Nutritional Assessment + History Flashcards
(19 cards)
Why can a patient become malnourished?
Increased nutritional requirement i.e. in burns victims Nausea and vomiting Anxiety Pain Malabsorption Diagnostic tests Medication Depression Difficult eating and swallowing Hospital environment i.e. due to having to micturate and defecate in same environment
What are the clinical affects of malnutrition?
Impaired survival Poor wound healing Anastomotic leaks Bed sores Increased sepsis Poor motivation Delayed rehabilitation
What is the NICE guidance on assessing nutrition of patients?
Patients need to be screened for malnutrition w/i 24 hours of admission to hospital and then on weekly basis
Using MUST screening tool
What are the benefits of BMI?
Can identify those who are undernourished
What does MUST stand for? When is it used? What are additional components of this screening tool?
Malnutrition
Universal
Screening
Tool
To assess whether patient is malnurished
BMI
Unintentional weight loss
Acute illness score
How can someone be a normal weight but be classed as malnurished?
If patient is acutely ill
If had >10% unplanned weight loss in 3-6 months
What are the limitations of BMI?
Not useful in pregnancy
Does not distinguish between body composition
Won’t identify lean body mass wastage
Not sensitive to fluid increases
What is sarcopenia of obesity?
Loss of muscle mass despite still being classified as obese under BMI/MUST
Why is obesity classed as malnourished?
Calorific excess can mask micronutrient and vitamin deficiencies Weight loss (sarcopenia of obesity) can be masked
What is short bowel syndrome?
(Look up)
What are antropometrics? When are they used?
Mid-arm circumference measurement
Tricep skinfold thickness- indication of subcutaneous fat
Used together for calculate mid arm muscle circumference (MAMC) as a method of indicating malnourishment
I.e. surrogate marker of muscle mass
What are the issues of anthropometrics?
Inter-observer variation
Intra-observer variation
Use of stretch tape-measuring rather than non-stretch
Time consuming
What is used instead of MAMC? Why is it better?
Hand grip strength of non-dominant hand
- acts as functional measure of nutritional status
- correlates with nutritional depletion and depletion
- less variation between observers
What are other factors to look for to indicate malnutrition?>
Change in clothes/dress sizes Belt notches Denture fit= can then further impact eating Temporalis wasting= lack of mastication Skin lesions
Why should you not rely on albumin as an indicator of nutrition?
Not sensitive marker for malnutrition
Effected by active inflammation, intravenous fluids and liver dysfunction
What trace markers are sometimes used to indicate nutritional status? Why are trace markers not good indicators of malnurishment?
All affected by acute inflammation
- iron is bound into cells in chronic disease
- copper levels rise because it is toxic to bacteria
What scanning can be used to assess nutritional status?
DEXA
CT
Bio-electrical impedance
What is bio electrical impedance analysis used for? What criteria must people meet?
Determining fat free mass, total body water, intra-cellular and extra-cellular water
Have no water or electrolyte disturbances
Patient not in clinical extremes of BMI
What is re-feeding syndrome?
Sudden change from catabolic to anabolic state
Glucose as main source of nutrition leads to shift of electrolytes and minerals and change in fluid dynamic
When someone has become malnourished, when start to re-feed there is sudden change in electrolytes, sodium and water homoestasis and glucose metabolism and can be life threatening
(ALTER)
