Undernutrition Flashcards

Question

How many stages are there of pressure sores?

Answer 1

There are 4 stages of pressure sores

Answer 2

Pressure sore prevalence * Physical disability 85% * Critically ill 33-53%, * Orthopaedics 19-30% * Hospitalized patients 3-23%, *

Answer 3

Role of undernutrition pressure sore development * Reduced nutrient supply> reduced energy metabolism> reduced maintenance and repair * Increased weakness> reduced mobility> increased pressure * Increased oedema> reduced tissue blood flow> ischaemia * Weight loss> prominent bones> increased sensitivity to pressure

Answer 4

Yes. Obese or overweight people can be undernourished

Answer 5

Sarcopenia is defined as loss of muscle mass, strength and function.

Answer 6

Undernutrition is defined by: * >5% unintentional weight loss in 3 months * > 10% unintentional weight loss in 3-6 months * BMI < 20 kg/m2 + unintentional weight loss > 5% in 3-6 months

Answer 7

Older people should have higher BMIs for optimal survival. (Cederholm 2015)

Answer 8

According to Stratton et al., 2003, BMI <18.5 kg/m2 is associated with: * Increased frequency of illness * Reduced ability physical work capacity

Answer 9

Characteristics associated with >5% weight loss: * Less energetic * Reduced voluntary activity *Fatigue

Answer 10

Characteristics associated with >10% weight loss * Disturbances in thermoregulation * Poor response to surgery and chemotherapy

Answer 11

Poor nutritional intake is not part of the process for ‘defining’ malnutrition, but it can help to assess risk.

Answer 12

Refeeding syndrome is the electrolyte/fluid shifts that occur following the introduction of nutrition in a malnourished individual. Electrolyte and fluids are imbalanced.

Answer 13

Phosphate, potassium and magnesium are affected in refeeding syndrome.

Answer 14

According to WHO (2021) 462 million adults are undernourished worldwide.

Answer 15

Wasting: Low weight for height

Answer 16

Stunting: low height for age

Answer 17

Various studies have found an increase in the frequency of illness amongst people with BMIs of **less than 20 kg/m2**

Answer 18

If someone has a BMI of less than **18.5** malnutrition is considered probable

Answer 19

With a BMI of **18.5-20** malnutrition is possible with unintentional weight loss

Answer 20

BMI cut offs are higher with **weight loss**

Answer 21

No, nutritional intake is not a part of the malnutrition defining process. It helps to assess if someone is at risk.

Answer 22

NICE 2006: ‘where a patient ‘has eaten little or nothing for more than 5 days and/or is likely to eat little or nothing for the next 5 days or longer’

Answer 23

Thiamine may be deficient in refeeding syndrome

Answer 24

**Refeeding syndrome pathophysiology** 1. Starvation: Catabolism dominates: Glucagon secretion increased. Glycogen (glycogenolysis), protein degradation & fat (lipolysis/ beta oxidation). Increased gluconeogenesis. 2. Depletion of macronutrient stores, protein, minerals, electrolytes 3. . Refeeding (nutrition introduced) 4. . Insulin increased> anabolic pathways increase 5. . Increased: glucose uptake, electrolyte uptake, micronutrient utilization (thiamine), protein synthesis, glycogenesis. 6. Electrolytes and micronutrients utilized faster than they can be replaced> refeeding syndrome 7. . Severe deficiency: Hypokalaemia, Hypomagnesaemia, Hypophosphataemia, Thiamine deficiency, salt and water retention: Oedema 8. Imbalance of electrolytes: heart, nervous system and organ failure.

Answer 25

Hypokalemia may lead to cardiac arrhythmias or weakness, fatigue, paralysis, hypoventilation, respiratory distress, and metabolic alkalosis

Answer 26

Hypophosphataemia may lead to: decreased cardiac contractility and arrhythmias. Increase haemoglobin'saffinity for oxygen> decrease oxygen release to the tissues; acuterespiratory failure.

Answer 27

Hypomagnesemia may lead to: exacerbated hypokalemia, neuromuscular symptoms and depression

Answer 28

Thiamine deficiency might lead to: lactate accumulation, Wernicke's syndrome, Korsakoff syndrome and cardiac dysfunction.

