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BS - Gastrointestinal System pt.1 > Artificial Feeding > Flashcards

Artificial Feeding Flashcards

1
Q

What percentage of patients are malnourished on acute admission to A and E?

A

40%

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2
Q

What percentage of patients are malnourished on discharge from hospital?

A

70%

The percentage increases from when the patient enters the hospital to when they leave

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3
Q

What happens if someone goes down to 30% of their normal body weight?

A

60% of people who reach this level will die

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4
Q

In a healthy person, how many days does it take for total starvation to occur?

A

between 60 and 70 days

if a small amount of food is allowed, the period of starvation is prolonged

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5
Q

In an ill person, how long would it take for 60% of patients to die from partial starvation?

A

between 30 and 40 days

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6
Q

What is the difference in the time it takes for a patient to die from complete starvation if they are healthy and if they have undergone trauma, infection or major surgery?

A

In a normal fit adult, complete starvation leads to death within 2 months

After trauma, infection or major surgery, starvation will lead to death in 1 month

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7
Q

what are the physical consequences of starvation?

A
  1. reduced muscle mass and function
  2. increased risk of chest infections
  3. difficulty in weaning from ventilator
  4. reduced cardiac output
  5. reduced motility which leads to bedsores and risk of DVT/PE
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8
Q

What are the immune consequences of starvation?

A
  1. impaired immune system leads to an increased risk of infection
  2. altered gut function leads to translocation of gut bacteria
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9
Q

What are the physiological consequences of starvation?

A
  1. depression
  2. apathetic tendencies
  3. irritability
  4. reduced mental concentration
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10
Q

How is malnutrition assessed in adults?

A

The malnutrition universal screening tool (MUST)

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11
Q

What does the malnutrition universal screening tool (MUST) assess?

A

Current malnutrition as well as malnutrition risk

This is whether someone is likely to become malnourished whilst in hospital

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12
Q

When is MUST carried out and how often is it repeated?

A

It is carried out within 24 hours of admission to hospital

It is then repeated weekly

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13
Q

What are the three trigger questions involved in MUST?

A
  1. has the patient lost weight recently?
  2. has the patient noticed a reduction in their appetite?
  3. will this admission have an impact on the patient’s nutritional uptake?

If the answer to any of the questions is yes, MUST should be carried out

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14
Q

What 3 measurements are involved in MUST?

A
  1. body mass index (BMI)
  2. recent weight loss as a percentage
  3. acute illness with, or likely to be, no nutritional intake for 5 days
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15
Q

How are the measurements taken in MUST scored?

A

BMI is scored between 0 and 2 points

Weight loss is scored between 0 and 2 points

No intake for the previous 5 days is scored either 0 or 2

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16
Q

What is considered a low, medium and high risk MUST score?

A

0 out of 6 is a low risk

1 out of 6 is a medium risk

greater than or equal to 2 is a high risk

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17
Q

What happens to patients who score 1 or more on MUST?

A

They are put on a food chart

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18
Q

What happens to patients who score 2 or more on MUST?

A

They are monitored as high risk patients

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19
Q

What are 4 common medical conditions that put patients at a high risk of malnutrition?

A
  1. swallowing problems
  2. poor absorption from the gut
  3. high nutrient losses
  4. increased nutritional needs
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20
Q

What is a common misconception about malnutrition?

A

Someone who is overweight or has a healthy BMI may still be malnourished

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21
Q

What are anthropometric assessments and what do they measure?

A

They measure fat

This involves measuring tricep skinfold thickness

or mid-arm circumference and mid-arm muscle circumference

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22
Q

What biochemical assessment is usually used in assessing malnutrition?

A

Blood test to measure serum albumin levels

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23
Q

Why are serum albumin levels measured in malnutrition?

A

It is not a marker of poor nutrition

albumin is a negative acute phase protein, so levels of albumin go down with sepsis

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24
Q

What else may be measured in the blood of a patient with malnutrition?

A

Levels of vitamins and trace elements

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25
Q

What does the amount of calories required depend on?

When calculating the amount of calories, what group equations are used?

A

amount of calories depends on physical stress and amount of physical activity

there are equations for each age group, gender and clinical condition

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26
Q

What do nutritional requirements ensure?

A

Patients get enough fat, protein and carbohydrate

They must also have sufficient levels of electrolytes, vitamins and minerals

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27
Q

What 3 categories of patients should have artificial nutrition?

A
  1. patients who cannot eat as they cannot swallow
  2. patients who cannot eat enough
  3. patients who shouldn’t eat
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28
Q

What type of patients cannot eat as they cannot swallow?

