Week 229 - Nutrition Flashcards
(33 cards)
Week 229 - Nutrition: What are some of the complications of parenteral nutrition?
- Catheter related problems - Sepsis and thrombosis.
- Hyperglycaemia
- Liver Dysfunction
- Osteoporosis
Week 229 - Nutrition: Which patients are most often malnourished of admission to hospital?
Elderly care.
Week 229 - Nutrition: How does malnutrition lead to impaired resistance to infection?
- Reduced lymphocyte proliferation.
- Decreased helper:suppressor T-cell ratio.
- Decreased antibody activity.
- Various cytokine deficiencies.
- Reduced phagocyte killing.
- Reduced Ig response.
Week 229 - Nutrition: How useful is albumin as a marker of nutritional state?
• Not very useful, it is a marker of illness so can be very inaccurate.
Week 229 - Nutrition: How can nutritional status be measured?
- 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.
Week 229 - Nutrition: In what situations is parenteral feeding indicated?
- Non-functioning gut
* Gut rest is required (Post-op)
Week 229 - Nutrition: What can cause a hyper metabolic state?
- Sepsis
- Trauma
- Post-op stress
Week 229 - Nutrition: What can indicate the need for a short-term (2 week) parenteral feeding?
- Severe pancreatitis
- Mucositis 2ndary to chemotherapy
- IBD
- Multiorgan failure
Week 229 - Nutrition: What can indicate the need for long term parenteral feeding?
- Intestinal atresia
- Crohn’s disease
- Extreme short bowel
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.
Glutamine
Week 229 - Nutrition: What are some of the complications of parenteral feeding?
- Line sepsis
- Thrombophlebitis
• Nutritional and metabolic complications;
- Fluid overload
- Hyperglycaemia
- Electrolyte imbalance
- re-feeding syndrome
Week 229 - Nutrition: What is the mechanism behind re-feeding syndrome?
• 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.
Week 229 - Nutrition: What is Hypophostaemia a complication of? How does it present?
• Re-feeding syndrome.
- Tissue Hypoxia
- Cardiac Dysrhythmia
- Thrombocytopaenia
- Confusion
Week 229 - Nutrition: What is a PICC line?
Peripherally Inserted Central Catheter
- Inserted into a vein in the antecubital fossa.
Week 229 - Nutrition: What is a Hickman line?
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.
Week 229 - Nutrition: What is the WAASP tool?
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
Week 229 - Nutrition: What are the four stages of the full nutritional assessment describe each briefly.
- 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.
Week 229 - Nutrition: What are the indications for PEG feeding?
- 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.
Week 229 - Nutrition: What are the ABSOLUTE contra-indications for PEG feeding?
- Contra-indication to OGD.
* Inability to transilluminate.
Week 229 - Nutrition: What are the relative contra-indications for PEG feeding?
- Unlikely to survive >30days
- Coagulopathy, gastric varices, morbid obesity, ascites, CAPD, neoplastic of inflammatory disease of stomach/abdominal wall.
Week 229 - Nutrition: What are the complications of PEG?
- Ileus (Hypomotility)
- Peri-stomal infection.
- Stomal infection
- Buried bumper
- Aspiration
- Haemorrhage
- Peritonitis
- Ulceration
Week 229 - Nutrition: What is the treatment of a leaking PEG?
- PPI to reduce acid
- Control of local infection
- Stoma care
- Foam dressing instead of gauze
- Rarely removal of PEG tube.
Week 229 - Nutrition: In terms of metabolism what is the change that occurs during re-feeding syndrome?
• Glycogenolysis, gluconeogenesis and protein catabolism is turned into anabolism.
Week 229 - Nutrition: What are the biochemical complications of re-feeding syndrome?
- Hypokalaemia
- Hypomagnesaemia
- Hypophosphataemia
- Thiamine deficiency
- Salt and water retention