Answer 29

**Consequences of starvation** * Decreased insulin and increased glucagon secretion * Glycogen stores depleted * Free fatty acids and ketones replace glucose as energy source (adipose tissue activated> fatty acids released) * BMR decreases * Brain adapts to using ketones * Atrophy of all organs * Reduced lean body mass * Abnormal liver function * Deficiency of vitamins and trace elements * Whole body depletion of potassium, magnesium and phosphate * Increased intracellular and whole body sodium and water * Impaired cardiac, intestinal and renal reserve, leading to inability to excrete excess sodium and water * Serum concentrations of electrolytes maintained within normal limits

Answer 30

4 refeeding syndrome triggers: 1. A switch from fat to carbohydrate metabolism 2. Increased insulin release 3. Increased uptake of glucose, phosphate, potassium, magnesium and water into the cells 4. Synthesis of lean tissue

Answer 31

The refeeding triggers lead to: 1. Fluid retention 2. Low serum levels of potassium, magnesium, phosphate 3. Cardiac, respiratory, neuromuscular, renal, metabolic, hepatic and GI problems 4. Vitamin deficiency (thiamine)

Answer 32

<3.2 mmol/L (Brown et al., 2015)

Answer 33

Mg is a co factor for ATP

Answer 34

**Glucose **reverses negative nitrogen balance via suppression of gluconeogenesis and reduced amino acid usage

Answer 35

Excess glucose can lead to: Hyperglycaemia Reduced sodium and water excretion Increased cellular thiamine utilisation due to its role as a co-factor for carbohydrate metabolism

Answer 36

NICE 2006 guidelines for refeeding syndrome risk: **At risk:** * Little or no food for >5days **High risk**: 1 or more of the following: * BMI < 16KG/M2 * Unintentional weight loss > 15% in 3-6months * Little or no food for > 10 days * Low K, Mg or Phosphate prior to feeding ** High risk:** 2 or more of the following: * BMI <18.5 kg/m2 * Unintentional weight loss >10% in 3-6 months * Little or no food >5 days * History of alcohol abuse or drugs including insulin, chemotherapy, antacids or diuretics. **Extremely high risk** * BMI < 14 kg m2 * Low or no food for > 15days

Answer 37

**NICE 2006 refeeding guidelines for At Risk** * 50% of total energy requirements for the first 2 days, * Full requirements of fluid, electrolytes, vitamins and minerals from day 1

Answer 38

**NICE 2006 refeeding guidelines for High Risk** * 10kcal/kg increased slowly to meet requirements after 4-7 days * Monitor fluid, K, P, Mg * Give thiamine and multivitamin

Answer 39

Baldwin and Weekes 2012 found that comparing dietary counselling with usual care and with ONS, had no effect on mortality but did increase weight –mean 1.7 kg.

Answer 40

Beck et al., 2014 found that the addition of a dietitian to the discharge team reduced hospital admissions and increased oral intake.

Answer 41

Elderly adults should have: Between 1.0 and 2.0 g/kg/day or higher (depending on health status e.g. severity of disease and risk of malnutrition) (ESPEN, 2019)

Answer 42

18-60 year olds need 35 ml/kg

Answer 43

>60 year olds need 30ml/kg

Answer 44

Other fluid requirement considerations: * Add 2-2.5 ml/kg for each degree rise in temperature above 37 * Assess additional losses from wounds and diarrhoea individually

Answer 45

1. Population: Age based EAR for BMI of 22.5. PAL:1.63 (SACN 2011) 2. Therapeutic diets: BMR: PAL: (Henry 2005) 3. Nutrition support: REE: PAL (PENG 2018)

Answer 46

Hand grip strength has been associated with assessment of: * serum albumin * sarcopenia * malnutrition * Nutritional status and disease severity in adults with cystic fibrosis * Nutritional status in cancer

Answer 47

The presence of low skeletal muscle mass and either low muscle strength (e.g., handgrip) or low muscle performance (e.g., walking speed or muscle power); when all three conditions are present, severe sarcopenia may be diagnosed.

Answer 48

**Food based strategy*** 1. Meal pattern e.g., regular meals 2. Snacks e.g., high energy + high protein snacks (flapjacks, custard, rice pudding) 3. Dietary advice to - choose energy dense foods - choose the best time to eat - opt for nutritious drinks - boost flavour and aroma of meals (especially with those who are consuming texture modified diets or have loss of taste and smell) -consider meal delivery services 4. Food fortification -adding extra calories to meals without increasing volume such as olive oil, cheese, cream, full-fat milk, skimmed milk powder, honey, jam and sugar. 5. Optimise appearance of foods (particular texture modified foods) use colourful plates to encourage food intake.

Answer 49

Smoliner et al. 2008 found that food fortification can increase protein intake, hand grip strength was maintained but was not significant.

Answer 50

If the Food Based Strategy doesn't work: * Oral Nutrition Supplements * Enteral nutrition * Patenteral nutrition * Tube feeding

Answer 51

1 tablespoon of dried milk powder: 55 calories, 5.5g protein

Answer 52

1 tablespoon of ground almonds: 60 calories, 2g protein

Answer 53

1 tablespoon of grated cheese: 40 calories, 2.5g protein

Answer 54

Mills et al., 2018 found that food fortification is: Effective, well‐tolerated and cost‐effective intervention to improve dietary intake amongst older inpatients

Answer 55

**Environment considerations for undernutrion** * Social –number of people and better known will increase intake * Encouragement * Protected mealtimes * Ambiance * Timing

Undernutrition Flashcards

(79 cards)