Nutrition Flashcards

1
Q

What are the nutritional requirements for people who are not severely ill/injured, nor at risk of re-feeding syndrome?

A
  • 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
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2
Q

What is the RDA?

A
  • 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
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3
Q

What is the RNI?

A
  • recommended nutrient intake
  • minimum amount of nutrient recommended for specific age groups
  • in the UK
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4
Q

Why might a patient have increased nutritional requirements?

A
  • involuntary movement
  • infection
  • inflammation
  • pyrexia
  • tissue healing
  • metabolic effects
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5
Q

Why might a patient have reduced nutritional intake?

A
  • anorexia
  • side-effects of tx
  • pain
  • dysphagia
  • physical disability
  • nil by mouth
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6
Q

Consequences of undernutrition: what happens physiologically as body weight decreases?

A
  • decreased muscle mass
  • decreased visceral proteins
  • impaired immune response
  • impaired wound healing + response to trauma
  • multiple organ failure
  • impaired adaptation
  • nitrogen death
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7
Q

Consequences of undernutrition: what happens psychologically as the available energy decreases?

A
  • fatigue, general weakness
  • lack of initiative
  • beridden
  • apathy (-> total apathy)
  • depression
  • changes of behaviour + personality
  • complete exhaustion
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8
Q

What are the hospital measures to reduce risk of undernutrition?

A
  • ‘red trays’
  • improved hospital food
  • protective mealtimes
  • ‘Enhanced recovery after surgery’ (ERAS)
  • nutritional screening
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9
Q

A normal GI history is important in taking a dietary history, but what are some key questions to ask?

A
  • “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?”
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10
Q

What are important topics to ask regarding weight loss (thinking of differentials and how to narrow them down)?

A
  • 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
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11
Q

What are you looking for in a history when a patient takes you through their normal daily diet?

A
  • 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
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12
Q

How do you calculate BMI?

A
  • BMI (kg/m2) = weight in kg / height in m2
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13
Q

What are the reference ranges for BMI?

A
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14
Q

What are the complications of obesity?

A

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
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15
Q

Describe different methods for enteral feeding: naso-gastric

A
  • tube inserted through the nose
  • passed down throat into stomach to aid feeding
  • generally for short term feeding
  • method depends on adequate gastric emptying
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16
Q

Describe different methods for enteral feeding: naso-jejunal

A
  • 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
17
Q

Describe different methods for enteral feeding: jejunostomy

A
  • 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
18
Q

Describe different methods for enteral feeding: gastrostomy (+PEG)

A
  • 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
19
Q

What are the potential problems with PEG feeding?

A
  • peritonitis
  • infection
  • discomfort
  • diarrhoea
20
Q

What is total parenteral nutrition?

A
  • 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
21
Q

What are the indications for enteral tube feeding?

A
  • 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