nutrition in medicine Flashcards
what are the levels of nutritional support?
parenteral nutrition gastrostomy tube nasogastric tube specialist enteral feeds Polymeric/(semi) elemental prescribable supplements Increased intake of normal diet
who makes up the nutrition support teams?
Dietitian Doctor Nurse Pharmacist (Chemical pathologist) (Speech & Language Therapist) (Micro / Infection control)
what are indications for enteral tube feeding?
- General debility – e.g slow postoperative recovery
- Reduced consciousness (Brain injury)
- Unsafe swallow - CVA, Parkinson’s disease, Motor neurone disease
- Pre-head & neck cancer surgery/radiotherapy
- Special situations - Cystic Fibrosis and Crohn’s Disease
what are possible risks with enteral tube feeding?
Tubes can become blocked
Patient tolerance can be an issue
how often should enteral tubes be checked?
daily
how are enteral tubes facilitated?
x-ray
endoscopy
what are alternatives to enteral tube feeding?
nasojejunal tubes
what are indications for gastrostomy?
As for Enteral Feeding – but longer term
Percutaneous Endoscopic Gastrostomy (PEG)
Radiologically Inserted Gastrostomy (RIG)
Surgically placed Gastrostomy
what are indications for parenteral nutrition - intestinal failure?
Prolonged postoperative ileus Intestinal obstruction - ongoing Short bowel Small bowel fistula Acute pancreatitis GI motility disorders
what is a fistula?
hole from the bowel to the skin
what are the principles of parenteral nutrition (PN)?
Calculate nutrient need Compound in a large IV bag Usually central vein access Pump infusion 24hrs (or less) ASEPSIS ASEPSIS Monitor - especially Water and Electrolytes to make sure they're getting enough
when do you stop parenteral nutrition?
when enteral working
when they can feed themselves
what are the different IV routed or parenteral nutrition?
R – drip goes in above the elbow. Loop it into the SVC just above the heart.
L – Hickman line. Same principle – goes into the skin above the breast on the right and goes over the clavicle and dips down into the vein
what are complications of parenteral nutrition?
Infection Water and electrolyte imbalance Diabetes Appetite suppression (or not !) Liver Disease – longer term Large vein thrombosis – longer term
what are the types of intestinal failure?
Type 1 – short term – post-operative ileus
Type 2 - > 28 days – major postoperative complications – enterocutaneous fistula
Type 3 – permanent - Home PN
short bowel
damaged bowel
GI motility disorders
