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
When is post pyloric feeding used?
- stomach doesnt function as in gastroparesis
- if there is risk of aspiration (into trachea)
- if patient is lieing down a lot
Post pyloric feeding can be used if a patients stomach is not functioning correctly, if they are at riak of aspiration (chocking or food going into trachea) or if they are supine a lot. What are the 2 nasal options for post pyloric feeding?
1 - nasoduodenal
2 - nasojejunal
Post pyloric feeding can be used if a patients stomach is not functioning correctly, if they are at riak of aspiration (chocking or food going into trachea) or if the patient is lieing down. What is a Gastrojejunostomy?
- normally piggy backs on to a gastrostomy
- bypasses the stomach and feeds into jejunem
A Jejunostomy is a form of post pyloric feeding that can be used if a patients stomach is not functioning correctly, if they are at riak of aspiration (chocking or food going into trachea), major upper GIT surgery or if the gastrostomy has failed. What is a Jejunostomy?
- a procedure producing stoma between jejunum and abdominal surface
- tube is placed surgically or radiologically
A Jejunostomy is a form of post pyloric feeding that can be used if a patients stomach is not functioning correctly, if they are at riak of aspiration (chocking or food going into trachea), major upper GIT surgery or if the gastrostomy has failed. Is it generally used long or short term?
- long term generally
When enteral feeding is performed there are generally 2 ways in which food can actually be administered, what are they?
- pump feeding (continuous rate for a set number of hours e.g. 125mls per hour for 16 hours)
- bolus feeding (large amount given via a syringe)
What is parenteral feeding?
- intravenous administration of nutrition
What 2 administration methods would have had to have failed or be unsuitable before parenteral feeding is used?
1 - oral
2 - enteral
For parenteral feeding to be used, oral and enternal feeding must have failed or not be accessible. What are some common examples where this may be the case clinically?
- major GIT surgery or obstruction
- severe malabsorption
- enterocutaneous fistulae (GIT and skin, food leaks out of skin)
- severe mucositis following chemotherapy
- multi organ failure
For parenteral feeding to be used, oral and enternal feeding must have failed or not be accessible. What are some of the risks associated with parenteral feeding?
- infections
- nutrient/eclectrolyte deficiencies/excess
- liver dysfunction
- hyperglycaemia and hyperlipidaemia
- cardiac failure
- pneumothorax or haemothorax
- thrombus, catheter occlusion, catheter fracture, thrombophlebitis, extravasation
For parenteral feeding to be used, oral and enternal feeding must have failed or not be accessible. How is parenteral feeding administered?
- via a pump over 24 hours
For parenteral feeding to be used, oral and enternal feeding must have failed or not be accessible. How often is parenteral feeding monitored for basic observations (HR, RR, BP, Os Sats, temperature and any gas) and blood glucose?
- every 4 hours
For parenteral feeding to be used, oral and enternal feeding must have failed or not be accessible. How often is parenteral feeding monitored for bloods including FBC, urea and electrolytes, line inspection and the patientds weight?
- daily
What is refeeding syndrome?
- patients are malnourished for a period of time
- refeeding is initiated
- patients experience severe electrolyte and fluid shifts
What are some triggers for refeeding syndrome?
- switching between fat and carbs
- increased insulin release
- ncreased glucose, phosphate, potassium, magnesium and water uptake into cells
- synthesis of lean tissue
Switching between fat and carbs, increased insulin release, increased glucose, phosphate, potassium, magnesium and water uptake into cells and synthesis of lean tissue are all triggers for reefeeding syndrome. What can this cause?
- oedema
- low serum levels of K+, Mg+ and phosphate.
Switching between fat and carbs, increased insulin release, increased glucose, phosphate, potassium, magnesium and water uptake into cells and synthesis of lean tissue are all triggers for reefeeding syndrome. This can cause oedema, low serum levels of K+, Mg+ and phosphate. What type of feeding can cause this?
- any form of feeding
- less likely if eating orally
When considering the risks associated with refeeding, what is classified as a high risk?
- very little / no food intake for >5 days
- BMI <20 kg/m2 with unintentional weight loss of >5% in last 3-6 months
When considering the risks associated with refeeding, what is classified as a very high risk?
- BMI <16 kg/m2
- unintentional weight loss of >15% in last 3-6 months
- very little or no nutrition for >10 days
- low levels of K+, Mg+ or phosphate prior to feeding
When starting to refeed a patient it is important to start feeding slowly, but what how many kcals/lg of body weight should be used?
- 5-10kcals /kg body weight or 50% of energy requirements depending on risk
When starting to refeed a patient it is important to start feeding slowly. Is is also important to start patients on a daily dose of what?
- thiamine (B1) and a multivitamin
When starting to refeed a patient it is important to start feeding slowly. Is is also important to monitor patients blood daily. What are the main things to monitor, especially in people at risk of refeeding syndrome?
- K+, Mg+ and phosphate
- blood levels can also guide supplements
What is Wernicke – Korsakoff’s syndrome caused by?
- thaimine (B1) deficiency
What is Wernicke – Korsakoff’s syndrome?
- thiamine (B1) deficiency
- a spectrum of disease
The Wernicke – Korsakoff’s syndrome can be subdivided into Wernicke’s encephalopathy and Korsakoff’s syndrome. What is Wernicke’s encephalopathy?
- a neurological disease
- characterized by the clinical triad of confusion, the inability to coordinate voluntary movement (ataxia), and eye (ocular) abnormalities
The Wernicke – Korsakoff’s syndrome can be subdivided into Wernicke’s encephalopathy and Korsakoff’s syndrome. What is Korsakoff’s syndrome?
- form of dementia and psychosis (inability to determine real from not real)
The Wernicke – Korsakoff’s syndrome can be subdivided into Wernicke’s encephalopathy and Korsakoff’s syndrome. Are these both permanent conditions?
- no
- Wernicke’s encephalopathy is reversible
- Korsakoff’s syndrome is irreversible
The Wernicke – Korsakoff’s syndrome can be precipitated when calories are given to patients in the absence of what vitamin?
- thiamine (B1)
The Wernicke – Korsakoff’s syndrome is common in what addictive disease?
- alcoholics
In alzheimer’s and dementia is the focus primarily on life expectancy or quality of life?
- quality of life
What is risk feeding?
- patients who continue to eat despite risks of choking or aspiration
