Malnutrition Flashcards

1
Q

What are obvious indicators of dysphagia?

A
Difficult, painful chewing or swallowing
Regurgitation of undigested food 
Difficulty controlling food in mouth 
Drooling
Hoarse voice 
Coughing or choking before/ after swallowing
Globus sensation
Nasal regurg
Feeling of obstruction 
Unintentional weight loss
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2
Q

What are less obvious indicators of dysphagia?

A

Change in respiratory pattern

Unexplained temp spikes

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3
Q

What are the indications for nutritional support?

A

BMI <18.5
Unintentional weight loss >10% in last 3-6 months
BMI <20 + 5% weight loss

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4
Q

Who is at risk of malnutrition?

A

Pts who have eaten little or nothing for more than 5 days + are expected to continue for next 5 days
Have a poor absorptive capacity and/or high losses or needs

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5
Q

What are the indications for oral nutrition support?

A

Pts who can swallow safely + are malnourished

Peri-op pts, post-caesarean

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6
Q

What is the total nutrient intake for an adult?

A

25-35 kcal/kg
1g protein/kg
30ml fluid/kg

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7
Q

If someone is malnourished, what support level should they be introduced at?

A

No more than 50% of requirements for first 2 days

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8
Q

What are the indications for enteral tube feeding?

A

Pts who are malnourished with inadequate or unsafe oral intake + a functional GI tract

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9
Q

When can PEG tubes be used for feeding?

A

4 hours after insertion

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10
Q

How are pts in ICU fed?

A

Through NG tube over 16-24 hours

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11
Q

What should be given to pts with delayed gastric emptying + not tolerating enteral feeding?

A

Offer motility agent

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12
Q

What are the indications for parenteral nutrition?

A

Inadequate or unsafe oral/ enteral intake

Non functional/ inaccessible GI tract

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13
Q

What route of access should be used for parenteral nutrition?

A

peripheral venous catheter for short term nutrition

Tunnelling subclavian line recommended for >30 days

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14
Q

How often should nutrition be delivered in parenteral nutrition?

A

Cyclical when using peripheral cannula

Continuous in severely ill people

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15
Q

What is refeeding syndrome?

A

Electrolyte derangements associated with massive intracellular shift of electrolytes

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16
Q

What electrolyte imbalances are seen in refeeding syndrome + why?

A

Hypophosphatemia due to extracellular phosphate being used to generate ATP
Hypokalaemia + hypocalcaemia

17
Q

Complications of refeeding syndrome

A

Cardiac - impaired contractility, decreased stroke volume, HF, arrhythmias
Seizures

18
Q

Prevention of refeeding syndrome

A

Limiting calories + fluid initially
Closely monitor pt
Aggressive correction of hypophosphatemia