circulation
Heart failure
Abdominal distension
Profound secretory diarrhoea
Cardiac arrhythmias

9

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.

10

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.

11

Methods of nutritional support?

Encourage & assist with feeding

Food supplements

Promote Digestion:

- Polymeric feeds
- Elemental feeds

Enteral feeding:

- NG, NJ, PEG, PEGJ, PEJ
- Overnight or continuous

Parenteral:

Peripheral, midline, PICC, central

12

R/F for malnutrition?

Olderpeopleaged>65years
– 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

13

Clinical effects of malnutrition

Ventilation - muscle atrophy

Depression

Immune vulnerability

Fatty liver disease

Hypothermia

Loss of strength

14

MUST tool definition?

Malnutrition universal screening tool

15

If you can't measure weight or height what should you measure?

Mid-upper arm circumference

16

Steps in MUST tool?

1. BMI 5days = 2 points)
4. add these scores together

17

What do the must scores mean

0 no risk
1 medium risk
2+ high risk

18

Action plan depending on the MUST score?

Low risk - Routine clinical care
medium risk - Observe and monitor
high risk - Treat & refer

19

Steps of nutritional assessment?

ABCDE

Anthropometry
Biochemistry
Clinical
Dietary
Environment

20

Blood tests done in a nutritional assessment?

Micronutrients
– Renal Function
– Electrolytes such as Mg2+, PO4, K+
– Inflammatory Markers
– Disease specific Markers: HbA1c/anti –tTG antibodies

21

Clinical assessments done in a nutritional assessment?

E.g. Burns, surgery (Increased Requirements) – GI disorders (Malabsorption)
– Neurological Conditions (Dysphagia)

22

Dietary assessments as part of a nutritional assessment?

Estimate total dietary intake and dietary adequacy

23

Environmental assessments as part of a nutritional assessment?

Social
• Ability to shop, cook, mobility, budget, family
support, meal timings (shift work)

Physical
Appetite, dentures, dexterity, sight, dysphagia, food intolerances, taste preferences

24

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

25

Cost associated with malnutrition treatment in the UK?

£20 million

26

What IBD has positive effects from enteral nutrition?

crohns not UC

27

Three aims of nutrition support?

• Resuscitate
• Repair
• Replete