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Revision Cards > Week 229 - Nutrition > Flashcards

Week 229 - Nutrition Flashcards

1
Q

Week 229 - Nutrition: What are some of the complications of parenteral nutrition?

A
  • Catheter related problems - Sepsis and thrombosis.
  • Hyperglycaemia
  • Liver Dysfunction
  • Osteoporosis
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2
Q

Week 229 - Nutrition: Which patients are most often malnourished of admission to hospital?

A

Elderly care.

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3
Q

Week 229 - Nutrition: How does malnutrition lead to impaired resistance to infection?

A
  • Reduced lymphocyte proliferation.
  • Decreased helper:suppressor T-cell ratio.
  • Decreased antibody activity.
  • Various cytokine deficiencies.
  • Reduced phagocyte killing.
  • Reduced Ig response.
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4
Q

Week 229 - Nutrition: How useful is albumin as a marker of nutritional state?

A

• Not very useful, it is a marker of illness so can be very inaccurate.

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5
Q

Week 229 - Nutrition: How can nutritional status be measured?

A
  • Subjective global assessment - Risk score.
  • Physical examination - oedema/cachexia
  • Anthropometry - Skinfold thickness
  • Muscle function
  • Blood Biochem. - Albumin not very accurate, transferring a bit more specific but also raised in stress/infection.
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6
Q

Week 229 - Nutrition: In what situations is parenteral feeding indicated?

A
  • Non-functioning gut

* Gut rest is required (Post-op)

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7
Q

Week 229 - Nutrition: What can cause a hyper metabolic state?

A
  • Sepsis
  • Trauma
  • Post-op stress
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8
Q

Week 229 - Nutrition: What can indicate the need for a short-term (2 week) parenteral feeding?

A
  • Severe pancreatitis
  • Mucositis 2ndary to chemotherapy
  • IBD
  • Multiorgan failure
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9
Q

Week 229 - Nutrition: What can indicate the need for long term parenteral feeding?

A
  • Intestinal atresia
  • Crohn’s disease
  • Extreme short bowel
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10
Q

Week 229 - Nutrition: Which amino-acid if the most abundantly free amino acid in the body? It also has an important role in nitrogen metabolism.

A

Glutamine

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11
Q

Week 229 - Nutrition: What are some of the complications of parenteral feeding?

A
  • Line sepsis
  • Thrombophlebitis

• Nutritional and metabolic complications;

  • Fluid overload
  • Hyperglycaemia
  • Electrolyte imbalance
  • re-feeding syndrome
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12
Q

Week 229 - Nutrition: What is the mechanism behind re-feeding syndrome?

A

• Switching energy source from endogenous ketones to exogenous glucose.
• This causes increased insulin secretion resulting in rapid uptake of PO4/K+/Mg2+ into cells.
- Na and water is also retained.

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13
Q

Week 229 - Nutrition: What is Hypophostaemia a complication of? How does it present?

A

• Re-feeding syndrome.

  • Tissue Hypoxia
  • Cardiac Dysrhythmia
  • Thrombocytopaenia
  • Confusion
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14
Q

Week 229 - Nutrition: What is a PICC line?

A

Peripherally Inserted Central Catheter

- Inserted into a vein in the antecubital fossa.

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15
Q

Week 229 - Nutrition: What is a Hickman line?

A

A venous catheter that is inserted into the subclavian vein.

It enters the skin in the chest but is tunneled before it goes into the vein.

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16
Q

Week 229 - Nutrition: What is the WAASP tool?

A 
A nutritional risk assessment for quantifying nutritional risk and what steps should be taken, i.e. monitor with food chart, refer to dietician etc.
• Weight
• Appetite
• Ability to eat
• Stress factors
• Pressure ulcers/wounds
17
Q

Week 229 - Nutrition: What are the four stages of the full nutritional assessment describe each briefly.

