nutrition Flashcards
why is good nutrition after surgery important?
aids healing
reduces risk of infection
faster recovery
esp important in those with malignancy, immunosuppression, severe sepsis, severe burns and intestinal fistulas
how is nutritional status of someone assessed?
BMI grip strength triceps skinfold thickness serum albumin serum transferrin.
what are the physiological effects of protein calorie malnutrition?
neutrophil and lymphocyte function is reduced
impaired albumin production
impaired wound healing and collagen deposition
skeletal muscle weakness
specific clinical syndromes related to vitamin deficiency
how many calories does the average man/woman require?
man 2500/day
woman 2000/day
30 cals/kg/day
THIS IS FOR MAINTAINANCE
what are the different methods of delivering nutritional support?
oral - e.g. fortisips - preferred as it is most normal and maintains GI flora
NG tube
gastrostomy/jejunostomy - for patients who cant use oropharyngeal route.
paraenteral feeding - via blood
what are the different types of paraenteral nutrition?
central or peripheral
central - into central vein e.g. SCV or brachiocephalic
peripheral - peripheral vein (for short term TPN)
what are the indications for TPN nutrition
prolonged post op ileus
acute abdo sepsis with ITU
long term poor GI absorption e.g. crohns or post radiotherapy, severe pancreatitis
unable o swallow - oes cancer
fistula, massive small bowel resection (short bowel syndrome)
what are the complications of enteral feeding?
aspiration
may have absorption problems and thus not effective
re feeding syndrome if not used to this
what are the complications of TPN (total parenteral nutrition)?
line related: - pneumothorax/haemothorax - vascular injury - infection/sepsis - infective endocarditis - thrombosis - VTE in long term use - air embolism feed related: - fluid overload - electrolyte imbalance - liver damage, cholestasis, pancreatic atrophy - lack of glycaemic control other: - refeeding syndrome - GI upset - changes to normal gut flora
in patients on TPN what should you be monitoring?
U and Es glucose LFTs micronutrients urine output
what is the indication for nasogastric feeding?
the need for mechanical ventilation
dysphagia
risk of aspiration
what are the indications for nasojejunal feeding?
allows stomach rest
what are the indications for gastrostomy or jejunostomy?
gastrostomy - dysphagia/ oesophageal problems
jejunostomy - if likely to vomit/aspirate /oesophageal problems. keep stomach empty and send food directly to jejunum.
gastrostomy = peg jejunostomy = J peg
what is refeeding syndrome?
during starvation the body breaks down fats and proteins, insulin levels drop etc. this process results in depletion of phosphate stores.
when refed there is a switch to glycogen and fat production from glucose which requires phosphate, K and Mg to enter cells and Na to leave. therefore there is a fluid shift and oedema as well as depletion in K, PO4 and Mg.
moreover urea cycle enzymes depleted so if given protein, the ammonia can have toxic effects.
how does refeeding syndrome present?
acute congestive heart failure due to fluid shifts and oedema
