Nutrition

Question 1

how would someone who is malnourished and dehydrated present?

Answer 1

Skin hanging off muscles 
	No fat between fold of skin
	Hair rough and wiry 
	Pressure sores
	Sores at corner of mouth 
	BMI 
Anthropomorphic indices: skin fold, grip strength

Question 2

how much fluid is required per day

Answer 2

2-3L

increased requirements for those with large output stomas, NG aspirated, diarrhoea, fever

Question 3

what patients do we restrict fluid intake

Answer 3

oedema

hepatic and renal failure

Question 4

how much energy do we need per day

Answer 4

1800-2400 kcal

Question 5

how much protein do we need per day

Answer 5

0.5g

Question 6

what patients require extra protein

Answer 6

extensive burns
sepsis
major trauma

Question 7

how much major minerals do we need in 1 day

Answer 7

60-100 mmol

GI effluents = increase
fluid overload or hypernatraemia or kalaemia = decrease

Question 8

which GIT feeding method requires increased calcium and magnesium

Answer 8

enteral - only a proportion of the minerals are absorbed by the gut

Question 9

which GIT feeding methods requires increased vitamins

Answer 9

paraenteral

Question 10

what system is used to assess a patient’s nutritional status

Answer 10

MUST (malnutrition universal screening tool)

done via questionare, weekly

Question 11

how many steps are there in the MUST score

Answer 11

5 steps

1) BMI (height and weight)
2) % unplanned weight loss in past 3-6 months
3) acute disease effect and score
4) overall risk of malnutrition by adding 1,2,3
5) management guidelines to develop a care plan

Question 12

what are the 3 levels of risk in step 5 of MUST - management guidelines

Answer 12

low risk 0 - routine clinical care

medium risk 1 - observe patient

high risk >2 = treat with dietician, increase nutritional intake

Question 13

what is enteral feeding

Answer 13

food is placed directly into the GI Tract via a tube

Question 14

what are the short term and long term enteral feeding tubes

Answer 14

short - NG (<4weeks)

long - gastrostomy (PEG) or jejunostomy (>4weeks)

Question 15

what are the indications for enteral feeding

Answer 15

• unsafe swallow - stoke, parkinsons
• inability to meet oral requirements - anorexia, dementia
• oesophageal stricture
• post major upper GI surgery
• post op ileus

Question 16

complications of NG tube

Answer 16

aspiration
discomfort
diarrhoea

Question 17

complications of PEG tube

Answer 17

• Peritonitis
• Infection
• Discomfort
• Diarrhoea

Question 18

what is paraenteral nutrition

Answer 18

administration of nutrition directly into a patient’s blood stream via vein (TPN - fluid), this should only be used as a last resort when the GI Tract isn’t working or isn’t accessible

Question 19

what are the indications for paraenteral nutrition

Answer 19

• Intestinal Obstruction
• Intestinal Perforation
• Short Bowel
• High-output small bowel fistula
  =Where the jejunum forms a fistula with the large colon, bypassing the majority of the small colon and thus greatly reducing absorption.

Question 20

what are the complications of paraenteral feeding

Answer 20

invasive - involves placement of large line into major blood vessel

• Infection
• Thrombosis – Around the line
• Electrolyte Disturbances – All the injected electrolytes are absorbed
• Hepatic Dysfunction
• Hyperglycaemia
• Re-feeding Syndrome