Malnutrition Flashcards

Flashcards about Malnutrition

What is Malnutrition?

A state of nutrition in which a deficiency or excess (imbalance) of energy, protein, and other nutrients cause measurable adverse effects on tissue/body form and function and clinical outcome.

What is Undernutrition?

Reduced food intake/absorption or disease burden/inflammation leading to altered body composition and diminished function.

According to ASPEN, what are the criteria for diagnosing malnutrition in adults?

Insufficient energy intake, Weight loss, Loss of muscle mass, Loss of subcutaneous fat, Fluid accumulation, and Diminished functional status.

What are two alternative ways to diagnose malnutrition per ESPEN guidelines?

BMI

How does ICD-10-AM define malnutrition in adults?

BMI <18.5kg/m2 or unintentional weight loss of at least 5% with evidence of sub- optimal intake resulting in subcutaneous fat loss and/or muscle wasting

What are the minimum requirements per GLIM for diagnosing malnutrition?

Must meet at least one aetiologic criterion plus one or more phenotypic criteria

Give some examples of phenotypic criteria for malnutrition per GLIM.

Weight loss >5% within the past 6 months or >10% beyond 6 months. BMI (kg/m2)

How often should you screen for malnutrition?

Constant screening.

Name some inclusions in a Nutrition Care Process Assessment.

Patient history, medical diagnosis and treatment plan; nutrition and medication histories, nutrition related physical examination including anthropometry, nutritional biochemistry, psychological, social, and environmental aspects.

Name a few nutrition screening tools.

MNA, MST, MUST, SGA, PG-SGA, and SCREEN 14.

What qualities should an effective screening tool have?

Simple and easy to use, Cost effective, Effective in identifying nutritional problems\reliable, Valid, and Suit the setting

What are the prevalence rates of malnutrition across various care settings?

Acute care = 20-50% Rehabilitation = 30-50% Residential aged care = 40-70% Community = 10-30%

What screening tool was used in the Nutrition Care Survey 2010?

MST

List the possible ratings in a Subjective Global Assessment (SGA).

SGA A, SGA B, and SGA C.

What are the three categories of malnutrition based on etiology per NCPT?

Starvation related malnutrition, Chronic disease or condition related malnutrition, and Acute disease or condition related malnutrition.

What benefits will implementation of DAA evidence-based practice guidelines for malnutrition achieve?

Improved access to ethical, effective and efficient patient care \ Correct diagnosis of malnourished patients \ Improved patient experience and health outcomes \ A skilled dietitian workforce \ Advocacy for appropriate and adequate food services, eating environments, staff resources and policy \ Capacity building in health and human services for preventing, recognising and treating malnutrition by the entire health workforce and health policy makers

What are your responsibilities as a dietitian?

Evaluate requirements (Fluids, Electrolytes, Nutrition) Prescribe nutrition (Oral enteral, Parenteral) Ongoing management until can safely eat and drink independently.

How can you increase nutrition intake in patients?

High quality of hospital food, Feeding assistance (cutlery), Protected mealtimes, Minimising fasting, Food fortification, and Oral nutritional supplements.

What is the caloric density for a 'low energy' oral nutritional supplement?

< 1.0 kcal/mL

What is the caloric density for a 'high energy' oral nutritional supplement?

≥ 1.2 kcal/mL

According to evidence-based practice guidelines, when should routine screening for malnutrition occur?

Routine screening for malnutrition should occur in the acute setting to improve the identification of malnutrition risk and to allow for nutritional care planning.

What does screening identify?

Identifies patients at nutritional risk and characteristics commonly associated with nutrition problems who may require comprehensive nutrition assessment and may benefit from nutrition intervention.

Which screening tool is validated for geriatric patients?

MNA

Which screening tool is validated for cancer and renal patients?

PG-SGA

Which screening tool is validated for inpatients and oncology outpatients receiving radiotherapy?

MST

Which screening tool is valid, applicable and reliable in all health care settings?

MUST

What is a Subjective Global Assessment (SGA)?

A simple bedside method of assessing the risk and malnutrition and identifying those who would benefit from nutrition care.

What should fluid and electrolytes be prescribed according to?

Fluid and electrolytes should be prescribed according to the patient’s needs.

What is the best regulator of fluid balance?

The gut, along with the kidney, is the best regulator of fluid balance.

When prescribing intravenous fluids, what are three possible reasons for this?

Resuscitation, Maintenance, or Replacement.

When should maintenance fluid be given?

Maintenance fluid – when patients aren’t eating or drinking. Fluids should then be stopped when they start eating or drinking or given enteral feeds.

Which IV fluids should be used to replace gastric and diarrhea losses?

Gastric loss (vomiting or high nasogastric output) – Use of 0.9% NaCl and Diarrhoea and ileostomy loss (lower gut) – Use PL148

What is one of the main learning objectives for enteral feeding?

To explore enteral nutritional strategies for the prevention/management of malnutrition.

What is one of the main enteral feeding indications?

If a patient has a functioning gut but is unable or unwilling to eat sufficient to meet his/her nutritional needs, various options of enteral feeding can be considered.

What is Enteral nutrition?

The infusion of a liquid diet, via naso-enteric or enteo-cutaneous tube, into the gastrointestinal tract.

What are some contraindications to enteral nutrition?

Absence of intestinal function, Complete intestinal obstruction, Inability to access the gut,, or High loss intestinal fistulae.

What are some different kinds of enteral feeding tubes?

Fine Bore (10 french or less), Wider Bore (12 French), NJ (jejunal/post-pyloric), PEG, or Orogastric.

What are some Enteral Tube modes of feeding?

Continuous infusion over 24hrs, Intermittent infusion, or Bolus feeding.

How should enteral feeding be transitioned?

Start 20-40mls/hr – increase to goal rate, Aim full enteral feed by day 2, titrate IVF, Transition to oral intake – top up feeds or supplements, or Food chart, weight chart, bowel charts.

What does EN help us achieve?

Fluid requirements Electrolyte requirements, Energy requirements, Protein requirements, and Micronutrient requirements.

What is the protein range to prescribe in an enteral feeding plan?

Protein – 1-1.2g/kg B.Wt

What is a main objective of Parenteral Nutrition?

To explore parenteral nutritional strategies for the prevention / Management of Malnutrition.

When is Parenteral Nutrition indicated?

When it is not possible to administer enteral nutrition because gut is not functioning, When the gut is not accessible, and When tube feeding is not safe or unlikely to be effective.

When is indicated TPN used?

Parenteral nutrition is indicated when nutritional support is required but cannot be met by enteral route for any reason.

What is the Intestinal Failure?

The reduction of a gut function below the minimum necessary for the absorption of macronutrients and/or water and electrolytes, such as the intravenous supplementation is required to maintain health and/or growth.

What is Short Bowel Syndrome?

Is the major benign indications for PN

What things to consider in the end of life issues?

PN in New Zealand, SCCM philosophy, and Dieticians perspective.

What do you need to be careful when prescribing supplemental PN?

Are to prevent over feeding in vulnerable patients.

What are the parts that conform a Nutrition Support Team?

Multidisciplinary dietetic, medical, pharmacy and nursing.