Advanced Clinical Nutrition 1 Flashcards
Why is nutrition important?
3 answers
- good for patient management
- reduces morbity and mortality rates
- reduces length of hospitalisation and complications
What are the indicators for malnutrition?
- loss of muscle condition
- over 5-10% unexplained weightloss
- poor coat condition
- reduced appetite for more than 2-3 days
- large protein losses
- burns
- head trauma
What is simple starvation?
- normal metabolic adaptations
- conservation of protein
- fat usage increased
What is stress starvation?
- hypermatabolism
- breakdown of protein/muscle wastage
- less time to state of malnutrition
- likely unwell
What is cachexia?
muscle loss in presence of disease
What are we assessing first for malnutrition?
hydration, elctrolytes, acid-base balance, pain
What are the short term aims for nutrition?
- provide ongoing nutritional requirements
- prevent or correct nutritional deficiencies or imbalances
- minimise metabolic derangements
- prevent further catabolism of lean body mass
What are the long term nutritional aims?
- Restoration of optimal body condition
- provision of required nutrients within the animals own environment
What is enteral feeding?
tube feeding
What are the 4 types of feeding tubes?
- naso-oesophgeal/gastric
- oesophagostomy
- gastrstomy
- jujunostomy
Which of the 4 types of feeding tubes are short erm?
naso-oesophageal
How can you determine which feeding tube to use?
- patient - tolerance, risk of GA, duration
- technical - clinician experience, complications, diet
- owner - cost, compliance
What is classed as short term?
5-7 days
Which feeding tube doesn’t require GA?
naso-oesophageal
What is re-feeding syndrome?
metabolic derangements occuring when enteral or parenteral nutrition is fed to extremely malnourished patients, or occuring after prolonged starvation
What state are patients with refeeding sydrome changing from?
catabolic to anabolic states
What metabolic states can be seen due to increased insulin release?
- severe hypophosphataemia
- hypokalaemia
- hyponatraemia
- hyperglycaemia
- hypocalcaemia
What are the signs associated with re-feeding syndrome?
- peripheral oedema
- haemolytic anaeamia
- cardiac failure
- neurological dysfunction
- respiratory failure
When would you remove a feeding tube?
Once the patient is voluntarily eating over 85% of the RER
Why is it good to introduce oral rehydration fluids
it prepares the gut for feeding before calories
How do you re introduce feeding?
- small frequent meals
- gradual introduction
risk assessment regarding malnutrition
What is parenteral nutrition?
proving nutriton intravenously when enteral nutrtion isn’t possible
How do you provide parenteral nutrtion?
through a peripheral line
What should you monitor when providing parenteral nutrition?
- signs of phelbitis
- infection
- metabolic complications
- sepsis
- occlusion or dislogement of line
- patient interference
