Nutrition Flashcards
Components of clinical assessment of nutrition
- history
- examination
- what to measure
History
- Wt. loss
- Diet
Examination
- Skin fat
- Dry hair
- Pressure sores
- Cheilitis (inflammation of the lip) → B6 deficiency
Measure
- weight and BMI
- Skin-fold thickness
- Arm circumference
Calorie requirements per kg weight for 24hours
20-40 kcal/kg/24 hours
How many g of carb, fat, protein is required per kg of a body mass in 24 hours?
Requirements (/kg/24h)
- Calories: 20-40 Kcal
- Carb: 2g
- Fat: 3g
- Protein: 0.5-1g
Possible routes of delivery of enteral nutrition
- oral → is best
- Fine bore NGT
- Percutaneous Endoscopic Gastrostomy (PEG)
- Jejunostomy
*Build up feeds gradually to prevent diarrhoea
What type of diet should we consider if there is a risk of aspiration?
Semi-solid
Indications for supplemental feeds
- Catabolic: sepsis, burns, major surgery
- Coma/ITU
- Malnutrition
- Dysphagia: stricture, stroke
Indications for use of a feeding tube
- used for individuals who have a functioning gastrointestinal (GI) tract but cannot ingest enough nutrients orally to meet their current needs
- tube feedings can be used as the sole source of nutrition or in combination with oral intake
What’s meant by enteral nutrition?
Enteral nutrition (EN) is the use of the GI tract for feeding
Advantages of using enteral nutrition
- GI tract should be used if possible because it tends to atrophy when not used
- Gut bacteria can translocate to the circulatory system through an atrophied GI tract and increase the risk for infection
What’s Parenteral nutrition?
Parenteral nutrition (PN) is the use of a site outside the GI tract, specifically, the circulatory system, for feeding
The general rule for deciding whether to use enteral or parenteral feeding is, “If the gut works, use it”
Specific indications for tube feeding
- Protein-energy malnutrition with inadequate oral nutrient intake for 5 or more days
- Less than 50% of required nutrient intake orally for 5-7 days
- Severe dysphagia
- Coma
- Low output enterocutaneous fistulas
Contraindications for enteral nutrition
- Intestinal obstruction, ileus, or hypomotility of the intestine
- Severe diarrhea
- High output enterocutaneous fistulas
- Severe acute pancreatitis or shock
- When prognosis does not warrant aggressive nutritional support
(3) types of transnasal tube feeding
Most commonly, feeding tubes are inserted through the nose and positioned to deliver formula into:
- the stomach (a nasogastric)
- the duodenum (a nasoduodenal)
- jejunum (a nasojejunal)
When to use the ostomy as a feeding route?
- ostomy can be used if there is a blockage in the GI tract -the ostomy would be created below the site of the blockage
- an ostomy (opening) can be surgically created so that the tube can be directly placed into the: esophagus (esophogastomy), stomach (gastrostomy ), or jejunum (jejunostomy)
Alternatives to surgical ostomies (2)
Alternatives to the classic surgical ostomies includemthe placement of the tube via:
- a needle catheter jejunostomy
- via a percutaneous endoscopic gastrostomy
Complications of tube feeding (just name)
- dumping syndrome
- regurgitation
- aspiration pneumonia
- diarrhoea and dyhadration
- Feed intolerance → diarrhoea
- Electrolyte imbalance
- Aspiration
- Refeeding syndrome
Why the use of a feeding tube may lead to regurgitation?
- the formula may enter the stomach much faster than it is emptied
If fluids are regurgitated and enter the lungs, a fatal infection or aspiration penumonia
Complications of NG tube use
- Nasal trauma
- Malposition or tube blockage
Indications for parenteral nutrition use
- Prolonged obstruction or ileus (>7d)
- High output fistula
- Short bowel syndrome
- Severe Crohn’s
- Severe malnutrition
- Severe pancreatitis
- Unable to swallow: e.g. oesophageal Ca
How is parenteral nutrition delivered?
- location
- short-term
- long - term
- Delivered centrally as high osmolality is toxic to veins
- Short-term: CV catheter
- Long-term: Hickman or PICC line
What to monitor with parenteral nutrition route use?
- standard monitoring
- initial monitoring
- monitoring when patient is stable
Line-related complications of parenteral nutrition (4)
- Pneumothorax / haemothorax
- Cardiac arrhythmia
- Line sepsis
- Central venous thrombosis → PE or SVCO
Feed - related complications of parenteral nutrition (7)
- Villous atrophy of GIT
- Electrolyte disturbances
- Refeeding syndrome
- Hypercapnia from excessive CO2 production
- Hyperglycaemia and reactive hypoglycaemia
- Line sepsis
- Vitamin and mineral deficiencies