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13 Cards in this Set
- Front
- Back
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Malnutrition |
Ay form of nutrition, whether over or under nutrition, which is sufficient to adversely effect the patient. |
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Undernutrition |
Reduced supply of food, or reduced ability to assimilate , digest and utilise nutrients. |
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Consequences of malnutrition |
Increased morbidity increased length o stay increased dependancy increased mortality increased cost of care |
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Causes of disease related undernutriton |
Reduced intake Increased requirement Increased nutritional losses. |
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MUST |
Malnutrition universal screenin tool- BMI Weight loss Acute disease effect score 0= low risk 1= medium risk 2 or more = high risk and treatment |
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Investigatios |
Clinical anthropometrics - skinfold thickness tst and mid upper arm cirumfrence. Imaging- DEXA Bioelectrical imoedence analysis Handgrip dynamometry. |
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Bloods |
Anaemia Plasma proteins Vitamin and mineral concentrations Lyphocyte count Delayed hypersensitivity reactio. |
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TEE |
Total energy expenditure = BMR Thermic efffect of food (energy used in digestion) DIT Physical activity Stress factors |
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Protein intake |
52.5kg for a 70kg adult 8.4g nitrogen a day |
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Enteral and parentrel |
Enteral- via gut, NG tube or gastrostemy feeding e.g. Parenteral- venous feeding. |
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Indications for gastostemy feeding |
reduced consciousness unsafe swallow pre head and neck cancer therapy or surgery. |
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Indications for parenteral feeding |
prolounged postoperative ilues. ongoing intestinal obstruction short bowel small bowel fistula acute pancreatitus Gi motility disorders. |
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Refeeding syndrome - mechanism |
During prolounged starvation there is a switch to gluconeogensis, protein catabolism, and ipolysis. intracellular stores of ions such as phosphates, potassium and magnesium are excreted to maintain blood levels and for use elsewhere in the body. When feeding begins there is a sudden bloog glucose rise and insulin release is triggered. This switches metabolism back to glycolysis, glycogen synthesis and protin anabolism. Thsi triggers masive cellular uptake of nutrients and ions from the blood. This leads to hypokalaemmia,hypoagnesaemia, hypophosphataemia, thiamine deficiency and salt and water retention. |
