Artificial feeding Flashcards
When, healthy how long does it take before total starvation occurs? (with water)
What increases this risk?
60-70 days
Starting off with illness
What medical conditions cause high risk of malnutrition?
poor absorption form gut
high nutrient loss
increased nutritional needs
What assessments should be carried out when an adult is being assessed for malnutrition?
Assessment of malnutrition risk
BMI
Recent weight loss
Assessment of malnutrition
What is anthropometry?
Study of the measurements and proportions of the human body
What anthropometric measurement should be carried out during a nutritional assessment?
Tricep skinfold thickness
Mid arm circumference
Mid arm muscle circumference
What biochemical nutritional assessment should be carried out?
Albumin (but not a good marker of poor nutrition)
Vitamins
Trace elements
What 3 groups of patients should get artificial nutrition? Give examples of each
Can’t eat - stroke, head and neck surgery
Can’t eat enough - burns (high calorie, high protein diet required), sepsis, pre-operative malnutrition
Shouldn’t eat - bowel obstruction, leaks after surgery, prolonged ileum (lack of gut movement after surgery)
What is enteral feeding?
Feeding directly into the gut. Gut must be functioning.
Can be naso-gastric or naso-jejenual
What is a PEG?
Percutaneous endoscopic gastrostomy (tube into stomach through abdominal wall for long term enteral feeding)
What is a RIG?
Radiologically inserted gastrostomy
required if there are cancers in upper GI tract
What is TPN?
Total parenteral nutrition
feeding directly into the vein. Long term patient usually have a mix of TPN and normal eating.
Used when; obstruction, short bowel syndrome, fistulae, post surgical complications
Name 5 complications of TPN (total parental nutrition)
Infection (only 4 neck veins can be used)
High blood sugar
Electrolyte disturbance
Abnormal liver tests (fatty liver)
Refeeding syndrome (too much too soon = massive shift in fluids electrolytes = death)
What happens to insulin and glucagon secretion in starvation?
Insulin secretion decreases because blood sugar is low
Glucagon secretion increases
There is a switch from glucose to ketones as the main energy source
What is refeeding syndrome?
Once being fed, there is increased uptake of glucose, phosphate, potassium, magnesium
This means Na+/K+ pump is reactivated and K+ moves into cells, NA+ and water move out
Massive fluid shift
Switch form catabolism (breaking things down for energy) to anabolic growth
Increased insulin which stimulates glycogen, fat, and protein synthesis using ions
increase demand for ions
Low potassium, magnesium, thiamine, phopshate
High glucose
cardiac failure, pulmonary oedema, dysrhythmia
What is the treatment for refeeding syndrome?
Give vitamins B, C and thiamine Feed slowly Daily electrolytes Correct abnormalities Monitor
Long term:
monitor temp, BP, weight, blood sugar, FBC, U&E, Mg, Ca, trace elements
