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Nutrition In Sick Patients PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Nutrition in Sick Patients".

This medical PowerPoint presentation discusses how nutrition is a crucial aspect of healthcare, especially for sick patients. Adequate nutrition plays an essential role in maintaining the bodys overall health and helping it fight off infections and diseases. Sick patients may have an increased nutritional requirement due to increased energy expenditure, decreased nutrient absorption, or impaired organ function.

The primary goal of nutrition in sick patients is to maintain or restore their nutritional status. Nutritional assessment and support should be initiated as soon as possible after admission to the hospital. This can be achieved through various methods, including enteral feeding, parenteral nutrition, and oral supplements.

Enteral feeding involves providing nutrition through a feeding tube directly into the gastrointestinal tract. This method is preferred over parenteral nutrition in most cases because it is less invasive, less expensive, and associated with fewer complications. However, it may not be feasible in patients with severe gastrointestinal disease or obstruction.

Parenteral nutrition involves providing nutrition through an IV line. This method is reserved for patients who cannot tolerate enteral feeding or have severe malnutrition. Parenteral nutrition can provide all essential nutrients, including carbohydrates, proteins, fats, vitamins, and minerals, but it is associated with a higher risk of infection and other complications.

Oral supplements are often used to increase calorie and nutrient intake in patients who are not meeting their nutritional requirements through regular food intake. These supplements can be in the form of powders, liquids, or bars and are available in a variety of flavors.

Tags : nutrition, nutrition in sick patients, Enteral feeding, parenteral nutrition, critical care medicine, critical care medicine PowerPoint presentation

Published on : Mar 28, 2023 | Views : 1179 | Downloads : 0

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Slide 1-

Nutrition in Sick Patients Why it is important? What is the evidence? How to treat and prevent malnutrition Which route to choose What sort of tubes are there? Calculations and refeeding syndrome
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Hippocrates 400 B.C. ‘A slender and restricted diet is always dangerous in chronic and in acute diseases’
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‘Do not let your patients starve and when you offer them nutrition support, do so by the safest, simplest, most effective route.’ Dr Mike Stroud Feb 2006 Chair of NICE committee
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Why is it important? McWhirter and Pennington 1994: 40% of hospital patients malnourished on admission and nutritional state usually deteriorates in hospital. Costs £3.8bn/yr Critically ill are often malnourished: admitted after major surgery, following extended illness or hospital stay, high rate of alcohol/drug misuse, poor self care, elderly, co-existing disease etc
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Effects of malnutrition
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Nutritional State and Complications HDU
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Metabolic response to starvation Aims to minimize impact on vital organs and conserve energy Reduction in tissue metabolism Decreased metabolic rate Decreased temperature Reduction in physical activity Protein loss
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Starvation Bobby Sands – lost 7 kg in first 17 days Approx 0.5kg/day Died at 65 days (9 weeks) Not expending excess energy, not in ICU ICU patients – often have increased metabolic demands AND starvation Complex metabolic changes
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Critical illness: Metabolic demand sympathetic nervous system stimulation acute phase response: cytokines severe catabolism organ failure, poor gut function increased oxygen requirements poor wound healing insulin resistance: hyperglycaemia Wasting iatrogenic problems – drugs/HAI
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Starvation and ICU Complex metabolic changes Weight loss is high if sick patients are not fed But nutrients are not always adequately absorbed or metabolised Weight loss occurs despite feeding Important to feed patients but with regard to their individual needs and complexities.
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ICU nutrition Used to be everything mixed up and given via NG tube Risk of infection Now specialised feeds are used in sterile packaging
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What is the evidence in HDU? Early nutrition is important Bowel function may recover within 12 hours Use the gut if you can Bowel sounds are not a good indication of bowel function Ileus is common Giving pre-op sugary drinks can speed bowel function (ERAS) Use EN + TPN to achieve goals
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How do we treat/prevent malnutrition? Whose role is it?
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How do we treat/prevent malnutrition? Think about it Identify it – history – weight loss, intake, vomiting, diarrhoea, IBD, cancer etc: doctors and nurses Weight- nurses Optimise intake – oral/enteral/parenteral: doctors/dietitians/nurses Monitor – nurses/dietitians/doctors
Slide 20-

Organisation of Nutrition Support 3. NICE Guidelines for Nutrition Support in Adults 2006
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Step 1: Screen MUST Malnutrition Universal Screening Tool from BAPEN BMI score, weight loss score, acute disease effect score together gives low, medium and high risk of malnutrition: if high, patient must be treated early
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At risk of malnutrition Eaten little or nothing for 5 days and unlikely to do so for at least next 5 days Poor absorptive capacity and/or high nutrient losses and/or increased nutritional needs due to catabolism etc 3. NICE Guidelines for Nutrition Support in Adults 2006 Patient at risk of becoming malnourished
Slide 23-

