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Malnutrition in geriatric clinical practice
Matoušková, Tereza ; Vágnerová, Tereza (advisor) ; Michálková, Helena (referee)
Introduction to the problem: Malnutrition is a prevalent disease in the geriatric population. Currently, there are several types of classification and assessment of malnutrition according to MKN-10, ESPEN, and GLIM. Based on the severity of the diagnosis, it is always necessary to proceed immediately to appropriate therapy that will improve patients' overall health and also lead to an improvement in their quality of life. Aims of the study and research questions: The first goal is to evaluate the nutritional status of patients based on the nutritional screening, MMSE test results, laboratory examination, and dietary intake in the first three days of hospitalization. The second goal is to assess the nutritional status of patients identified in nutritional screening tests, such as MNA and SNAQ, at risk of malnutrition or already in a state of malnutrition using the GLIM diagnostic criteria. To better evaluate both objectives of the study, five research questions were formulated: 1. How many respondents had a normal nutritional status, were in a state of malnutrition, or were at risk of malnutrition? 2. What was the specificity and sensitivity of each nutritional screening compared to the GLIM diagnostic criteria? 3. Did malnutrition and malnutrition-risk respondents have worse laboratory index...
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Nutritional status of patients with acute leukemia during the oncological treatment
Kupilíková, Veronika ; Šťastná-Marková, Markéta (advisor) ; Křížová, Jarmila (referee)
Acute leukemia is defined as a heterogeneous group of malignant hematopoietic stem cell disorders. The aim of this study was to investigate the extent to which nutritional disorders occur in patients with acute leukemia during the cancer treatment, their severity, the most common causes of weight loss, and the extent to which different forms of nutritional intervention are applied in patients. The research was carried out in the Institute of Haematology and Blood Transfusion, during the hospitalization of patients in the inpatient ward, intensive care unit and transplant unit. The study population consisted of 40 patients diagnosed with acute leukemia. Outcomes from nutritional status screening (MNA questionnaire, BMI, weight, mid arm circumference, calf circumference, BIA, biochemical nutritional parameters), and functional assessment (ECOG PS, Chair-stand test, Hand grip test) were used to process the practical part and answer the research questions. Measurements were performed twice with approximately one month intervals. The study confirmed weight loss since the onset of the disease in 95 % of patients. The dominant cause of weight loss was identified in 80 % as lack of appetite. Nutritional screening by MNA evaluated the patient population with a mean score of 22,8 ± 2,9, referring to the risk...
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Saturation of nutrition needs of seniors in seniors´ homes.
KAHOUNOVÁ, Dagmar
This bachelor thesis deals with the topic of saturation of nutrition of elderly people living in the retirement homes. Nutrition condition in the retirement homes is disturbing. The nutrition condition of elderly people is not rated enough. Insufficient nutrition causes many results and influences overall condition of elderly person organism. Reasons of insufficient nutrition can be influenced. The cornerstone for improving of nutrition condition of elderly people would be implementation of nutrition screenings to everyday care. The nutrition of elderly people has its specifics that should be kept during the elderly persons nutrition care. The bachelor thesis consists of a theoretical part and practical part. In the first part - theory -the main topics are old age, nutrition and malnutrition. The practical part follows on with a research. The aim of bachelor thesis was to find out which obstacles occur during the food intake of elderly people in retirement homes, how nurses satisty the nutrition needs of elderly and how nurses co-operate with other members of nursing care team. For achieving this goal there was used a qualitative research. The research was realized by method of semi-structured dialoques, questioning method. There were 10 nurses working for retiremnet homes who participated in above stated research. The interviews were written down by pencil-paper method and transcribed. As a result was detected that the nutrition condition of elderly people is only minimally rated. In the retirement homes there usually is not implemented any standard, there are only internal procedures. A nutrition specialist usually does not join the nursing care team. If there is neither its own cooking area/kitchen in the retirement home nor the nutrition specialist, there is not served the suitable food for each of the elderly person individual needs. It is neccessary to implement the nutrition screenings to everyday nursing care.
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Comparison and validity of new criteria for the diagnosis of malnutrition by GLIM in clinical practise
Boček, Petr ; Vágnerová, Tereza (advisor) ; Topinková, Eva (referee)
Aim of thesis: The aim of this bachelor thesis was to compare the standardized nutrition screening tools and the new diagnostic criterita of malnutrition according to GLIM with the practical findings of muscle mass using BIA in the clinical practice. Methods: Recently admitted and suitable patients aged 60+ at the Geriatric clinic of the General University Hospital in Prague and the First Faculty of Medicine of Charles University were selected for this research. Age, weight, height and subsequently BMI were determined at these patients. A standardized screening MUST (according to BAPEN), MUST in the modification of the General University Hospital, MNA-SF, SGA, evaluation according to the new criteria according to GLIM using BIA to determine seriousness of sarcopenia were performed. Results: According to GLIM criteria (SMI value [kg/m2 ] is 10,76 for the diagnosis of sarcopenia and 8,51 for severe diagnosis of sarcopenia for men and 6,76 for the diagnosis of sarcopenia and 5,76 for severe sarcopenia for women), there were 80,4 % of patients sarcopenic. The average SMI for men was 8,6±1,0 and 6,3 ±1,1 for women. The MUST screening had an overall low sensitivity - 61 %. In contrast, the MNA had high sensitivity - 91 % compared to the SGA. The best validity for malnutrition and sarcopenia is given by...
