How Are Patients Artificially

Question 1

What is rickets

Answer 1

Vitamin D deficiency

Question 2

When was malnutrition first identified as a problem

Answer 2

1970 - identified as high prevalence

Question 3

What percentage of patients are malnourished on acute admission

Answer 3

40%

Question 4

What percentage of patients are malnourished upon discharge

Answer 4

70% of patients

Question 5

How quick do you die after starvation

Answer 5

• 2 months healthy
• 1 month ill
• if 1/3 lost = imminent death

Question 6

Consequences of starvation

Answer 6

• muscle degradation
• poor wound healing/pressure sores
• decreased immune response
• prolonged recovery/admission to hospital and readmission

Question 7

Adult malnutrition assessment

Answer 7

MUST
Given within 24 hours of admission, repeated weekly
- BMI
- recent weight loss %
- is there an acute illness

Score from 1-6 - 1 =-6 food chart, 2 = risk!!

Question 8

What does MUST assess

Answer 8

• assessment of risk
• and assessment of malnutrition

Question 9

What other nutritional assessments are there?

Answer 9

• anthropometric - tricep skin fold thickness/mid arm circumference/arm muscle circumference
• Biochemical - poor = blood test… albumin NOT marker of poor nutrition

Question 10

Who needs artificial nutrition

Answer 10

• can’t eat - stroke/head and neck surgery
• can’t eat enough - pre-op malnutrition/sepsis/burns
• shouldn’t eat - bowel obstruction, leaks after surgery

Question 11

Simple measures to help eating

Answer 11

• encouragement
• protected meal times
• red trays = at risk
• change consistency of foods to help

Question 12

What oral nutritional supplements are there

Answer 12

200 ml bottle of fortisip
- 340 kcal
- 20g protein
- vitamins and minerals

Question 13

Different types of artificial feeding if oral fails

Answer 13

• enteral - into gut
• parenteral - into vein

Question 14

Short term enteral feeding options

Answer 14

Nasogastric

Nasojejenul feeds - if gastric outlet os delayed/emptying

Question 15

Long term enteral feeding options

Answer 15

Gastrostonty - fed directly into stomach

Pegs or rigs

Question 16

What are PEGS

Answer 16

Not for people with cancer (rigs instead)
- percutaneous edoscopic gastrostomy
Tubes into stomach

Question 17

What are rigs used for

Answer 17

Radiologically inserted gastrostomy
- for people with cancer

Question 18

What is TPN

Answer 18

Total parenteral nutrition - feeds into vein
- when you can’t use gut
- if gut can’t absorb properly

Question 19

Indications for TPN

Answer 19

• bowel obstruction
• short bowel syndrome
• fistulae - abnormal connections between bowel and skin = short bowel syndrome)

Complications post surgery

Question 20

What is refeeding syndrome

Answer 20

• too much too soon!
• patients at risk are those who are malnourished/norecent intake/ alcoholic
  What happens?
• ,electrolyte shift
• fluid shift