Malnutrition and Parenteral Feeding Flashcards
What may contribute to malnutrition?
inadequate food intake
disease related
determine using nutritional assessment (diet history) or nutrition screening
anthropometrics (BMI, % weight loss, muscle circumference
Parenteral nutrition?
giving nutrients centrally/peripherally where GI tract inaccessible or insufficient GI function
most common site for insertion is via PICC line
- if GI function not working
- if all other enteral routes not working
- <5 days
e.g. pancreatitis Ehlers Danlos syndrome post op gut paralysis Crohns disease prolonged obstruction/ileus prolonged intestinal failure oncology patients - BM transplant
What is nutritional support?
for people who cant get nutrition from food and drink
What is oral nutrition support?
food first approach
fortified diets
more snacks
increase food density with fats
Ward based practical strategies?
red tray approach assistance with feeding/positioning swallow assessment food/fluid charts manage nausea/vomiting/bowls
What are oral nutritional supplements?
on prescription
by GPs/dieticians
composition varies
tolerance/compliance varies
When to use a nasogastric feed?
inpatients with poor appetite and not meeting nutritional requirements
poor appetite/wound healing
stroke patients with dysphagia
after surgery
intensive care patients sedated and on ventilator
What is nasogastric feed?
temporarily unable to meet nutritional requirements
usually under 1 month
What is purpose of gastrostomy?
neurological swallowing problems, cognitive impairment, mechanical obstruction
long term >1 month
high post insertion mortality if places inappropriately
What is a jejunostomy?
upper GI obstruction, fistula (neoplastic disease of stomach/duodenum)
How to determine how much to feed?
indirect calorimetry
weight based equation/predictive equations (25030kcal/kg)
Enteral feeding complications?
nausea/vomiting
- medication
- high feed volume
- delayed gastric emptying
tube issues
- pain, laryngeal ulcers
- tube blockage
- misplaced into lungs
diarrhoea
- intestinal infection
- medication
- malabsoprtion
- constipation
metabolic
- over/under feeding
- refeeding syndrome
Long term complications of parenteral nutrition?
high risk of infection and sepsis pneumothorax line sepsis bleeding misplacement/break/leak REFEEDING SYNDROME
Enteral feeding complications?
nausea/vomiting
- medication
- high feed volume
- delayed gastric emptying
tube issues
- pain, laryngeal ulcers
- tube blockage
- misplaced into lungs
diarrhoea
- intestinal infection
- medication
- malabsorption
- constipation
metabolic
- over/under feeding
- refeeding syndrome
Long term complications of parenteral nutrition?
high risk of infection and sepsis pneumothorax line sepsis bleeding misplacement/break/leak REFEEDING SYNDROME
Main advantages/dis of enteral feeding?
ADV fewer risk of side effects less invasive (nasogastric) vas parenteral uses gut at bedside cheap at bedside low level monitoring use long term (PEG - gastrostomy tube)
DISADV metabolic problems nausea/vomiting tube misplace/blockage/aspiration into lungs hypo/hyperglycaemia
Main advatnages/dis of parenteral feeding?
ADV
can meet nutritional needs when GI tracts inaccessible
DISADV expensive line places in radiology aseptic conditions complications (pneumothorax) metabolic/electrolyte complications close monitoring
What is refeeding syndrome?
syndrome with metabolic disturbances after re-instituting nutrition to patients who are starved or severely malnourished
usually if starved from >5 days
- chronic malnutrition, prolonged fast
- metabolic effects of starvation (glycogenolysis, gluconeogenesis)
- feed patient (increase uptake of glucose/phosphorus/Mag/K)
- need to supplement if levels too low
low K, Mg and phosphate consequences: MI, arrhythmia, ventilatory fail, paralysis, weakness
How to monitor and treat refeeding syndrome?
Daily biochemistry
vitamin supplementation
nutrition support at 10kcal/kg/day
