Nutrition support

Question 1

______________ is defined by the following:

- BMI <18.5 and unintentional weight loss >10% over the last 3-6 months
- BMI <20 and unintentional weight loss >5% over the last 3-6 months

Answer 1

Malnourished

Question 2

A person who has eaten little or nothing for > ___ days and/or likely to eat little or nothing for the next ___ days or longer is at risk of malnutrition

Answer 2

5, 5

Question 3

Eating or drinking ________ should always be the preferred method of nutrition support

Answer 3

orally

Question 4

Patients with inadequate or unsafe oral intake with a functional and accessible gastrointestinal tract should be considered for _______ ______ feeding

Answer 4

Enteral tube

Question 5

__________ nutrition should ONLY be considered in those patients with a non-functional, inaccessible, obstructed, or perforated GI tract

Answer 5

Parenteral

Question 6

Oral nutritional support should be considered for any patient with ___________ food and fluid intakes to meet requirements unless they cannot swallow safely, have inadequate GI function, or if no benefit is anticipated (eg end of life).

Answer 6

inadequate

Question 7

What is the main indication for enteral nutritional support?

Answer 7

When oral intake is insufficient or unsafe

Question 8

What are the four routes of gastric enteral feeding?

Answer 8

Orogastric, nasogastric, gastrostomy, oesophagostomy tubes

Question 9

List the four routes of post pyloric enteral feeding

Answer 9

Nasoduodenal, nasojejunal, gastrojejunostomy or jejunostomy

Question 10

Nasogastric feeding is only to be used for < _____ weeks

Answer 10

4

Question 11

Name some of the complications of NG feeding

Answer 11

ASPIRATION PNEUMONIA
DISPLACEMENT, blockage, knotting
Sinusitis, sore throat, difficultly swallowing, candidiasis

Question 12

What does “PEG” stand for?

Answer 12

percutaneous ENDOSCOPIC gastroscomy

Question 13

What does “RIG” stand for?

Answer 13

RADIOLOGICALLY inserted gastroscomy

Question 14

Why is it important to understand the difference between a “PEG” and a “RIG?”

Answer 14

It has implications for the type of tube that it is, how long it can last, how the tube is held in place, and how it is cared for.

Question 15

Due to the risk of “tumour seeding” in head and neck cancers, _______ tubes are contraindicated for these patients.

Answer 15

PEG

Question 16

Which type of feeding tube placement has very low risk of tumour seeding, doesn’t require sedation, and provides better placement of the tube in cases where endoscopic placement was unsuccessful?

Answer 16

RIG

Question 17

What are some of the complications of enteral feeding?

Answer 17

• Refeeding syndrome
  
  • Aspiration
  • Diarrhoea
  • Tube blockage
  • Microbial contamination of the feed
  • Accidental tube removal
  • Stoma site problems (leakage, peritonitis, etc)
  • Buried bumper syndrome

Question 18

What is “buried bumper syndrome?”

Answer 18

Occurs when the gastric mucosa grows over the retention device can pull it into and through the stomach wall. Can result in peritonitis and death. Easy to prevent, rotating the tube daily and pushing it back and forth into the stomach, once weekly.

Question 19

What type of feeding support can be used in patients with gastroparesis and/or patients who spend most of the time lying flat?

Answer 19

Post pyloric feeding routes: Nasoduodenal or nasojejunal feeding (routes that bypass the stomach)

Question 20

This is a type of post pyloric feeding access that can be obtained in patients with established gastrostomy access by the insertion of an extension device that threads through the existing gastrostomy lumen into the jejunum

Answer 20

gastrojejunostomy

Question 21

What route of feeding might be indicated after major GI or hepatobiliary surgery, increased likelihood of gastric stasis, or if gastrostomy feeding has failed?

Answer 21

Jejunostomy

Question 22

What route of feeding is indicated in cases of GI obstruction, severe malabsorption, severe mucositis following chemotherapy, or multi-organ failure?

Answer 22

Parenteral nutrition

Question 23

List the risks associated with parenteral nutrition

Answer 23

• Catheter related infections
  
  • Deficiencies and excesses of fluid and nutrients
  • Electrolyte disturbances
  • Liver dysfunction
  • Hyperglycaemia and hyperlipidaemia
  • Cardiac failure
  • Insertion related complications (thrombosis, cardiac arrythmias, nerve injury)

Question 24

Electrolyte and fluid shifts that happen when you feed patients that have been starving for a prolonged period of time are known as

Answer 24

refeeding syndrome

Question 25

Refeeding syndrome can lead to fluid retention and low serum levels of which minerals?

Answer 25

Potassium, magnesium, phosphate

Question 26

Patients who are malnourished or those with a history of alcohol abuse, or those on drugs such as insulin, chemotherapy, antacids, or diuretics are at increased risk of __________ syndrome

Answer 26

refeeding

Question 27

What nutrients are recommended to prevent refeeding syndrome?

Answer 27

Thiamine and a multivitamin

Question 28

Levels of potassium, Mg, and phosphate are likely to drop on the _______ day after assisted nutrition route, so bloods should be monitored ________.

Answer 28

third, daily