A

Stroke patients

Patients who have had head and neck surgery

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29
Q

What type of patients cannot eat enough?

A

usually patients who have sepsis or severe burns

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30
Q

what type of patients shouldn’t eat?

A

patients with a bowel obstruction, leaks after surgery and prolonger paralytic ileus

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31
Q

What is the preferred route for artificial feeding?

A

If the gut is functioning, it is always the preferred route for artificial feeding

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32
Q

What are 4 simple measures in place in hospital to prevent patients from becoming malnourished?

A
  1. encouragement to eat meals
  2. protected meal times
  3. red trays
  4. the consistency of food is changed to help patients with swallowing difficulties
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33
Q

What is meant by ‘protected meal times’ and ‘red trays’?

A

protected meal times mean that patients cannot be disturbed during the time they are eating, unless it is an urgent test

red trays are used to identify patients who cannot reach food placed at the end of their bed

34
Q

What are oral nutrition supplements?

What is their nutritional value?

A

200ml bottles of fluid for patients struggling to consume food

each bottle has 340 kcal and 20 g of protein

it also contains 1/5 daily requirement for vitamins and minerals

35
Q

What are the 2 types of artificial feeding?

A

Enteral and parenteral

36
Q

What is enteral feeding?

A

Feeding into the gut

It requires a functioning gut

37
Q

What types of patients will have enteral feeding?

A
  1. patients with persistent and poor oral intake
  2. patients with dysphagia (difficulty swallowing)
  3. patients who have had a head injury with prolonged recovery
38
Q

What are the types of short-term enteral feeding?

how long are they used for?

A

Naso-gastric or a naso-jejunal feed

Nasal tubes are used for less than 4 weeks

39
Q

What is involved in a naso-gastric feed?

A

A flexible, narrow tube enters the nose and sits in the stomach

40
Q

When is a naso-jejunal feed used?

A

the tube sits in the jejunum, rather than the stomach

it is used if there is a gastric outlet obstruction or delayed emptying of the stomach

41
Q

What are the two methods used in longer-term enteral feeding?

A
  1. percutaneous endoscopic gastrostomy (PEG)

2. Radiologically inserted gastrostomy (RIG)

42
Q

What equipment is used in a PEG?

Why must this equipment be used?

A

It starts as a normal endoscopy, with a bright light at the end of the tube

If light can be seen from outside the stomach, then there is no part of the bowel that will be speared by the needle

43
Q

What happens in a PEG?

A

A small opening through the skin of the upper abdomen, directly into the stomach, is made

A feeding tube can then placed and secured in the stomach

44
Q

When is a RIG used?

Why is it used?

A

When patients have cancer in the upper GI tract

The pulling technique used in PEG has a risk of pulling cancer cells into the stomach

45
Q

What is the basic procedure involved in a RIG?

A

Air is used to inflate the stomach, which is then pulled towards the abdominal wall

46
Q

What is parenteral feeding?

A

Feeding through through a vein

47
Q

What is the name of the type of nutrition used when the gut is not accessible?

A

Total parenteral nutrition

48
Q

What is the difference in treatments if patients are having artificial feeding acutely and in the long-term?

A

Acutely - often solely parenteral nutrition

Long-term - may be a mixture of oral, parenteral and enteral feeding

49
Q

What are the two requirements for parenteral nutrition?

In which patients is it normally used?

A
  1. there is an inability to establish any other route for nutrition
  2. there is an inability to meet nutritional requirements via the oral or enteral route

It is usually used when there is an obstruction in the GI tract

50
Q

What 3 conditions usually lead to patients requiring parenteral nutrition?

A
  1. patients with short bowel syndrome
  2. fistulae, often between the bowel and skin
  3. patients who have had complications post-surgery
51
Q

What are the 6 components of the parenteral nutrition feed?

A
  1. proteins
  2. glucose
  3. fats
  4. electrolytes
  5. vitamins
  6. trace elements

all components are made up to match an individual patient’s requirements

52
Q

What electrolytes are included in a parenteral feed?

A
  1. sodium
  2. potassium
  3. calcium
  4. magnesium
  5. phosphate
53
Q

What vitamins are included in a parenteral feed?

A

Both fat-soluble and water-soluble vitamins

54
Q

What trace elements are included in parenteral feed?

A
  1. zinc
  2. selenium
  3. manganese
  4. copper
  5. iron
55
Q

What types of veins are used as a route of insertion for intravenous feeding?

A

Either basilic or cephalic veins

56
Q

What types of intravenous feeding techniques are used for short, medium and long-term feeding?

