clinical nutrition and intestinal failure Flashcards
what can be used for a nutritional assessment at the bedside?
- simple questions about their appetite, diet history, changes in oral intake and changes in weight
- the malnutrition universal screening tool (MUST) considers BMI, unplanned weight loss and any illnesses and calculates risk of malnutrition
what can be done to manage malnutrition?
- food and encouragement, minimise mealtime interruptions
- encourage high calorie options
- assistance with eating, appropriate cutlery and their teeth
- dietitian should be used and can advise supplement drinks which can be nutritionally complete
when is an NG tube used?
patient can’t meet nutritional requirements by themselves or have unsafe swallowing/non functioning GI tract
short term access to provide all the nutritional and fluid requirements, or be used for supplementary feeding on top of the patients usual oral intake
check pH prior to each use to ensure the tip is in the stomach and not the lungs
(Can be affected by PPI, use CXR to confirm)
if patient has swallowing issues, decrease risk of aspiration due to food, but still a risk as can aspirate on saliva
when is a PEG/RIG/PEGJ/RIGJ tube used?
provide longer-term enteral access than an NG tube. The tube may feed into the stomach (PEG or RIG) or into the small bowel (PEG-J or RIG-J) and be placed endoscopically (PEG and PEG-J) or radiologically (RIG and RIG- J).
indicated when the feeding difficulty, or need to provide supplementary feeding, is likely to be medium or long term.
what is parenteral nutrition?
provides nutrition and fluid directly into a patients veins
only indicated when the GI tract is not accessible (blocked) or not working (short, leaking or diseased).
It is a complex mix of fluid, macronutrients and micronutrients and needs to be given via a dedicated central line (PICC or Hickman line). There are risks of line sepsis and liver dysfunction.
