Malnutrition

Question 1

What are the two broad strategies that can be utilised when patients cannot eat

Answer 1

Enteral feeding - delivery of nutritious fluid past the upper GI tract and into the stomach/small intestine

Parenteral - Delivery of nutrients into the blood

Question 2

What are the routes of delivery for enteral feeding

Answer 2

Nasooesophageal
Nasogastric
Nasoduodenal

Question 3

What are the complications of enteral feeding

Answer 3

(Low risk)
Nausea
Vomition
Apsiration

Question 4

What are the complications of parenteral nutrition

Answer 4

(high risk)
Blood clots
Infection
Liver failure

Question 5

Compare enteral feeding to parenteral nutrition

Answer 5

requires basic training vs requires specialist training
Maintains internal structure and function vs causes atrophy of the GI tract due to underuse
Cheaper vs expensive

Question 6

What is short bowel syndrome

Answer 6

Characterised by significant removal of the bowel to leave the patient with <100cm of functional intestinal tract
Leads to dehydration, malnutrition and malabsorption

Question 7

What are the consequences of short bowel syndrome

Answer 7

Reduction in SA
Control of gut function via hormones lost
Increased risk of infection

Question 8

Describe the management for short bowel syndrome

Answer 8

Provide adequate nutrition
Ensure adequate water and electrolytes for homeostasis
Correction and prevention of acid base imbalance
Anastamosis

Question 9

What are the potential consequences of being malnourished

Answer 9

Reduced immunity 
Inability to regulate salt and water via kidneys
Muscle weakness
Increased fall risk
Impaired temp. regulation 
Growth failure and stunting

Question 10

How is malnutrition diagnosed

Answer 10

Nutrition screening
Nutrition assessment
Nutritional diagnosis

Question 11

What is nutrition screening

Answer 11

Assessed patient’s nutritional status and categorises into risk
During initial assessment of the patient
By a non-nutrition professional
BMI, assessing diets, GI symptoms, diabetes history, functional impairment

Question 12

What is nutrition assessment

Answer 12

More detailed and in-depth
Could use anthropometrics
By a dietitian or specialist nutrition nurse

Question 13

What are the indications for enteral feeding

Answer 13

Poor appetite
Not meeting nutritional requirements by mouth
Wound healing
Stroke patients with impaired swallow
Intensive care patients who are sedated and on ventilator
Dysphagia, trauma

Question 14

What conditions may require removal of the bowel

Answer 14

Crohn’s disease
Cancer
Ischaemia
Ulcerative colitis

Question 15

What is refeeding syndrome

Answer 15

Metabolic disturbances that occurs when nutritional support is reinstated in severely malnourished patients

Question 16

What are the clinical features of refeeding syndrome

Answer 16

Hypokalaemia
Hypomagnesaemia 
Low phosphate
Thiamane deficiency 
Salt and and water retention

Question 17

What are the reasons for malnutrition in cancer patients

Answer 17

Latrogenic = decreased food intake/ increased energy expenditure
Chemotherapy = fatigue/nausea/vomiting
Poor symptom contour = loss of appetite
Increased metabolic rate in cancer patients

Question 18

What is cancer cachexia

Answer 18

Metabolic response due to the presence of a tumour resulting catabolic action