Nutrition support Flashcards
______________ is defined by the following:
- BMI <18.5 and unintentional weight loss >10% over the last 3-6 months - BMI <20 and unintentional weight loss >5% over the last 3-6 months
Malnourished
A person who has eaten little or nothing for > ___ days and/or likely to eat little or nothing for the next ___ days or longer is at risk of malnutrition
5, 5
Eating or drinking ________ should always be the preferred method of nutrition support
orally
Patients with inadequate or unsafe oral intake with a functional and accessible gastrointestinal tract should be considered for _______ ______ feeding
Enteral tube
__________ nutrition should ONLY be considered in those patients with a non-functional, inaccessible, obstructed, or perforated GI tract
Parenteral
Oral nutritional support should be considered for any patient with ___________ food and fluid intakes to meet requirements unless they cannot swallow safely, have inadequate GI function, or if no benefit is anticipated (eg end of life).
inadequate
What is the main indication for enteral nutritional support?
When oral intake is insufficient or unsafe
What are the four routes of gastric enteral feeding?
Orogastric, nasogastric, gastrostomy, oesophagostomy tubes
List the four routes of post pyloric enteral feeding
Nasoduodenal, nasojejunal, gastrojejunostomy or jejunostomy
Nasogastric feeding is only to be used for < _____ weeks
4
Name some of the complications of NG feeding
ASPIRATION PNEUMONIA
DISPLACEMENT, blockage, knotting
Sinusitis, sore throat, difficultly swallowing, candidiasis
What does “PEG” stand for?
percutaneous ENDOSCOPIC gastroscomy
What does “RIG” stand for?
RADIOLOGICALLY inserted gastroscomy
Why is it important to understand the difference between a “PEG” and a “RIG?”
It has implications for the type of tube that it is, how long it can last, how the tube is held in place, and how it is cared for.
Due to the risk of “tumour seeding” in head and neck cancers, _______ tubes are contraindicated for these patients.
PEG
Which type of feeding tube placement has very low risk of tumour seeding, doesn’t require sedation, and provides better placement of the tube in cases where endoscopic placement was unsuccessful?
RIG
What are some of the complications of enteral feeding?
- Refeeding syndrome
- Aspiration
- Diarrhoea
- Tube blockage
- Microbial contamination of the feed
- Accidental tube removal
- Stoma site problems (leakage, peritonitis, etc)
- Buried bumper syndrome
What is “buried bumper syndrome?”
Occurs when the gastric mucosa grows over the retention device can pull it into and through the stomach wall. Can result in peritonitis and death. Easy to prevent, rotating the tube daily and pushing it back and forth into the stomach, once weekly.
What type of feeding support can be used in patients with gastroparesis and/or patients who spend most of the time lying flat?
Post pyloric feeding routes: Nasoduodenal or nasojejunal feeding (routes that bypass the stomach)
This is a type of post pyloric feeding access that can be obtained in patients with established gastrostomy access by the insertion of an extension device that threads through the existing gastrostomy lumen into the jejunum
gastrojejunostomy
What route of feeding might be indicated after major GI or hepatobiliary surgery, increased likelihood of gastric stasis, or if gastrostomy feeding has failed?
Jejunostomy
What route of feeding is indicated in cases of GI obstruction, severe malabsorption, severe mucositis following chemotherapy, or multi-organ failure?
Parenteral nutrition
List the risks associated with parenteral nutrition
- Catheter related infections
- Deficiencies and excesses of fluid and nutrients
- Electrolyte disturbances
- Liver dysfunction
- Hyperglycaemia and hyperlipidaemia
- Cardiac failure
- Insertion related complications (thrombosis, cardiac arrythmias, nerve injury)
Electrolyte and fluid shifts that happen when you feed patients that have been starving for a prolonged period of time are known as
refeeding syndrome
Refeeding syndrome can lead to fluid retention and low serum levels of which minerals?
Potassium, magnesium, phosphate
Patients who are malnourished or those with a history of alcohol abuse, or those on drugs such as insulin, chemotherapy, antacids, or diuretics are at increased risk of __________ syndrome
refeeding
What nutrients are recommended to prevent refeeding syndrome?
Thiamine and a multivitamin
Levels of potassium, Mg, and phosphate are likely to drop on the _______ day after assisted nutrition route, so bloods should be monitored ________.
third, daily
