Undernutrition & Nutritional Support

Question 1

What is the incidence/complications of undernutrition?

Answer 1

25% of inpatients
Increased requirements
Increased nutritional losses
Decreased intake
Nasoduodenal tubes

Question 2

What are the indications for the insertion of an NG tube?

Answer 2

To empty the stomach (pre-op, obstruction)
Intra-operatively (inflate/deflate stomach)
For irreversible dysphagia
To feed ill patients

Question 3

How should NG tubes be removed?

Answer 3

Weaning w/ intermittent spigotting

Ensure patient can tolerate not having NG

Question 4

What alternatives to NG tubes are available?

Answer 4

Gastrostomies placed endoscopically/surgically
Jejunostomies placed surgically
Nasoduodenal tubes

Question 5

What is enteral nutrition?

Answer 5

Nutrition given into GI tract, either by mouth/liquid nutrition via tube feeding

Question 6

What is parenteral nutrition?

Answer 6

Nutrition given outside the GI tract, usually via a central venous line/PICC line
-pharmacist adds trace elements/electrolytes

Question 7

What are the indications for parenteral nutrition?

Answer 7

Only considered if pt will be malnourished w/o it
-GI tract not functioning >7/7
Specialist advice vital

Question 8

What are the general complications of total parenteral nutrition (TPN)?

Answer 8

Thrombosis (PE)
Infection
Pneumothorax

Question 9

What are the metabolic complications of TPN?

Answer 9

Electrolyte/lipid/glucose disturbances
Hypercapnia (excess CO2 production)
Deficiency syndromes
Refeeding syndrome

Question 10

What is refeeding syndrome?

Answer 10

Complication of restoring nutrition after prolonged starvation
Increased insulin –> hypophosphataemic state
-can be fatal

Question 11

What are the complications associated w/ passing an NG tube?

Answer 11

Pain
Electrolyte loss
Oesophagitis/tracheal/duodenal intubation