Lecture 3: Nutrition

Question 1

What screening tool is used to identify malnutrition?

Answer 1

MUST (Malnutrition Universal Screening Tool)

Question 2

What 3 factors does MUST include?

Answer 2

1. BMI
2. Weight Loss
3. Acute Dz factor (ex: decreased appetite)

Question 3

What are the complications (5) associated with malnourishment?

Answer 3

1. impaired wound healing
2. decreased immune function
3. Atrophy (muscles/intestines)
4. change in respiratory mechanics
5. More post-op complications

Question 4

What are the serum markers of nutrition? (not reliable markers)

Answer 4

Serum albumin, pre albumin, transferrin

Question 5

How can you assess for malnourishment on PE?

Answer 5

1. Chronic illness
2. weight loss
3. Fat/muscle/temporal/clavicle wasting

Question 6

What condition is associated w/ protein and calorie malnutrition, Vitamin and mineral deficiencies?

Answer 6

Alcoholism

Question 7

What is the treatment for acute alcohol intoxication?

Answer 7

Banana Bag

contains thiamine, folic acid, MVI, magnesium

Question 8

What type of of diet is recommended for alcoholic liver disease?

Answer 8

High protein, low sodium diet

Question 9

What is refeeding syndrome?

Answer 9

Electrolyte imbalances that occurs as a result of aggressive nutrition support

Question 10

What is the early warning sign of refeeding syndrome?

Answer 10

Severe HYPOphosphatemia

Question 11

What electrolytes are affected in refeeding syndrome?

Answer 11

K, Mg, P - replete them aggressively

Question 12

What are the possible consequences of refeeding syndrome?

Answer 12

Respiratory distress, tetany, cardiac arrest

Question 13

What are the 3 most important nutrients for wound healing?

Answer 13

1. Protein
2. Zinc Sulfate
3. Vitamin C

Question 14

How is enteral nutrition provided?

Answer 14

Nutrients given via the GI tract

Question 15

What are the 3 short term routes for EN nutrition?

Answer 15

1. Oro-gastric
2. Naso-gastric
3. Naso-enteric

Question 16

What are the 3 long term routes for EN nutrition?

Answer 16

1. Gastromstomy
2. Jejunostomy
3. Transgastric jejunostomy

Question 17

What should be used to unclog a feeding tube?

Answer 17

warm water

- if it doesnt work dissolve tab of pancreatic lipase & Sodium Bicarb into warm water

Question 18

What type of medications can be given via a feeding tube?

Answer 18

liquid meds or powders suspended in liquids

NEVER ADD meds/suppplements to enteral feeding

Question 19

How is parenteral nutrition (TPN) provided?

Answer 19

IV

Question 20

Which type of TPN can be given long term?

Answer 20

CPN (central peripheral nutrition)

- delivered to high flow vein (SVC)

Question 21

What are the metabolic risks/complications of TPN?

Answer 21

Hypo or hyperglycemia
Excess CO2 production
HYPERtriglyceridemia
Abnormal LFTs

Question 22

What are the risks for small bore feeding tubes?

Answer 22

More likely to become clogged

Question 23

What are the indications for TPN?

Answer 23

1. No gut function
2. Ischemic bowel
3. Ileus
4. SBS (Short Bowel Syndrome)
5. High output fistula
6. Intractable V/D
7. Peritonitis
8. EN intolerance/unable to get access

Question 24

What are the indications for Enteral nutrition?

Answer 24

1. Malnourished & unable to eat for >5-7 days
2. Normally nourshed & unable to eat 7-9 days
3. Impaired swallow function
4. Major trauma, burns, wounds
5. Malnourished pre-op pt
6. Intubation

Question 25

What is the gold standard for determining protein and calorie needs?

Answer 25

Indirect Calorimetry