Flashcards in Week 229 - Nutrition Deck (33):
Week 229 - Nutrition: What are some of the complications of parenteral nutrition?
• Catheter related problems - Sepsis and thrombosis.
• Liver Dysfunction
Week 229 - Nutrition: Which patients are most often malnourished of admission to hospital?
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?
• 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
• 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.
Week 229 - Nutrition: What are some of the complications of parenteral feeding?
• Line sepsis
• Nutritional and metabolic complications;
- Fluid overload
- 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
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.
• 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
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?
• Thiamine deficiency
• Salt and water retention
Week 229 - Nutrition: What are the high risk factors for causing refeeding syndrome?
• BMI less than 16kg/m2
• Weight loss >15% in 3-6 months
• Little or no intake for >10days
• Low baseline potassium, phosphate or magnesium
Week 229 - Nutrition: How can we help to prevent refeeding syndrome?
• Have a reduced rate of refeeding for those at high risk increasing it to full by 4-7 days.
• Monitor fluid balance and clinical status and give electrolytes if needed.
Week 229 - Nutrition: If refeeding changes do occur what should be done?
• Reduce the feeding rate
• Correct electrolytes
• Care with fluid and sodium prescribing
Week 229 - Nutrition: What is in TPN?
• Macro nutrients - Proteins, Carbs, Fats
• Micro nutrients - Vitamins and Minerals
Week 229 - Nutrition: What can cause short bowel syndrome in newborns?
• Necrotizing enterocolitis
• Congenital defects of the bowel, such as: Midgut volvulus, omphalocele etc.
Week 229 - Nutrition: What can cause short bowel syndrome in children and adults?
• Following surgery
• Crohns disease
Week 229 - Nutrition: Which part of the bowel secretes Cholecystokinin and Secretin, and absorbs Calcium, Magnesium, Folate and Iron?
Week 229 - Nutrition: Which part of the bowels absorbs glucose, amino acids, fat, thiamine and vitamin C?