Artificial Feeding

Question 1

what sort of patients are affected by malnutrition

Answer 1

40% of patients malnourished on acute admission

up to 70% of patients malnourished on discharge

Question 2

statistically if people go down 30% of their body weight what happens

Answer 2

2/3 of those die

total starvation occurs between 60-70 days

Question 3

what are the consequences of poor nutrition

Answer 3

physical - reduced muscles mass and function, reduced CO, DVT risks
immune - increased risk of infection, altered gut function - translocation of gut bacteria
physiological - depression, irritable, reduced mental concentration

Question 4

how do you assess malnutrition

Answer 4

MUST - Malnutrition universal screening tool

assessment of malnutrition risk and itself

Question 5

what are the three measurements of must

Answer 5

BMI (weight/height ^2)
recent weight loss
acute illness with or likely to be nutritional intake

Question 6

the score for BMI has three tiers

Answer 6

between 0 and 2

0 = obese

Question 7

what are the colours of BMI

Answer 7

green is greater than 20
yellow is 18.5-20
red is BMI less than 18.5

Question 8

overall what is the score ratio for must

Answer 8

bmi - 0 1 2
recent weight loss 0,1,2
no intake for previous 5 days 0,1,2
overal out of 6 
0 low, 1 medium, anything above 2 is high

Question 9

what high risk medical conditions are associated with risk of malnutrition

Answer 9

dysphagia
poor absorption in the gut
high nutrient loss
increased nutritional needs

Question 10

what types of people need artificial feeding

Answer 10

can’t eat - stroke and head/neck surgery
can’t eat enough - runs - sepsis - pre-operativer malnutrition
shouldn’t eat - bowel obstruction, leaks after surgery, prolonged paralytic ileum

Question 11

what is fortisip / fortijuice

Answer 11

200 ml bottle

provides, minerals, protein, calories and vitamins

Question 12

what are the type injection routes for artificial feeding

Answer 12

enteral - into gut

parenteral - into vein

Question 13

why do you need enteral feeding

Answer 13

persistant or poor oral intake
dysphagia
head injury

but requires functioning gut

Question 14

what are short term enteral feeding

Answer 14

naso gastric feeds
naso-jejunal feeds if gastric outlet / obstruction /delayed emptying
usually last less than four weeks

Question 15

what are long term enteral feeding techniques

Answer 15

percutaneous endoscopic gastrostomy

Radiologically inserted gastrostomy (used if cancer is in upper GIT)

Question 16

what is TPN in artificial feeding

Answer 16

total parenteral nutrition
feeding into the vein - mainly used for acute action
long term may be a mixture of both methods

Question 17

what are the prior requirements for the use of TPN

Answer 17

inability to establish any other route for nutrition

inability to meet nutritional requirements via the oral or enteral routes

Question 18

what will be in TPN solution

Answer 18

protein glucose and fats 
electrolytes 
vitamins 
trace elements 
(tailored to individuals needs)

Question 19

what are the routes for intravenous feeding

Answer 19

short-term - peripheral feeding midline (Basal or cephalic vein)
medium term - central feeding PICC (neck)
long term - tunnelled lines - hickman (through chest)

Question 20

what are some complications of PN

Answer 20

infection (usually from midline) 
high blood sugar 
electrolyte disturbance 
abnormal liver test 
refeeding syndrome

Question 21

what is refeeding syndrome

Answer 21

too much too soon
patients at risk are malnurishoued, no recent intake, alcoholic
causes fluid shifts and electrolyte shifts

Question 22

what was the initial documentation of refeeding

Answer 22

joesoph flavius

deaths from jews who were trapped and then escape, ate too much and died

Question 23

what happens to your body during starvation

Answer 23

decrease in insulin secretion and increase in glucagon
switch from glucose to ketones for energy
glycogen stores used and BMR decreases
atrophy or organ and reduced lean body mass

Question 24

what are the physiological consequences of starvation

Answer 24

deficiency of vitamins and trace elements
reduced k, magnesium, phosphate leading to impaired cardiac, intestinal and renal reserve
serum electrolytes maintained within normal limits

Question 25

what happens to uptake in the body during refeeding

Answer 25

increased uptake of glucose, phosphate, potassium magnesium
reactivation of Ka, k pump
switch from metabolism to growth - increased demand for phosphate, k, glucose and water
increased thiamine utilisation

Question 26

what are the consequences of refeeding

Answer 26

high glucose, low thiamine, low magnesium, low k and low phosphate
leads to cardiac failure, pulmonary odema and dysrhythmia

Question 27

what is the treatment for refeeding syndrome

Answer 27

give pabrinex - prevents wernickes/korsakoff
feed slowly
daily electrolytes