Quiz 5.5 Flashcards
What is malnutrition? Primary malnutrition?
Loss of body composition, particularly fat and proteins which can be prevented or reversed by nutritional repletion. Usually results from a decrease in nutrient intake in the absence of an underlying disease process.
What is secondary malnutrition?
Caused by underlying organic disease process, often malfunction of GI tract.
Energy provided by normal nutrient intake is overwhelmed by body’s inability to use nutrients- unusual energy requirements of illness, failure of GI function.
What are reasons for malnutrition?
95% of pediatric cases- not enough calories.
Increased needs with cardiac or chronic lung disease!
Malabsorption or poor absorption.
What is malabsorption?
Inability of the intestinal mucosa to absorb nutrients from the gut.
Diseases of GI tract lead to generalized malabsorption of all macronutrients (fat/carb/protein) or los of specific micronutrients (minerals/vit).
Happens in pancreatic diseases also (CF).
What’re the main reasons children won’t eat?
Gagging, vomiting, diarrhea, constipation
What is gastroesophageal reflux? (GER)
When the contents of the stomach are forced through sphincter back up to esophagus.
Happens most often in those under 2, esp in premies.
Can be functional GER “happy spitter” which decreases after 6 mos.
Rule out nonpathologic GER
How do we evaluate GER?
Barium swallow/upper GI pH probe Endoscopy Scintigraphy (if you see it, you know it's happening, if you don't could still be happening)
What is a barium swallow/upper GI for GER eval?
Assessment of anatomy and function of esophagus, stomach and duodenum
Detects obstructions and malformations, esophageal lesions and backflow of barium
Does NOT assess oropharyngeal fxn
What is a pH probe for GER eval?
pH probe put through nasopharynx and tip stays superior to lower sphincter (in esophagus toward bottom)
Measures times of episodes, percent of time reflux present
Outpatient in supine or upright
What is an endoscopy for GER eval?
Sedated assessment necessary to dx esophagitis- biopsy if esophagus looks normal. Erosive esophagitis is clearly visible but absence does not rule out GER.
What is scintigraphy for GER eval?
Ingestion of radiolabelled formula/food.
Images reveal isotopes through esophagus and stomach
Read gastric right after feed, 30 min, 1 hr.
Findings may show–> GER- isotope returns to esophagus OR aspiration- isotope in lung fields
What are some alternative feeding methods?
Eneral v parenteral IV peripheral or central
Orogastric OG tube
Nasogastric NG tube nose to stomach
Gastronomy G tube directly to stomach
Gastro-jejunal GJ tube stomach with 2 ports with 1 ending in stomach and one in jejunum
Jejunostomy J tube
When is tube feeding considered?
When a child is not safe to ingest liquids and foods orally
No weight gain or weight loss for three consecutive months
What is a Orogastric OG tube?
Advantages are that it uses mouth, necessary for neonates and infants, preserves GI tract fxn
Disadvantages are that it interferes with sucking, is not well tolerated, obstruction and dislodgment
Use with babies because largest hole in body that they have
What is a Nasogastric NG tube?
Advantages are that it’s appropriate for short term use (6-8 wks), quick way to prove weight gain, preserves GI tract fxn.
Disadvantages are that it interferes with infants nasal breathing, uncomfortable, obstruction and dislodgment.
