Nutrition in medicine Flashcards
how do we treat malnutrition and diet deficienes
- Increased intake of normal diet
- Prescribe supplements
- Specialist enteral feeds
- Nasogastric tube
- Gastrostomy tube
- Parenteral nutrition
As you go down the list it applies to fewer patients
what are specialist entral feeds
– completely balance, has all nutrients that you need so you could live on it, they are useful but quite expensive
how do you know someone needs to be watched for nutrition in a hospital
- red tray - make sure that someone takes notes and helps them eat
when is tube feeding used
- this is used when patients can’t or won’t swallow but the gut is working
what happens if you don’t use the gut when it does work
- if the gut is working then we should use it, the gut does not like being starved,
- most of the bodily cells get nutrients from the bloodstream,
- the gut mucosa has a blood supply and it also like nutrients in the lumen of the gut and if you don’t have that the gut atrophies and the vili shrink and excess bacteria grows where there not supposed to go and you get more transfer of bacteria from the lumen to the bloodstream and circulate around the body and cause other endogenous infections
what people make up nutrition support teams
- Dietitian
- Doctor
- Nurse
- Pharmacist
- (Chemical pathologist)
- (Speech & Language Therapist)
- (Micro / Infection control)
can you withdraw feeding
- you can withdraw feeding as it is treatment
what are the indications for enteral tube feeding
• General debility – e.g slow postoperative recovery
• Reduced consciousness
– Brain injury- cannot eat
• Unsafe swallow
– CVA
– Parkinson’s disease
– Motor neurone disease
• Pre-head & neck cancer surgery/radiotherapy
• Special situations
– Cystic Fibrosis
– Crohn’s Disease
what are the things that you need to look at about the tube that you use for feeding
• Careful checking of tube position – initially - must never go into the lungs
• Careful checking – daily
• Tubes can become blocked
• Patient tolerance can be an issue
• Insertion facilitated by Xray or Endoscopy
• Nasojejunal tubes are possible
- the tube can be put further down the bowel if there is a problem with gastric emptying
what are the indications for gastrostomy
- As for Enteral Feeding – but longer term
- Percutaneous Endoscopic Gastrostomy (PEG)
- Radiologically Inserted Gastrostomy (RIG)
- Surgically placed Gastrostomy
what are the indications for parenteral nutrition
- intestinal failure - patients usually have had surgery on the abdomen
what can cause intestinal failure
- Prolonged postoperative ileus
- Intestinal obstruction - ongoing
- Short bowel
- Small bowel fistula
- Acute pancreatitis
- GI motility disorders
what is acute pancreatitis
- this is when the pancreas is inflamed
what are the principles of parenteral nutrition
- Calculate nutrient need
- Compound in a large IV bag
- Usually central vein access
- Pump infusion 24hrs (or less)
- ASEPSIS
- Monitor especially Water and Electrolytes
- Stop when Enteral working
what are the complications of parenteral nutrition
- Infection!!!!!
- Water and electrolyte imbalance
- Diabetes
- Appetite suppression (or not )
- Liver Disease – longer term – long term inflammatory liver disease, more at risk of quite a dangerous liver disease
- Large vein thrombosis – longer term
