Nutrition Flashcards
What are the nutritional requirements for people who are not severely ill/injured, nor at risk of re-feeding syndrome?
- 25-35 kcal/kg/day total energy (incl that derived from protein)
- 0.8-1.5g protein (0.13-0.24g nitrogen)/kg/day
- 30-35ml fluid/kg (w/ allowance for extra losses from drains and fistulae for example, and extra input from other sources - eg. iv drugs)
- adequate electrolytes, minerals, micronutrients
What is the RDA?
- recommended daily amount of a nutrient
- the average amount recommended to be eaten every day
- RDAs apply to whole population of the country
- set by a European Committee
What is the RNI?
- recommended nutrient intake
- minimum amount of nutrient recommended for specific age groups
- in the UK
Why might a patient have increased nutritional requirements?
- involuntary movement
- infection
- inflammation
- pyrexia
- tissue healing
- metabolic effects
Why might a patient have reduced nutritional intake?
- anorexia
- side-effects of tx
- pain
- dysphagia
- physical disability
- nil by mouth
Consequences of undernutrition: what happens physiologically as body weight decreases?
- decreased muscle mass
- decreased visceral proteins
- impaired immune response
- impaired wound healing + response to trauma
- multiple organ failure
- impaired adaptation
- nitrogen death
Consequences of undernutrition: what happens psychologically as the available energy decreases?
- fatigue, general weakness
- lack of initiative
- beridden
- apathy (-> total apathy)
- depression
- changes of behaviour + personality
- complete exhaustion
What are the hospital measures to reduce risk of undernutrition?
- ‘red trays’
- improved hospital food
- protective mealtimes
- ‘Enhanced recovery after surgery’ (ERAS)
- nutritional screening
A normal GI history is important in taking a dietary history, but what are some key questions to ask?
- “Can I ask about your weight and eating habits?”
- “Are you happy with your weight?”
- “Do you have any concerns over your weight?”
- “Can you take me through a typical day’s food and drink?”
- “Do you eat a special diet?”
What are important topics to ask regarding weight loss (thinking of differentials and how to narrow them down)?
- onset, how much, intentional, collateral
- appetite, swallowing, physical activity
- symptoms suggestive of:
- malabsorption (diarrhoea, vom, fatigue)
- DM (polydipsia/uria, fatigue)
- hyperthyroidism (anx, palps, tremor, heat intol)
- Addisons (weakness, dizziness, xs sweat, skin)
- Depression (mood, appetite, sleep)
- Malignancy (bowel habit, night sweats, bleeding)
- Chronic infection (tb, hiv, maliase, fever, rashes, sputum)
- PMHx
- MHx - diuretics, laxatives, diet pills, alternative, allergies
- SHx - smoking, alcohol, rec drugs, abroad, infection, partners, jobs, sleep
What are you looking for in a history when a patient takes you through their normal daily diet?
- unrefined/wholegrain vs refined carbohydrates
- adequate protein intake
- modest unsaturated good fats vs XS bad fats
- plenty of fruit and veg
- ready meals
- junk food
- snacks - how often? night? how much?
- drinks - fizzy, coffee, alcohol
- vegetarian or vegan diets
- weight loss diets
- food intolerances
- orthorexia
How do you calculate BMI?
- BMI (kg/m2) = weight in kg / height in m2
What are the reference ranges for BMI?
What are the complications of obesity?
Obese pts are at an increased risk of premature death, primarily from diabetes, IHD and cerebrovascular disease.
Obesity is also associated with an increased risk of:
- hypertension
- OSA
- osteoarthritis of knees + hips
- fatty liver
- gallstones
- inc cancer risk
- NAFLD
- metabolic syndrome
Describe different methods for enteral feeding: naso-gastric
- tube inserted through the nose
- passed down throat into stomach to aid feeding
- generally for short term feeding
- method depends on adequate gastric emptying
Describe different methods for enteral feeding: naso-jejunal
- tube inserted through the nose
- passed down the throat into the stomach
- then through pylorus into duodenum into jejunum
- these reduce incidence of GORD and useful in presence of delayed gastric emptying
Describe different methods for enteral feeding: jejunostomy
- artifical opening in jejunum
- to allow feeding tube to be inserted
- they permit early post-op feeding
- useful in patients at risk of reflux
- inserted through stomach into jejunum
- using a surgical or endoscopic technique
Describe different methods for enteral feeding: gastrostomy (+PEG)
- artifical opening in stomach
- to allow feeding tube to be inserted
- can be through surgical approach, percutaneous by interventional radiology or percutaneous endoscopic gastrostomy (PEG)
-
PEG:
- endoscope passed through mouth to stomach
- contains powerful light to help visualise from outside abdomen
- needle inserted, suture passed through
- needle grasped by endoscope + pulled up through oesophagus
- suture is then tied to end of PEG tube that will be external
- pulled back down through oesophagus, stomach and out through abdominal wall
- tube is kept within stomach either by balloon on its tip or by a retention dome
What are the potential problems with PEG feeding?
- peritonitis
- infection
- discomfort
- diarrhoea
What is total parenteral nutrition?
- nutritional requirements given intravenously
- “total” refers to where it is given as the sole source of nutrition
- as opposed to be using to supplement oral-enteral intake
- TPN only indicated when:
- GI tract inaccessible
- complete rest of GI tract is needed
- functional derangement of GI tract
- enteral feeding is not meeting nutritional requirements of an individual due to limited fxn of GI tract
What are the indications for enteral tube feeding?
- unsafe swallow (CVA, Parkinson’s, motor neuron disease)
- inability to meet oral requirements (anorexia, dementia)
- oesophageal stricture
- pre-head and neck surgery/DXT
- post-major upper GI/pancreatico-biliary surgery
- post-operative ileus
