Feeding workshop

Question 1

Give an overview of the management for nutritional support according to the degree of malnutrition risk

Answer 1

1. Food fortification & dietary counselling
2. Oral nutrition support – e.g. additional snacks and/or sip feeds
3. Enteral tube feeding – the delivery of a nutritionally complete feed directly into the gut via a tube
4. Parenteral nutrition – the delivery of nutrition intravenously

Question 2

Who needs nutritional support ?

Answer 2

• BMI <18.5
• Unintentional weight loss >10% within the last 3–6 months
• BMI <20 and unintentional weight loss >5% within the last 3–6 months
• Have eaten or are likely to eat little or nothing for more than 5 days or longer
• Poor absorptive capacity and/or high nutrient losses and/or increased nutritional needs from causes such as catabolism

Question 3

What are some of the reasons for requring nutritional support in hospital ?

Answer 3

• Difficulty swallowing
• Cognitive impairment
• Learning disability

Question 4

Give some examples of oral nutritional supplements ?

Answer 4

• Ready made drinks (sip feeds)
• Powders to reconstitute with milk e.g. Build-up, Enshake
• Puddings e.g. Forticreme
• Carbohydrate supplements (powder or liquid)
• Fat supplements e.g. Calogen
• Fat and protein supplements (powder or liquid) e.g. Pro-Cal

Question 5

What are the indications for needing oral nutritional supplements ?

Answer 5

• Disease related malnutrition
• Intractable malabsorption
• Per-operative preparation of malnourished patients
• Dysphagia
• Proven IBD
• Post total gastrectomy
• SBS
• Bowel fistulae

Question 6

What is enteral tube feeding ?

Answer 6

Delivery of a nutritionally complete feed via a tube into the stomach, duodenum or jejunum

Question 7

What are the main indications for enteral tube feeding ?

Answer 7

• Inadequate or unsafe oral intake, and Need a functional, accessible GI tract

Question 8

What is parenternal nutrition ?

Answer 8

Nutrition given via the IV route

Question 9

What are the indications for parenternal nutrition?

Answer 9

Inadequate or unsafe oral and/or enteral nutritional intake and a non-functional, inaccessible or perforated (leaking) gastrointestinal tract

Question 10

Type of IF:

Type I

• Description Acute, short term, usually self-limiting condition
• Care location - Wards, (HDU, ITU)

Type II

• Descripiton - Prolonged acute condition, often in metabolically unstable patients, requiring complex multi-disciplinary care and intravenous supplementation over periods of weeks or months
• Care location - HDU, ITU, (wards).

Type III

• Description - Chronic condition, in metabolically stable patients, requiring intravenous supplementation over months or years. It may be reversible or irreversible
• Care location - Wards to Home

Question 11

What are some of the common conditions requiring home PN?

Answer 11

• Cancer
• CNS& mental health
• Non-malignant GI