Nutritional Support

Question 1

What should all patients be screened for once admitted to hospital?

Answer 1

Malnutrition

Question 2

Following screening on admission what is created for the patient amongst the MDT and dietitian?

Answer 2

Care Plan - then discussed with the patient and consent gained for any NG tube feeds or parenteral nutrition

Question 3

Which 3 groups is it usually necessary to provide nutritional support for?

Answer 3

1. All severely malnourished patients on admission
2. Mod malnourished patients who because of their illness are not expected to eat for >5days
3. Normally nourished patients not expected to eat for >5 days or expected to eat <50% normal intake for 8-10 days

Question 4

Which feeding method is preferred in a patient with a functioning GI tract?

Answer 4

Enteral (via oesophagus, stomach, small or large intestine) rather than parenteral (intravenous)

Question 5

In re-feeding syndrome, shifts in what can be life-threatening during enteral and parenteral nutrition?

Answer 5

Water and electrolytes

Question 6

Carbohydrate stimulates insulin release which leads to a cellular uptake of what three things?

Answer 6

Potassium, phosphate and magnesium

Question 7

Complications in re-feeding syndrome include?

Answer 7

hypophosphataemia, hypokalaemia, hypomagnesaemia and fluid overload due to sodium retention (decreased renal excretion of Na+ and H2O)

Question 8

What biochemical abnormalities can occur during re-feeding syndrome?

Answer 8

Cardiac arrhythmias and respiratory insufficiency

Question 9

Patients who have eaten little or nothing for >5days should initially receive no more than ___% of their energy requirements?

Answer 9

50% (NICE guidelines)

Question 10

Patients at risk of re-feeding syndrome should be given what three things?

Answer 10

1. High potency vitamins dailys for 10 days
2. Oral or enteral thiamine 50mg 4 times daily for 10 days
3. Multivitamins

Question 11

What are the typical daily fluid requirements?

Answer 11

2-3L daily

Question 12

What conditions would require reductions in daily fluid requirements?

Answer 12

Oedema, hepatic (liver failure), renal failure and brain oedema

Question 13

What conditions would require increased daily fluid requirements?

Answer 13

Large-output fistulae (ulcers/sores), nasogastric aspiration (feeding stomach via NGT & draining contents via suction), diarrhoea, fever

Question 14

What are the typical daily protein requirements per day?

Answer 14

9-15gN/day (0.94-1.56g/kg/d)

Question 15

Extra protein may be required in severely catabolic conditions such as?

Answer 15

Burns, sepsis and major trauma

Question 16

What are the typical sodium and potassium daily requirements?

Answer 16

60-100mmol day

Question 17

In what condition would sodium and potassium requirements increase?

Answer 17

In those with increased GI liquid waste

Question 18

Requirements of sodium and potassium may be lowered in those suffering which conditions?

Answer 18

Hypernatraemia and hyperkalaemia

Question 19

The requirements for calcium and magnesium are higher in enteral than parenteral nutrition because?

Answer 19

Only a proportion of these elements is absorbed in the gut

Question 20

Which vitamin is usually absent from parenteral feeds and may need to be administered seperately?

Answer 20

Vitamin K

Question 21

What are the 4 reasons many vitamins are given in higher quantities in parenteral compared to enteral nutrition?

Answer 21

1. Patients on parenteral nutrition may have increased requirements
2. Severe disease
3. They may already have depleted vitamin pools
4. Some vitamins degrade during storage

Question 22

What are the 4 routes in which enteral nutrition feeds can be given?

Answer 22

1. Via mouth (food supplemented with solid or liquid supplements with multiple benefits)
2. By fine-bore nasogastric tube
3. By percutaneous endoscopic gastrostomy (PEG) - those needing enteral nutrition >30 days - a catheter is placed percutaneously into the stomach under endoscopic control
4. Needly catheter jejunostomy - fine catheter is inserted into the jejunum and brought out through the stomach wall

Question 23

What are the 4 main complications of NGtubes?

Answer 23

1. Regurgitation and aspiration into bronchus
2. Blockage of the NG tube
3. GI side effects - diarrhoea
4. Metabolic complications e.g. hyperglycaemia, hypokalaemia and low levels of magnesium, calcium and phosphate

Question 24

What is a polymeric diet?

Answer 24

Intact nutrients that are more palatable and cheaper than semi-elemental diets

Question 25

Would patients with severely impaired GI function require a polymeric diet or a pre-digested (semi-elemental/elemental) diet?

Answer 25

Pre-digested

Question 26

In parenteral nutrition how is energy supplied?

Answer 26

Glucose with additional calories provided by a fat emulsion

Question 27

Peripheral parenteral nutrition is administered by how many litre bags over how many hours?

Answer 27

3L over 24 hours

Question 28

What is peripheral parenteral nutrition?

Answer 28

The delivery of nutrients into a small vein using a feeding catheter

Question 29

What is central venous catheter parenteral nutrition?

Answer 29

Used when the catheter tip is placed in a large, high-flow vessel such as the superior vena cava

Question 30

What 3 things are monitored in a central venous parenteral nutrition regimen?

Answer 30

1. Bloods - Plasma e-, glucose daily, full blood count, liver biochemistry, Ca2+, phosphate, Mg2+, zinc and triglycerides
2. Nutritional Status - skinfold thickness and weight
3. Nitrogen balance - complete urine collection

Question 31

Which 3 groups are likely to benefit from nutritional supplements?

Answer 31

1. Those with BMI <20kg/m2
2. Children with growth failure (weight for height <85%)
3. Weight-losing patients >10% with BMI >20kg/m2

Question 32

What is the most common reason for starting home tube feeding?

Answer 32

Swallowing difficulties

Question 33

What diseases may cause swallowing difficulties?

Answer 33

Motor neurone disease, MS, parkinsons and cerebrovascular disease (bleed on brain)