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Viola Geraldo

on 17 May 2017

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Transcript of Undernutrition

Explain malnutrition including causes, consequences and effects in different populations
Explain disease-related malnutrition and its treatment
Detail the alternative routes of feeding and its advantages and disadvantages

Disease-related malnutrition
Frequent in hospital populations. Cachexia = physical wasting with loss of weight & muscle mass - caused by disease
Cachexia-linked diseases
: cyctic fibrosis, IBD, AIDs, cancer, congestive HF, COPD, severe schizophrenia, drug addiction
Treatment of undernutrition/cachexia
food fortification to increase energy density of meal (e.g skimmed milk powder)
small frequent meals & snacks
Non prescribable nutritional supplements (Complan) or prescribable (Fortimel)
All supplements should be used in adjunct to dietary fortification & snacking -
as a
meal replacement
Artificial feeding
When nutritional needs through oral intake cannot be met:
poor oral intake
physical inability to eat
increased nutritional requirements (eg. cachexia, cystic fibrosis)
Alternative routes of feeding:
Nasogastric & nasoenteric - short-term feeding< 2 weeks
Gastrostomy - long term feeding at home (eg. stroke pt)
Jejunostomy - if unlikely to resume full oral intake after abdominal surgery/laparotomy
Parenteral nutrrition - if the gut is not functioning (eg. severe pancreatitis, GI fistulas)
Achieving dietary goals to optimum health
Enjoy your food
Eat a variety
Eat the right amount to be a healthy weight
Eat plenty of starchy foods, esp. wholegrains & nuts
5-9 pieces fruit/veg per day
Choose foods low in fat & some fish
Reduce sugary foods & drinks
Plenty of fluid, esp. water
Limit alcoholo
Increase disease risk if outside of optimum weight (overweight/anorexic)
= protein energy malnutrition (PEM) - deficiencies in any/all nutrients, micronutrient deficiencies - deficiency in specific micronutrients
: reduced food intake, decreased absorption, decreased activity of co-factors (eg. intrinsic factor & vit B12), increased metabolism, underlying disease
impaired immune function
delayed wound healing
decreased muscle strength & fatigue
reduced respiratory muscle function & cough pressure
immobility predisposing to VTE & pressure sores
reduced final height in women --> decreased pelvic size & small birth weight babies
Psychological & behavioural
reduced will to recover
poor bonding with mother & child
loss of libido
- not invasive surgery, quick, cheap, nutritionist can administer
- irritation, risk of sinusitis/oesophagitis, dysphagia, risk of misplacement, risk of reflux, easy tube movement/removal, regular tube replacement, X-ray confirmation, stigmatising
- less stigmatising, less tube migration, less tube removal, less reflux, no nasal irritation, no dysphagia, no tube replacement
- invasive, sedation & antibiotics, irritation at site, leakage into abdomen, translocation of bowel, X-ray confirmation, tube clogging, hematomas causing bowel occlusion
Enteral feeding
Nasogastric feeding - short-term <14 days, unable to take any nutrition orally (eg. stroke), additional nutrition to improve adequate intake (eg. burns)
Types - standard (Osmolite), high energy (ensure plus). Jevity - fibre added (normalise bowel), low sodium (HT), low electrolyte (fluid restriction), peptide (CD)
Common problems
Diarrhoea - temp of feed, rate, check date, fibre
Constipation - fluid balance, fibre
Vomiting - rate of feed, position of pt, infection
Blocked tube - feed, meds, not flushed
Improved outcomes after enteral feeding
: shorter hospital stays, lower mortality & hospital admissions, improved immunity & fewer infecrions, improved wound healing, inproced clinical scores in CF & CD, improved quality of life & well-being, improved liver function in liver disease, reduced complication rate after surgery & liver disease, longer living in cancer
PEM in children
Acute - acute inadequate nurition leading to rapid weight loss/failure to gain weight normally (due to infection) --> wasting
Chronic - inadequate nutrition over long period of time leading to failure of linear growth --> stunting
Acute & chronic --> wasting/stunting/both
Anorexia nervosa
Eating disorder - very low weight, distorted body image, obsessive fear of gaining weight
Older adults
Common particularly in institutionalised - PEM & micronutrient deficiencies
Decreased GI function with decreased absorption/metabolism
Underlying disease & interaction with drugs
Decreased intake possibly due to dysphagia/poor appetite/poor mastication
Full transcript