MALNUTRITION IN HOSPITAL MALNUTRITION IN HOSPITAL By Geoffrey Axiak By Geoffrey Axiak B.Sc.(Nursing), S.R.N., Dip. R. & C. Hypnotherapy (T.O.R.C.H.), B.Sc.(Nursing), S.R.N., Dip. R. & C. Hypnotherapy (T.O.R.C.H.), P.G.Dip. (Nutrition & Dietetics) P.G.Dip. (Nutrition & Dietetics) Clinical Nutrition Nurse Clinical Nutrition Nurse St. Luke St. Luke ’ ’ s Hospital s Hospital
29
Embed
Malnutrition in hospitals - Geoffrey Axiak's Nutrition Pages
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
MALNUTRITIO
N IN HOSPITAL
MALNUTRITIO
N IN HOSPITAL
By Geoffrey Axiak
By Geoffrey Axiak
B.Sc.(N
ursing), S.R.N., Dip. R. & C. Hypnotherapy (T.O.R.C.H.),
B.Sc.(N
ursing), S.R.N., Dip. R. & C. Hypnotherapy (T.O.R.C.H.),
P.G.Dip. (N
utrition &
Dietetics)
P.G.Dip. (N
utrition &
Dietetics)
Clinical Nutrition Nurse
Clinical Nutrition Nurse
St. Luke
St. Luke’’ s Hospital
s Hospital
Defining malnutrition
Defining malnutrition --11
�Malnutritionis the condition that develops when
the body does not get the right am
ount of the
vitam
ins, m
inerals and other nutrients it needs to
maintain healthy tissues and organ function (Fyke,
2003).
�It occurs in people who are either undernourished
(e.g. P.E.M
.) or over-nourished
(e.g. obesity).
Defining malnutrition
Defining malnutrition --22
�The World Health Organisation (W.H.O.) defines
malnutritionas “the cellular im
balance between
the supply of nutrients and energy and the body’s
dem
and for them
to ensure growth, maintenance
and specific functions”.
�Malnutrition can encompass a wide range of
deficiencies
(e.g. protein-energy) and excesses
(e.g. obesity). However, one area –under-
nutrition–has emerged as a priority area (Reuben et
al.,1995).
Stress, e.g.
infection/
trauma
PEM
(Kwashiorkor)
Absolute deficit
in protein but energy intake
relatively adequate
(esp. Carbohydrate)
Increased insulin:
cortisol ratio
Maintenance of:
Skeletal
muscle
Subcutaneous fat
Little wasting: patient
looks deceptively
well fed
Shortage of am
ino
acids for albumin
synthesis. M
ore
importantly, albumin seeps
out of blood into
surrounding tissues
Albumin levels fall quickly
Oedem
a: m
oon-faced
PEM
(Marasmus)
Absolute deficit
in protein and
energy
Decreased insulin:
cortisol ratio
Mobilisationof:
Skeletal
muscle
Subcutaneous
fat
Wasting
Albumin levels
fall slowly
Pathogenesis of malnutrition
Pathogenesis of malnutrition
Causes of malnutrition
Causes of malnutrition
��Poverty
Poverty
��Inadequate food intake
Inadequate food intake
��Chronic disease / illness
Chronic disease / illness
��Old age
Old age
��Decreased absorption
Decreased absorption
��Abnorm
al m
etabolism
Abnorm
al m
etabolism
��Hospitalisation
Hospitalisation
Malnutrition in hospital
Malnutrition in hospital --11
�On the 5thDecem
ber 2001, the BBC issued front-
page new
s: Hospital Patients –‘M
alnourished on
Arrival’. “An incidence of one patient in every
five admitted to hospital in the UK was found to
be malnourished, and this [they say] may be an
underestimate of the true scale of the problem”
(BBC, 2000).
Wednesday, 5 December, 2001, 12:06 GMT
Malnutrition in hospital
Malnutrition in hospital --22
�Malnutritionin hospital is a well-documented and
significant problem and contributes to increased
recovery tim
es, length of stays, cost to the health
services and patient mortality and m
orbidity.
�Surveysshow a very high incidence of
malnutrition among adults in surgical wards in the
UK (Hill et al.,1977, cited in Lennard-Jones, 1992),
Australia (Zader
& Trusw
ell, 1987, cited in Lennard-
Jones, 1992)and America (Bistrianet al.,1974, cited in
Lennard-Jones, 1992).
Malnutrition in hospital
Malnutrition in hospital --33
�P.E.M
.in hospitalised patients is usually due to:
–Difficulties with chew
ing, sw
allowing, digesting food,
pain, nausea and lack of appetite.
–Nutrient loss can be accelerated by bleeding, diarrhoea,
malabsorption disorders and other factors.
–Fever,
infection,
surgery,
trauma, burns
and some
medications and benign or malignant tumours increase
the am
ount of nutrients needed by patients.
–Severe sepsis, inflam
matory disease and surgery switch
on inflam
matory mediators whose job is to mobilise
muscle tissue to provide am
ino acids for an effective
acute-phase response.
A Case In Point: M
alta
A Case In Point: M
alta
��In M
alta a
In M
alta a 40%
40%
incidence of malnutrition was
incidence of malnutrition was
identified in patients undergoing renal dialysis on
identified in patients undergoing renal dialysis on
a regular basis (HD or CAPD)
a regular basis (HD or CAPD) (A
xiak, 2003).
(Axiak, 2003).
None
None
were referred for nutritional assessm
ent and help.
were referred for nutritional assessm
ent and help.
��Only
Only 22-- 3%
3%
of ward patients are referred to the
of ward patients are referred to the
Clinical Nutrition Services (St. Luke
Clinical Nutrition Services (St. Luke’’ s Hospital)
s Hospital)
for treatm
ent of malnutrition
for treatm
ent of malnutrition (Clinical Nutrition
(Clinical Nutrition
Services Statistics, M
alta, 2003).
Services Statistics, M
alta, 2003).
Nutritional status that
gets more precarious
Increased length of stay and
decreased access to services
Increased m
orbidity and
increased m
ajor complications
Prolongation / aggravation
of malnutrition
Increased
mortality
Increase in
care
prolongation
Return to compromised
home food supply
Unplanned
readmission
The vicious circle of malnutrition
The vicious circle of malnutrition
in hospital
in hospital
Under
Under-- recognition of
recognition of
malnutrition in hospitals
malnutrition in hospitals
�Numerous research studies have documented the
inability of many health care providers to identify
nutritional deficit vulnerability and early and
advanced m
alnutrition status (Ennis et al.,2001).
This sets chronically ill patients on a carousel of
morbidity (Ward, 2001).
�Rollins (2002)mentions a frequency of 70%
of
malnutrition that is unrecognised in hospital
outpatients.
Reasons for under
Reasons for under-- recognition of
recognition of
malnutrition in hospitals
malnutrition in hospitals
�While healthcare staffregularly m
onitor patients
for adverse changes in respiratory function, fluid
and electrolyte balance, the effects of starvation or
semi-starvation often go unrecognised.
�Clinical nutritionis not taught to the present
generation of doctors, and it is still a cinderella
subject in undergraduate medical and nursing
schools (N.M
.E., 1983, cited in Lennard-Jones, 1992;
Judd, 1988, cited in Lennard-Jones, 1992; Plester, 1996).