nutrition

Question 1

What are the 4 different types of malnutrition?

Answer 1

decreased nutrient intake, malabsorption, increased energy requirements, or all above

Question 2

What are the consequences of malnutrition?

Answer 2

Consequences: micronutrient deficiency, muscle wasting, increased falls, inactivity, immobility also means greater chance of infections, weaken immune system, wounds healed less quickly

Question 3

How do you score MUST?

Answer 3

BMI (18.5-20 =1 or <18.5 =2)
wt loss (5-10% =1 or >10%=2)
acute disease effect (pt ill and likely to be intake for >5 days)

Question 4

At what MUST score do you intervene with malnutritioned pts?

Answer 4

Score over 2 - monitor feeding and wt

If 1 monitor food intake for 3 days

Question 5

What are the different lines of mx for MUST?

Answer 5

1st line: food - snacks, nourishing drinks and food fortification eg fortisip
2nd line: nutrient supplements -liquid, powder, semi solid - micro and macro
3rd line: enterol via PEG or NGT -
4th line: parenteral - food via central line

Question 6

+ves and -ves of eneterol mx?

Answer 6

+ves: direct feeding into gut, preserves gut mucosa and integrity as still being exposed to food and digesting - less expensive than perenterol
-ves: can get nausea, early satiety, constipation, diarrhoea, uncomfortable to place

Question 7

How do you check a NGT is properly in place?

Answer 7

1st line: acid pH aspirate to check in stomach - aims pH less than 5.5; 2nd line: CXR

Question 8

What is the difference between naso jejunal and NGT?

Answer 8

Naso jejunal - decreased gastric emptying or pancreatitis so want to avoid stomach, less than 60 days use, radiologically guided, can’t check with pH

Question 9

What is an indication of a naso jejunal tube?

Answer 9

indications: dysphagia, CF (higher nutritional requirements), inadequate nutritional intake

Question 10

What is a pharnygeal pouch?

Answer 10

hernia, that occurs in the pharynx.

sx: dysphagia, regurgitation, halitosis, chronic cough, hoarse voice, wt loss, aspiration, lump

Question 11

What is refeeding syndrome?

Answer 11

Shift use energy stores from fat met to carb met -> insulin -> increased cellular uptake K, phosphate and mg -> Shift fluids and electrolytes -> fluid retention, cardiac arrhythmias, resp insufficiency death

Question 12

What is the mx of refeeding syndrome?

Answer 12

Mx: BEFORE FEED for first ten days give IV thiamine and other vit Bs then slow introduction of nutrition, daily monitor refeeding blds: U+Es, phosphate, Mg