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Clinical reality - nutritional screening and nutritional status.
Mikhaylova, Olga ; Meisnerová, Eva (advisor) ; Vágnerová, Tereza (referee)
(v AJ) Malnutrition is serious problem, increases patient morbidity and mortality. It is important to find patients at risk of malnutrition in time to start nutritional support. Nutritional screening should be clear, simple and easy to find as many individuals as possible at risk of malnutrition. Current nutritional screenings - NRS 2002, MUST, MNA that we use in clinical practice fail. The topic of my bachelor thesis is the evaluation of nutritional screening on the internal separation of unselected internal income. The aim of my bachelor thesis was to evaluate nutritional screening of NRS 2002 recommended for nutritional screening of adult patients in ESPEN guidelines and new GLIM criteria for diagnosis of malnutrition. In the theoretical part the thesis deals with the issue of malnutrition. It focuses on the causes and mechanisms of formation, consequences and diagnosis of malnutrition. Existing nutritional screening, its structure, use in practice and results of studies comparing its effectiveness are described in more detail. The pivotal point of the theoretical part is the introduction of the new GLIM criteria for the diagnosis of malnutrition from 2018. The practical part deals with the main objective of which is to compare the results of the evaluation of nutritional status of hospitalized...
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Application of nutritional risk screening of hospitalized pediatric patients
Baliková, Marieta ; Tláskal, Petr (advisor) ; Boženský, Jan (referee)
The thesis summarizes present knowledge about assessment of growth and development in childhood (antropometric assessment, assessment of biological age and assesment of nutritional status). Nutrition in childhood and adolescence is also described. The thesis deals with silure to drive- its causes, definitiv, consequences and treatment. Most of nutritional screening forms (foreing and also Czech screening form) are mentioned. Practical part is realized on childern wards, Motol University Hospital. The aim of the thesis is to evaluate two nutritional risk screening which have been gradually introduced in Motol Univrsity Hospital to determinate the nutritional risk of hospitalized pediatric patients.
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Hidden malnutrition in patients with advanced stage of ovarian carcinoma
Ožanová, Michaela ; Tuček, Štěpán (advisor) ; Kostková, Lenka (referee)
This diploma thesis deals with the topic of hidden malnutrition in patients with advanced stage of ovarian carcinoma. Tumor diseases are often accompanied by malnutrition. In the case of ovarian cancer, malnutrition may be hidden, primarily due to ascites, which can distort body weight. Out of the patients included in this study 32 % had ascites. The basic nutritional status test in hospitals is the nutritional screening performed on each hospitalized patient to detect the risk of malnutrition. Other methods such as anthropometric measurements, laboratory values, bioimpedance analysis, or less commonly, imaging processes can also be used to detect malnutrition. The aim of this thesis was to evaluate whether nutritional screening and regular weight control in patients with advanced ovarian cancer is sufficient to diagnose malnutrition. The results have shown that the inclusion of anthropometric measurements between routine screening can be beneficial in detecting a greater number of malnourished patients. Also shifting the BMI threshold in nutritional screening for patients over 65 would greatly increase the capture of patients at risk of malnutrition. The secondary focus was to find whether the presence of ascites can be a determining factor in malnutrition being left undiagnosed, and which simple...
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The role of a nurse in the care of a patient´s nutrition
SKŘÍŠOVSKÁ, Martina
This Master's Thesis "The Role of a Nurse in the Care of a Patient's Nutrition" is written in a purely theoretical plane, deals with the basic pillar of the existence of the human organism the correct and sufficient nutrition of a human, and studies the extent of an involvement of the general nurse in satisfying biological, psychological aspects of patient's nutrition in the nursing process. The topic of nutrition plays an important part of the complete spectrum of each medical expertise. The satisfaction of patient's need for nutrition in all of the stages of his life is a part of a nurse's job in a nursing process not only in Intensive Care Units, Resuscitation Care Units and Standard Care Departments, but even in Geriatric Units and Social Care Institutes. The thesis is methodically divided into separate parts, each logically following its preceding one. In the Introduction we define malnutrition as a global medicinal and social problem, introduce principles and theoretical starting points of an organisation of an optimal nutrition care and introduce international activities, which contribute to creating guidelines using the Evidence Based Practice method, and implementation of effective methods in providing complex care of a patient's nutrition in medical facilities and institutes of social care. We follow with the summarisation of basic nutrients, emphasising their importance for the right function of a human body, and negative effects of their insufficiency in the food intake. The thesis presents an algorithm of an evaluation of a patient's nutrition state in a nursing process, comparing available screening standardised questionnaires, which are usable in detecting sings of a malnutrition. We present the possibilities of food fortification, specify targets of nutritional support in medical facilities, focusing on indications, benefits, risks and paths of application of enteral and parenteral nutrition, and provide complete summary of nutritional interventions in the context of nursing care, which is oriented on ensuring the food intake. In the Conclusion, we identify those aspects of the patient's nutrition care, which are hard to fulfil and realise, and those psychological and social-cultural aspects, which the nurse can in the nursing process satisfy only when using holistic and empathetic approach. The altruistic, but controversial and ethical-philosophical topic represents not initiating or ending the interventions of nutritional support, where this decision respects principles of beneficence and non-maleficence of The Hippocratic Oath, the quality of a patient's life and human dignity.
