Nutrition Support Flashcards
What does malnourished mean?
- patients diet does not contain the right amount of nutrients
According to the Royal College of Physicians, what is malnourished defined as?
- BMI <18.5 kg/m2 and unintentional weight loss >10% over last 3–6 months
•BMI <20 kg/m2 and unintentional weight loss >5% over last 3–6 months.
According to the Royal College of Physicians, what has to happen for a patient to be at risk of malnutrition, relating to dietary intake?
- eaten little or nothing for >5 days and/or likely to eat little or nothing for the next 5 days or longer
- poor absorptive capacity and/or high nutrient losses and/or increased nutritional needs
What should always be the preferred method of nutritonal support?
- oral eating and drinking
- if cannot eat and drink clinical assistance should be provided
What are the 3 routes of nutritional support?
1 - oral
2 - enteral (tube feeding directly into GIT)
3 - parenteral (intravenous administration of nutrition)
When should enteral feeding be considered in a patient?
- when patients oral intake is inadequate or unsafe due to chewing or swalling issues
- GIT must be functioning normally though
When should parenteral feeding be considered in a patient?
- when oral or GIT has failed
What are the 2 main locations in the GIT where enteral feeding should apply nutrients?
1 - gastric
2 - post pyloric feeding
Enteral feeding is generally into the stomach or into duodenum. What are the 4 options for delivering food directly into the stomach?
- orogastric (tube through mouth)
- nasogastric (tube through nose)
- gastrostomy (tube through abdomen)
- oesophagostomy tube (tube through oesophagus)
Enteral feeding is generally into the stomach or into duodenum. What are the 4 options for delivery for after the stomach into the duodenum?
- nasoduodenal (tube from nose to duodenum)
- nasojejunal tube (tube through the jejunum)
- gastrojejunostomy (stomach to the jejunum)
- jejunostomy (tube directly into jejunem)
The nasogastric feeding feeds directly into the stomach is an example of enteral feeding. Is this approach generally used long or short term?
- short term feeding <4 weeks
- passed through the nose and in to the stomach via the oesophagus VERY UNCOMFORTABLE
- deaths have occurred from incorrect placement
What is a never event?
- events that should never happen
- can always be avoided with correct procedures
- always reported nationally if something happens
The nasogastric (NG) feeding feeds directly into the stomach as an example of enteral feeding. This approach is generally used short term. What are the complications of NG feeding?
- sinusitis, sore throat, difficulty swallowing, candidiasis
- aspiration pneumonia
- displacement, blockage and knotting are frequent complications NOT IN THE LUNGS
Gastrostomy feeding feeds directly into the stomach as an example of enteral feeding. What is gastrostomy feeding?
- an artificial tract between the stomach and abdominal surface
- placed endoscopically, surgically or radiologically.
Gastrostomy feeding feeds directly into the stomach as an example of enteral feeding where an artificial tract is made between the stomach and abdomen. Is the generally used long or short term?
- generally long term enteral support.
- can be placed endoscopically, surgically or radiologically.
Gastrostomy feeding feeds directly into the stomach as an example of enteral feeding where an artificial tract is made between the stomach and abdomen. to provide long term enteral feeding. PEG and RIG describe the procedure but commonly used to describe the type of tube. What does PEG and RIG refer to?
- PEG = Percutaneous Endoscopic Gastrostomy
- a procedure in which a flexible feeding tube is placed through the abdominal wall and into the stomach guided through oesophagus
- RIG = Radiologically Inserted Gastrostomy
- a procedure in which a flexible feeding tube is placed through the abdominal wall and into the stomach using X-ray to guide
Gastrostomy feeding feeds directly into the stomach as an example of enteral feeding where an artificial tract is made between the stomach and abdomen to provide long term enteral feeding. PEG and RIG describe the procedure but commonly used to describe the type of tube. Both need a retention device to keep them in place. What are the 2 different types?
1 - fixed internal retention device like a bumper)
2 - fluid filled balloon.
What are the benefits of Percutaneous Endoscopic Gastrostomy, where a flexible feeding tube is placed through the abdominal wall and into the stomach guided through oesophagus?
- can be performed as a day case procedure (20 minutes)
- high success rate
- general anaesthetic not needed
- low incidence of complications
What are the negatives/contraindications of Percutaneous Endoscopic Gastrostomy, where a flexible feeding tube is placed through the abdominal wall and into the stomach guided through oesophagus?
- severe obesity
- portal hypertension or oesophageal varices
- coagulation abnormalities
- active gastric ulceration or malignancy
- total or partial gastrectomy
- ascites
- peritoneal dialysis
- tumour seeding
- chronic progressive neurological and neuromuscular disorders
Radiologically Inserted Gastrostomy (RIG) is a procedure in which a flexible feeding tube is placed through the abdominal wall and into the stomach using X-ray to guide for long term enteral feeding. What are some advantages of using RIG?
- balloon gastrostomy tubes most commonly used
- very low risk of tumour seeding
- sedation not required
- clear picture of anatomy, good for difficult patients where endoscopic is not possible
Radiologically Inserted Gastrostomy (RIG) is a procedure in which a flexible feeding tube is placed through the abdominal wall and into the stomach using X-ray to guide for long term enteral feeding. What are some complications of using RIG?
- refeeding syndrome
- aspiration – same risk as for NG and gastrostomy
- diarrhoea – rarely attributable to the feed itself
- tube blockage
- microbial contamination of the feed
- accidental tube removal – more common in NG tubes
- stoma site problems – leakage, exit site infections, peritonitis, overgranulation
- buried bumper syndrome