A

Short-term: peripheral feeding (midline)

Medium-term: central feeding (PICC)

Long-term: Tunnelled lines - Hickman

57
Q

What is involved in peripheral feeding (midline)?

A

A long cannula is placed into a small arm vein

Feeding is done peripherally

58
Q

what is involved in central feeding (PICC)?

A

A peripherally inserted central catheter enters the arm, but feeds into a large vein with fast-moving blood

59
Q

What is involved in a tunnelled line (Hickman)?

A

A central line is inserted into the chest and tunnelled under the skin

60
Q

Why is the Hickman line tunnelled under the skin?

A

To reduce the infection rate as it can stay in for up to 10 years once inserted

61
Q

What lung condition can result from a Hickman line and why?

A

Pneumothorax

This occurs when the line damages the lung and causes it to rupture

62
Q

What leads to a Hickman line infection and what do TPR charts show in this case?

A

If a line sits next to a stoma bag

TPR charts show fast pulse, high temperature and fast respiratory rate

63
Q

Why is contrast fluid used when inserting an intravenous feeding line?

A

Putting in the line can puncture the outside of the vein

Contrast fluid can help to identify whether any of the contrast is outside of the vein

64
Q

What is thrombophlebitis?

A

This occurs when the Hickman line irritates the vein and causes it to become inflamed

65
Q

Why are patients on parenteral nutrition often given insulin?

A

Parenteral nutrition may result in high blood sugar levels as all of the daily blood sugar is given in a 12-hour period

Insulin prevents the risk of diabetes

66
Q

What is refeeding syndrome (too much too soon) characterised by and who does it often affect?

A

characterised by fluid and electrolyte shifts

usually affects malnourished patients, those with no recent intake and alcoholics

67
Q

In starvation, what does the absence of carbohydrates lead to?

A

Decreased insulin secretion and increased glucagon secretion

68
Q

What is the main source of energy in starvation and why?

A

All of the glycogen stores are used up so the brain switches from using glucose to ketones

69
Q

What are the consequences of ketones becoming the main source of energy?

A
  1. basal metabolic rate declines
  2. overall reduced lean body mass
  3. the brain adapts to using ketones, but there is atrophy (become smaller) of all other organs
70
Q

What trace elements are most affected in starvation?

A

Potassium, magnesium and phosphate

They move out of the cells to try and protect the serum concentration

71
Q

what happens to the movement of potassium, magnesium and phosphate as soon as feeding is recommenced?

A

The electrolytes go back into the cells causing the serum electrolyte levels to plummet

72
Q

In refeeding, what is there an immediate increased uptake of?

What are the effects of this?

A

Increased uptake of glucose, potassium, phosphate and magnesium

It causes serum levels to plummet

73
Q

What enzyme is re-activated when refeeding commences?

A

Sodium-potassium pump

This begins to move potassium back in to cells

It moves sodium and water out of cells

74
Q

what happens in refeeding when carbohydrates begin to be consumed?

A

The body switches from catabolism to anabolic growth

75
Q

What are the consequences of increased thiamine utilisation in refeeding?

A

Acute thiamine deficiency

Patients tend to act as if they are drunk

If this is not treated, it leads to irreversible loss of short-term memory

76
Q

What are the consequences of re-feeding?

A
  1. low phosphate
  2. low potassium
  3. low magnesium +/- calcium
  4. low thiamine (Wernicke-Korsakoff’s)
  5. High glucose
  6. cardiac failure, pulmonary oedema and dysrhythmia
77
Q

What drug is used to treat patients who are at risk of re-feeding syndrome?

What does it prevent?

A

Pabrinex

It is an IV version of vitamin B, vitamin C and thiamine

It prevents Wernike-Korsakoff’s syndrome

78
Q

In what other ways is re-feeding syndrome avoided?

A
  1. patients are fed slowly, and this is built up over time

2. potassium, phosphate and magnesium levels are measured daily and abnormalities are corrected

79
Q

What type of measurements are taken daily in long-term monitoring of parenteral nutrition?

A
  1. temperature
  2. pulse
  3. blood pressure
  4. weight measurements
  5. blood sugars are taken every 6 hours
80
Q

What other tests are performed in long-term monitoring of parenteral nutrition?

A
  1. full blood count, U&E, magnesium and calcium readings taken daily at first

and then

  1. calcium, magnesium, phosphate and LFTs are performed 3 times a week
81
Q

Which trace elements are given regularly in long-term monitoring of parenteral nutrition?

A

copper, zinc and selenium

BS - Gastrointestinal System pt.1 (22 decks)

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