Malnourished BMI less than 18.5 Kg/m2 Weight loss > 10% within last 3-6 months BMI < 20Kg/m2 and unintentional weight loss > 5% in last 3-6 months 3. NICE Guidelines for Nutrition Support in Adults 2006 Patient already malnourished
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Weighing Patients Important for nutrition screening/dosage Drug dosages Cardiac output monitoring Fluid balance CT scanning Estimation?
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Routes: Enteral Preserves intestinal mucosal structure and function More physiological Reduced risk of infectious complications £6 vs £66
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Routes Of feeding
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Naso-gastric Feeding Risk of aspiration in ICU: HOB 30 degrees Don’t start feed at night Risk of displacement High aspirates and inadequate calories common in ICU PEG/gastrostomy feeding for long-term
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Jejunal Feeding Jejunal feed: via a tube placed Trans-nasally by endoscopy, radiologically, at the bedside. Into the jejunum either at laparotomy or laparoscopy May reduce incidence of aspiration Often increases dose of EN given over NG
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Why do we use TPN?
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Parenteral Nutrition GI tract is not functional GI tract cannot be accessed Inadequate GI feeding: Optimise enteral first if possible; if not absorbing start TPN on day 3-7 depending on nutritional state
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TPN Doctors decide patient needs it Dietitian sees patient Decides best regime Orders bag from pharmacy Made up aseptically to requirements Start low and build up Monitor bloods
Slide 35-

Access for PN Usually central line in ICU – keep a clean port if PN may be needed. 5 lumen Short term PN – can have PIC (need a different formula) or PICC Long-term TPN – tunnelled subclavian catheter (Hickman) or subcutaneous port is usually inserted – OBSERVE STRICT ASEPSIS if handling these lines.
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Tubes and Lines
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Complications Constipation Diarrhoea – important points? Intolerance: ? Sepsis Use pro-kinetics, NJ feeding, drugs Line sepsis Ileus – Avoid opioids, optimise fluid balance and electrolytes, ?trickle of feed
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Overfeeding Lactic acidosis Hyperglycaemia Increased infections Liver impairment (Alk phos, ALT, GGT, acalculous cholecystitis) Persistent pyrexia
Slide 42-

How much to give – general recommendations Prescription calculated by dietitian Schofield equation e.g. for 60-74 year old woman: BMR = (9.2x weight in kg) + 687, (tables available)=requirement in Kcal/24hr Add Activity factor and stress factor e.g. 10% for bedbound + 20-60% for sepsis – burns i.e for 65kg woman ventilated woman with sepsis this works out as 1670 Kcal = approx 25 Kcal/kg/24hr Rough guide to start: 25 Kcal/kg/day total energy. Increase to 30 as patient improves
Slide 43-

How much to give – general recommendations 1.25g/kg/day protein more just gets excreted 30ml fluid/kg/24 hours. Add 100-200ml/day for each degree of temperature Account for excess losses Adequate electrolytes, micronutrients etc Avoid overfeeding Obesity: feed to BMR no stress factor unless stress is severe e.g. burns/trauma
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Refeeding Syndrome 1944 conscientious objectors/concentration camps – CCF when fed Starvation 1st 24-72 hours – body uses glycogen stores for gluconeogenesis, 72+ hours – FFA oxidation to ketones, sparing protein. Feeding – metabolism shifts back to glucose –ATP and 2-3DPG produced. Phosphate drops and K and Mg shift into cells due to anabolism and insulin release. Extra-cellular fluid expansion and thiamine B1 deficiency occur (co-factor in CH metabolism).
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Refeeding Syndrome Unlikely to be a clear diagnosis Contributes to fluid imbalances, arrhythmias, muscle weakness, failure to wean, cardiac failure Awareness of the possibility is important: nutritional history and electrolytes Remember in HDU patients too – may not be fed for a long time
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Risk of re-feeding syndrome One or more of the following: BMI less than 16 kg/m2 unintentional weight loss greater than 15% within the last 3-6 months little or no nutritional intake for more than 10 days Very low levels of potassium, phosphate or magnesium prior to feeding NICE Guidelines for Nutrition Support in Adults 2006
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Risk of re-feeding syndrome Two or more of the following: BMI less than 18.5 kg/m2 unintentional weight loss greater than 10% within the last 3-6 months little or no nutritional intake for more than 5 days a history of alcohol abuse or drugs including insulin, chemotherapy, antacids or diuretics
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Managing refeeding problems start nutrition support at 10 kcal/kg/day maximum increase levels slowly restore circulatory volume and monitor fluid balance and clinical status provide multivitamin/trace element supplementation: Pabrinex (B1,B2,C) o.d. or thiamine B1 +Vigranon B before feed provide extra Phosphate, K+ and Mg2+ NICE Guidelines for Nutrition Support in Adults 2006
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Complex nutrition: Monitoring U & Es, phosphate, calcium, magnesium Glucose LFTs Fluid balance Haematology Weight Trace elements if long-term
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Conclusion Do not forget about feeding Keep an eye on whether nutritional targets are being met Speak to the surgeons and dietitian Remember refeeding syndrome Do not be reluctant to start PN in a supplemental capacity Avoid hyperglycaemia Nutrition is often neglected