Artificial feeding

Question 1

What percentage of patients are malnourished on admission?

Answer 1

40%

Question 2

What percentage of patients are malnourished on discharge?

Answer 2

70%

Question 3

Effects of poor nutrition (mortality):

Answer 3

Normal fit adult - complete starvation: death in two months.
After trauma/infection/major surgery - starvation: death in one month.
Acute weight loss of more than 1/3 - impending death.

Question 4

Effects of poor nutrition (physical):

Answer 4

Reduced muscle mass/function
Increased risk of chest infections
Difficulty in weaning from ventilator
Reduced cardiac output
Reduced mobility → bedsores and DVT/PE risk

Question 5

Effects of poor nutrition (immune):

Answer 5

Impaired → increased risk of infection

Altered gut function → translocation of gut bacteria

Question 6

Effects of poor nutrition (psychological):

Answer 6

Depression
Apathetic
Irritable
Reduced mental concentration

Question 7

How is malnutrition assessed in adults?

Answer 7

Malnutrition Universal Screening Tool. Within 24 hrs of admission then repeated weekly.

Question 8

What are the trigger questions for a MUST?

Answer 8

Has the patient lost weight recently?

Has the patient noticed a reduction in their appetite?

Will this admission have an impact on patient’s nutritional intake

Question 9

What are the three MUST measurements and how are they used?

Answer 9

BMI 0, 1 or 2
Recent weight loss 0, 1 or 2
No intake for previous 5 days 0 or 2

Score 0 – 6
0: Low 1: Medium ≥2: High

Question 10

Can the obese be malnourished?

Answer 10

Yes! It’s quite possible that an obese individual that has lost a lot of weight has a high must score.

Question 11

Who should have artificial nutrition?

Answer 11

Can’t eat - Stroke, Head and neck surgery

Can’t eat enough -Burns, Sepsis, Pre-operative malnutrition

Shouldn’t eat - Bowel obstruction, Leaks after surgery Prolonged ileus

Question 12

What are the indications for enteral (nasogastric or nasojejunal) feeding?

Answer 12

Poor oral intake for > 3 days
Dysphagia
Head Injury
Prolonged recovery

Question 13

What are the options for long-term enteral feeding?

Answer 13

PEG (percutaneous endoscopic gastrostomy)

RIG (radiologically inserted gastrostomy)

Question 14

What are the indications for total parenteral nutrition?

Answer 14

Inability to establish any other route for nutrition

Inability to meet nutritional requirements via the oral or enteral route

Obstruction

Short Bowel Syndrome

Fistulae

Complications post-surgery - Prolonged Ileus, Anastomotic leaks

Question 15

Under what circumstances would you use a Hickmann line for TPN?

Answer 15

If the TPN is to continue for more than 4 weeks.

Question 16

What are the complications of TPN?

Answer 16

Infection
High blood sugar- may require insulin
Electrolyte disturbance
Abnormal liver tests- fatty liver
Refeeding Syndrome

Question 17

How do you prevent refeeding syndrome?

Answer 17

Treatment
Identify patients at risk
Give pabrinex (iv Vit B and C – thiamine)
Prevents Wernicke’s / Korsakoff’s
Feed slowly and build up
Daily electrolytes
Na, K, Ca, PO4, Mg
Correct abnormalities