Artificial Feeding Flashcards
What drives problem of malnutrition?
Lack of education and ‘poor knowledge’ by doctors, nurses medical students etc
How many patients are affected by malnourishment?
- 40% malnourished on acute admission
- 70% on discharge
When does total starvation occur in normal fit adults?
Between 60-70 days
How much body weight needs to be lost to cause death?
Acute weight loss of 1/3 of body weight
What can malnourishment lead to?
- Prolonged recovery / hospital stay
- Fatigue depression
- Poor mobility (increase DVT, poor wound healing, pressure sores)
- Increased morbidity and mortality
What is MUST?
Malnutrition Universal Screening Tool (developed by BAPEN 2003)
Assessment of malnutrition and malnutrition risk
3 measurements:
- BMI (Weight/Height2)
- Recent weight loss (%)
- Acute illness with, or likely to be, no nutritional intake for 5 days
Score 0-6 (0=low), more than 2=high
When should adult malnutrition be assessed?
- Within 24 hours of admission
- Repeated weekly
Trigger questions
- Have you lost weight recently?
- Have you noticed a reduction in appetite?
- Will this admission have impact on patient’s nutritional intake (e.g. swallowing problems, multiple injuries)
MUST should be completed if ‘yes’ to ANY trigger questions
What are high risk medical conditions for malnutrition?
- Swallowing problems
- Poor absorption from gut
- High nutrient loss
- Increased nutritional needs
Key point about overweight people
Overweight people can be malnourished as well (high BMI=0 points, sudden weight loss and lack of intake can = points using MUST)
How is anthropometry used to assess nutrition?
- Tricep skinfold thickness
- Mid arm circumference
- Mid arm muscle circumference
How are biochemical measurements used to assess nutrition?
- Poor
- Albumin is not a marker of poor nutrition
- Can measure levels of vitamins/ trace elements etc
What do nutritional requirements depend on?
Age group, gender, clinical condition, job, activity levels etc
Who should have artificial nutrition?
- Can’t eat (stroke, head and neck surgery)
- Can’t eat enough (burns, sepsis, pre-operative malnutrition)
- Shouldn’t eat (bowel obstruction, leaks after surgery, prolonged paralytic ileus)
What are types of artificial feeding?
- Enteral (into gut) –> if gut works, use it
- Parenteral (into vein)
When might enteral feeding be required?
- Persistent and poor oral intake for > 3 days
- Dysphagia (difficulty in swallowing)
- Head injury with prolonged recovery
Need a functioning gut
What are the types of short-term enteral feeding?
- Naso-gastric feed (tube in nose and sits in stomach)
- Nasojejunal feeds (if problem with stomach e.g. gastric outlet obstruction/delayed emptying)
What are problems of nasal tubes?
Can be sore –> usually <4 weeks for nasal tubes
What is used for longer term enteral feeding?
- PEG (percutaneous endoscopic gastrostomy)
- RIG (radiologically inserted gastrostomy)
What is PEG?
Scope into stomach, shine bright light so can see through abdominal wall, press finger in
Should be able to see light from outside and sharp indentation of finger from inside
If whole bowel pushes on stomach then implies problem (e.g. transverse colon pushing on stomach)
Needle into stomach and wire passed through and pulled out of mouth (patient sedated)
When would RIG be used instead of PEG?
If cancers in upper GI tract e.g. mouth
When would intravenous nutrition be used?
When guts don’t work (e.g. after operation, little bowel left)
What is intravenous nutrition typically called?
TPN (total parenteral nutrition)
- So actually PN (patients often eat)
- Feeding into vein
Define parenteral
Administered or occurring elsewhere in the body than the mouth and alimentary canal.