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The Use of Nutritional Screening in Nursing Care
KOPPOVÁ, Veronika
Nutritional screening is a simple tool for detecting the nutritional status of a patient and is primarily intended to detect the risk of malnutrition or to detect already developed malnutrition. Malnutrition is a pathological condition caused by a lack of nutrients or by their misalignment. This is an unpleasant nutritional complication that can cause other complications that result in a higher risk of mortality and morbidity, prolong treatment time and hence increase the cost of treating the patient. The advantage of nutritional screening is to monitor the nutritional status of the patient throughout hospitalization, because the patient's nutritional requirements may change. The concept of the bachelor thesis is theoretical - empirical. The theoretical part of the bachelor thesis describes the current state of nutrition, the evaluation of the patient's nutritional status in the hospital, the most serious complications of nutrition - malnutrition and nursing practice in the area of nutrition. The second part of the bachelor thesis is a research survey. The aim of the work was to find out how nurses use nutritional screening in practice. Three research questions have been identified to achieve the goal. How do nurses work with nutritional screening? At what time intervals nurses work with nutritional screening. How do nurses know about nutritional screening? Responses were obtained through a pre-prepared semi-structured interview with nurses in the after-care department. A post-natal care department was selected for the research investigation due to the hospitalization of the chronically ill, geriatric patients. This group of patients is one of the most risky for complications caused by insufficient nutrition. The research has revealed that nurses are not sufficiently aware of the items under consideration and the importance of nutritional screening, do not communicate with the nutritional therapist as it is, but they are interested in the nutritional status.
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Importance of nutritional screening in the scope of general nurses
JANÍK, Martin
Current status: Although it was developed and published in many studies pointing to the impact of malnutrition and its relationship to the patient and the economy of the health systems, malnutrition remains a silent guide of hospitalized patients. In the year of 2014, the authors of the study group feedM.E. indicate in their articles the worldwide prevalence of malnutrition as a common and a costly (especially for the elderly). The rate of prevalence of malnutrition in a group of hospitalized patients is around 50%, according to this working group. Objectives: The goal of the project was to describe the methods for screening the patients with nutritional needs interventions by the nurses, the continuity of the care for patients in the risk of malnutrition, transmitting the information about the nutritional status of the patient during his hospitalization and delivery of care to another provider of health services and interdisciplinary co-workers involved in the care of patients in the risk of malnutrition. Methods: The research investigation conducted by the method of the qualitative research. The research subject was the process of detecting malnutrition and continuity of nutritional care for recipients of health services from the perspective of persons providing these services. The research method was chosen a depth interview. The sample of respondents was intentional and the file size was determined by saturation of the collected data. For data processing was used open coding and following categorization of the data which was obtained from interviews. The results were interpreted by using the "showdown". Participants: The request to facilitate the initiation of research has been mostly refused and addressed to the health service providers. Selection of interviewees was intentional by the circle of my former colleagues. With research have expressed their consent five nurses and five dietitians, which are working in the Czech Republic. Results: For identification of patients at the risk of malnutrition, all respondents have described the identification of patients at the risk of malnutrition on admission to the hospital by collecting of nursing history. During the interviews, the respondents have reported the problems both with the absence the reports including detection of patients at the risk of malnutrition from some stations at hospitals, as well as the jurisdictional disputes about the role of the dietitians in patient nutrition at intensive care unit, the complications with material and technical equipment of nursing stations and its applicability for use in specific patients. Also expressed the ignorance of screening tools which are used at the sites of all respondents, including dietitians. The inaccurate ideas of some respondents were in the terms of the skills and the competencies of individual professionals which are involved in the care of patients in the risk of malnutrition. Three nurses of the five indicated that information about the nutritional balance of the patient and their needs should affect the assessment of the patient's overall condition and could lead to changes in the nursing care plan or risk assessment (eg. the risk of pressure ulcers, etc.). Conclusion: The method of providing nutritional care in hospitals, in which respondents are employed, is headed toward pursuing the recommendations of the professional associations. In detail, however, they differ and are often close to the boundaries defined as a legal standards. Breaks are noticeable in continuity of the care, or are put excessive approval procedures, which can lead to delay of required nutritional interventions. Here is a lack of information about the various screening tools and their applicability to the certain groups of patients. Therefore I recommend issuing guidelines by professional society, in the direction of the definition of screening tools and their using in the certain groups of patients, for the healthcare providers in
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