A
  • Dietary assessment - As it says on the day, assessment food intake and requirements using the PENG guidance.
  • Physical assessment - To give an insight into nutritional status, appearance, oedema, sores, mobility mood etc.
  • Biochemical and haematological assessment - Hydration status, re-feeding syndrome, vitamins, minerals etc.
  • Anthropometry - Measuring heigh,weight, skinfold thickness, size of areas of the body.
18
Q

Week 229 - Nutrition: What are the indications for PEG feeding?

A
  • Stroke (Swallowing problems).
  • Patients with chronic neurological conditions.
  • Head and neck malignancy.
  • Psychiatric patients with eating disorders (Controversial).
  • Patients needing tube feed but unable to tolerate nasogastric tube.
19
Q

Week 229 - Nutrition: What are the ABSOLUTE contra-indications for PEG feeding?

A
  • Contra-indication to OGD.

* Inability to transilluminate.

20
Q

Week 229 - Nutrition: What are the relative contra-indications for PEG feeding?

A
  • Unlikely to survive >30days
  • Coagulopathy, gastric varices, morbid obesity, ascites, CAPD, neoplastic of inflammatory disease of stomach/abdominal wall.
21
Q

Week 229 - Nutrition: What are the complications of PEG?

A
  • Ileus (Hypomotility)
  • Peri-stomal infection.
  • Stomal infection
  • Buried bumper
  • Aspiration
  • Haemorrhage
  • Peritonitis
  • Ulceration
22
Q

Week 229 - Nutrition: What is the treatment of a leaking PEG?

A
  • PPI to reduce acid
  • Control of local infection
  • Stoma care
  • Foam dressing instead of gauze
  • Rarely removal of PEG tube.
23
Q

Week 229 - Nutrition: In terms of metabolism what is the change that occurs during re-feeding syndrome?

A

• Glycogenolysis, gluconeogenesis and protein catabolism is turned into anabolism.

24
Q

Week 229 - Nutrition: What are the biochemical complications of re-feeding syndrome?

A
  • Hypokalaemia
  • Hypomagnesaemia
  • Hypophosphataemia
  • Thiamine deficiency
  • Salt and water retention
25
Q

Week 229 - Nutrition: What are the high risk factors for causing refeeding syndrome?

A
  • BMI less than 16kg/m2
  • Weight loss >15% in 3-6 months
  • Little or no intake for >10days
  • Low baseline potassium, phosphate or magnesium
26
Q

Week 229 - Nutrition: How can we help to prevent refeeding syndrome?

A
  • Have a reduced rate of refeeding for those at high risk increasing it to full by 4-7 days.
  • Monitor fluid balance and clinical status and give electrolytes if needed.
27
Q

Week 229 - Nutrition: If refeeding changes do occur what should be done?

A
  • Reduce the feeding rate
  • Correct electrolytes
  • Care with fluid and sodium prescribing
28
Q

Week 229 - Nutrition: What is in TPN?

A
  • Electrolytes
  • Fluid
  • Macro nutrients - Proteins, Carbs, Fats
  • Micro nutrients - Vitamins and Minerals
29
Q

Week 229 - Nutrition: What can cause short bowel syndrome in newborns?

A
  • Necrotizing enterocolitis

* Congenital defects of the bowel, such as: Midgut volvulus, omphalocele etc.

30
Q

Week 229 - Nutrition: What can cause short bowel syndrome in children and adults?

A

• Following surgery

  • Crohns disease
  • Ischaemia
  • Trauma
  • Cancer
31
Q

Week 229 - Nutrition: Which part of the bowel secretes Cholecystokinin and Secretin, and absorbs Calcium, Magnesium, Folate and Iron?

A

Duodenum

32
Q

Week 229 - Nutrition: Which part of the bowels absorbs glucose, amino acids, fat, thiamine and vitamin C?

A

Jejenum

33
Q

Week 229 - Nutrition: Which part of the bowel absorbs the following? Fluid, and electrolytes, bile acids, vitamin B12, Vitamins A,D,E,K, phosphorus and Zinc?

A

Ileum

Revision Cards (61 decks)

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