Lecture 3: Nutrition Flashcards
What screening tool is used to identify malnutrition?
MUST (Malnutrition Universal Screening Tool)
What 3 factors does MUST include?
- BMI
- Weight Loss
- Acute Dz factor (ex: decreased appetite)
What are the complications (5) associated with malnourishment?
- impaired wound healing
- decreased immune function
- Atrophy (muscles/intestines)
- change in respiratory mechanics
- More post-op complications
What are the serum markers of nutrition? (not reliable markers)
Serum albumin, pre albumin, transferrin
How can you assess for malnourishment on PE?
- Chronic illness
- weight loss
- Fat/muscle/temporal/clavicle wasting
What condition is associated w/ protein and calorie malnutrition, Vitamin and mineral deficiencies?
Alcoholism
What is the treatment for acute alcohol intoxication?
Banana Bag
contains thiamine, folic acid, MVI, magnesium
What type of of diet is recommended for alcoholic liver disease?
High protein, low sodium diet
What is refeeding syndrome?
Electrolyte imbalances that occurs as a result of aggressive nutrition support
What is the early warning sign of refeeding syndrome?
Severe HYPOphosphatemia
What electrolytes are affected in refeeding syndrome?
K, Mg, P - replete them aggressively
What are the possible consequences of refeeding syndrome?
Respiratory distress, tetany, cardiac arrest
What are the 3 most important nutrients for wound healing?
- Protein
- Zinc Sulfate
- Vitamin C
How is enteral nutrition provided?
Nutrients given via the GI tract
What are the 3 short term routes for EN nutrition?
- Oro-gastric
- Naso-gastric
- Naso-enteric
What are the 3 long term routes for EN nutrition?
- Gastromstomy
- Jejunostomy
- Transgastric jejunostomy
What should be used to unclog a feeding tube?
warm water
- if it doesnt work dissolve tab of pancreatic lipase & Sodium Bicarb into warm water
What type of medications can be given via a feeding tube?
liquid meds or powders suspended in liquids
NEVER ADD meds/suppplements to enteral feeding
How is parenteral nutrition (TPN) provided?
IV
Which type of TPN can be given long term?
CPN (central peripheral nutrition)
- delivered to high flow vein (SVC)
What are the metabolic risks/complications of TPN?
Hypo or hyperglycemia
Excess CO2 production
HYPERtriglyceridemia
Abnormal LFTs
What are the risks for small bore feeding tubes?
More likely to become clogged
What are the indications for TPN?
- No gut function
- Ischemic bowel
- Ileus
- SBS (Short Bowel Syndrome)
- High output fistula
- Intractable V/D
- Peritonitis
- EN intolerance/unable to get access
What are the indications for Enteral nutrition?
- Malnourished & unable to eat for >5-7 days
- Normally nourshed & unable to eat 7-9 days
- Impaired swallow function
- Major trauma, burns, wounds
- Malnourished pre-op pt
- Intubation
What is the gold standard for determining protein and calorie needs?
Indirect Calorimetry
