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Flashcards in Nutrition and hydration Deck (17)
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1

Define malnutrition

  • A deficiency or excess of energy, protein, or micronutrients
  • Causing adverse effects on tissues, body function, or clinical outcome

2

Describe the relationship between acute care admission and malnutrition

1/3 of patients admitted to acute care will be malnourished or at risk of malnourishment within 6 months.

3

State three risk factors for malnourishment in children

  • Young age (<5yrs)
  • Co-morbid chornic illness or developmental delay
  • Neglect by care-givers
  • Poverty
    • Financial situation
    • Education
    • Sanitation
    • Food production and security
    • Cultural and religious traditions
    • Infectious diseases
    • Access to nutrition programmes and health services

4

State three risk factors for malnourishment in elderly people

  • Living alone
  • Institutionalisation
  • Severe intellectual disabilities or mental illness
  • Diseases affecting appetite, swallowing, GI function
  • Catabolic states: HIV, cancer, elderly weight loss
  • Cognitive impairment
  • Sensory impairment: vision, smell, taste

5

Categorise and provide examples for causes of malnutrition

  • Increased nutritional requirements
    • Surgery, trauma
    • Infection
    • Pressure sores & burns
    • HIV, cancer, elderly weight loss
    • Malabsorption
  • Reduced nutritional intake
    • Nausea, poor appetite, dysphagia
    • NBM
    • Oral health
    • Constipation
    • Mood
  • Reduced nutritional absorption
    • Diarrhoea
    • Cystic fibrosis, IBD, Coeliac disease
    • Pancreatitis
    • Medication interfering with micronutrient absorption or production

6

Descibre the presentation of malnutrition in adults

  • BMI is a key measure
    • 17-18.5: mild malnutrition
    • 16-17: moderate malnutrition
    • <16: severe malnutrition
  • Listlessness: tired and weak
  • Increasing fatigue
  • Cold sensitivity
  • Non-healing wounds and severe pressure sores

7

Outline the assessment of malnutrition

  • Medical factors
    • NaV, diarrhoea
    • Temperature
    • Skin condition
    • Biochemistry
  • Physical factors
    • Appears underweight, loose clothes
    • Pale, SoB
    • Mood
    • Poor feeding
  • Dietary factors
    • Food record, charts, observation
  • Anthropometrics
    • BMI or alternative measurements eg. ulnar length
    • Nutritional screening tools

8

Describe nutritional screening tools for inpatient and community use

  • Malnutrition Universal Screening Tool (MUST): inpatient assessment and management based on scoring and risk of malnutrition

    • Height, weight, and BMI

    • % of unplanned weight loss in past 3-6 months

    • Effect of acute disease on nutrition

  • Nutritional screening tool for use in the community: community assessment, initial management, and referral recommendation

    • BMI

    • Ability to eat

    • Skin type

    • Bowel movements: attributed to medication

    • Appetite and dietary intake

    • Psychological state

    • Age

9

Name three consequences of malnutrition

  • Impaired immune system
  • Pressure sores
  • Reduced wound healing
  • Muscle wasting/weakness
  • Impaired mental function
  • Prolonged hospitalisation and financial costs
  • Impaired QoL
  • Poorer health outcomes

10

Outline the general management of malnutrition in elderly populations

MDT input is crucial

  • General nutritional advice
  • Supplements
  • Refer to social services and dieticians if unable to shop or meal prep
  • Social: communal meal times, improve palatability, optimise location
  • Refer to OT for aids regarding feeding utensils
  • Antiemetics for nausea
  • Dentist input for oral pathology
  • Refer to SALT for dysphagia
    • Modified food and drink texture
    • Enteral and paraenteral feeding
  • Pharmacist for medication review

11

What is refeeding syndrome?

  • Potentially fatal shifts in fluids and electrolytes
  • Occuring in malnourished patients receiving artificial refeeding
  • Characterised by biochemical changes
    • Fluid-balance abnormalities
    • Abnormal glucose metabolism
    • Hypophosphataemia
    • Hypomagnesaemia
    • Hypokalaemia
    • Thiamine deficiency

12

Which patients are at high risk of refeeding syndrome?

  • Anorexia nervosa
  • Chronic alcoholism
  • Cancer
  • Postoperative debilitation
  • Elderly patients with comorbidities and reduced physiological reserve
  • Uncontrolled DM
  • Chronic malnutrition

13

How is refeeding syndrome prevented?

  • Lower rate of initial feeding
  • Supplementation of potassium, phosphate, magnesium, calcium
  • Monitor electrolyes

14

Name 4 causes of dehydration

  • Poor intake
    • Dysphagia
    • NaV
    • Poor appetite
    • Reduced access to drinks
    • Infection
    • Delirium
  • Increase losses
    • Diarrhoea
    • Diuretics
    • Blood loss
    • Fever and sepsis

15

List six symptoms and/or signs of dehydration

  • Malaise, apathy, fatigue
  • Postural hypotension and dizziness
  • Uraemia: NaV, loss of appetite, fatigue, poor concentration
  • Tachycardia
  • Reduced skin turgor
  • Dry mucous membranes
  • Darker urine
  • Constipation

16

How is dehydration investigated?

  • Serum osmolality
  • U&Es
    • Hypernatraemia
    • Urea and creatinine levels

17

Outline the management of dehydration

  • Treat any reversible causes
    • Infection
    • Delirium
  • Encourage oral intake and replace electrolytes
  • Medication review
    • Stop diuretics and anti-hypertensives worsening dehydration
    • Assess if any sedatives being used
    • Start anti-emetics if patient nauseous
  • SC and IV fluid replacement