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Flashcards in Week 229 - Nutrition Deck (33):
1

Week 229 - Nutrition: What are some of the complications of parenteral nutrition?

• Catheter related problems - Sepsis and thrombosis.
• Hyperglycaemia
• Liver Dysfunction
• Osteoporosis

2

Week 229 - Nutrition: Which patients are most often malnourished of admission to hospital?

Elderly care.

3

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.

4

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.

5

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.

6

Week 229 - Nutrition: In what situations is parenteral feeding indicated?

• Non-functioning gut
• Gut rest is required (Post-op)

7

Week 229 - Nutrition: What can cause a hyper metabolic state?

• Sepsis
• Trauma
• Post-op stress

8

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

9

Week 229 - Nutrition: What can indicate the need for long term parenteral feeding?

• Intestinal atresia
• Crohn's disease
• Extreme short bowel

10

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

11

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

12

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.

13

Week 229 - Nutrition: What is Hypophostaemia a complication of? How does it present?

• Re-feeding syndrome.
- Tissue Hypoxia
- Cardiac Dysrhythmia
- Thrombocytopaenia
- Confusion

14

Week 229 - Nutrition: What is a PICC line?

Peripherally Inserted Central Catheter
- Inserted into a vein in the antecubital fossa.

15

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.

16

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

17

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.

18

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.

19

Week 229 - Nutrition: What are the ABSOLUTE contra-indications for PEG feeding?

• Contra-indication to OGD.
• Inability to transilluminate.

20

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.

21

Week 229 - Nutrition: What are the complications of PEG?

• Ileus (Hypomotility)
• Peri-stomal infection.
• Stomal infection
• Buried bumper
• Aspiration
• Haemorrhage
• Peritonitis
• Ulceration

22

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.

23

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.

24

Week 229 - Nutrition: What are the biochemical complications of re-feeding syndrome?

• Hypokalaemia
• Hypomagnesaemia
• Hypophosphataemia
• Thiamine deficiency
• Salt and water retention

25

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

26

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.

27

Week 229 - Nutrition: If refeeding changes do occur what should be done?

• Reduce the feeding rate
• Correct electrolytes
• Care with fluid and sodium prescribing

28

Week 229 - Nutrition: What is in TPN?

• Electrolytes
• Fluid
• Macro nutrients - Proteins, Carbs, Fats
• Micro nutrients - Vitamins and Minerals

29

Week 229 - Nutrition: What can cause short bowel syndrome in newborns?

• Necrotizing enterocolitis
• Congenital defects of the bowel, such as: Midgut volvulus, omphalocele etc.

30

Week 229 - Nutrition: What can cause short bowel syndrome in children and adults?

• Following surgery

• Crohns disease
• Ischaemia
• Trauma
• Cancer

31

Week 229 - Nutrition: Which part of the bowel secretes Cholecystokinin and Secretin, and absorbs Calcium, Magnesium, Folate and Iron?

Duodenum

32

Week 229 - Nutrition: Which part of the bowels absorbs glucose, amino acids, fat, thiamine and vitamin C?

Jejenum

33

Week 229 - Nutrition: Which part of the bowel absorbs the following? Fluid, and electrolytes, bile acids, vitamin B12, Vitamins A,D,E,K, phosphorus and Zinc?

Ileum