Nutrition - Acute Care Needs (Generic Content) Exam With 100% Correct Answers

What are the three phases of swallowing? Name these in order. 1) Oral phase (preparatory & transport) 2) Pharyngeal phase 3) Oesophageal phase Define dysphagia. Difficulty with swallowing. What different reasons might be there be for dysphagia? Muscle weakness, myopathy, neurological disorders that can affect swallowing, structural abnormalities, masses on the tongue or phayrynx/larynx. What are some of the signs and symptoms of dysphagia? (6 listed) Coughing/choking when eating or drinking; coughing/choking when swallowing; wet-sounding voice; changes in breathing when eating or drinking; frequent respiratory infections; known/suspected aspiration pneumonia. What is refeeding syndrome? Disturbances in the body's metabolism after a period of nutrition deprivation. How does the body adapt to a low nutritional intake? The body uses less glucose. What happens when the body, after nutritional deprivation, is given carbohydrates? The body cells increase their uptake of glucose, but there is a drop in electrolyte levels like potassium and phosphate. What risk factors are there in refeeding syndrome? 1) A low BMI 2) Unintended weight loss of more than 10% of their body weight 3) Little or no nutritional intake for over 5 days 4) A history of alcohol abuse 5) Low electrolyte levels before refeeding (K, Mg, PO4) 6) Certain drugs: insulin, chemotherapy, antacids, diuretics. What is important to note about the signs and symptoms of refeeding syndrome? The signs and symptoms are non-specific to refeeding syndrome. What signs and symptoms can be observed in refeeding syndrome? Name a few. Weakness, seizure, altered mental status, paralysis, myalgia, hypoxia, anorexia, abdominal pain, diarrhoea, dysarrythmias, hypotension, oedema, breathlessness, breathlessness, changes in HR. What could us as nurses do to help plan the care of someone with suspected or confirmed refeeding syndrome? 1) A risk assessment to identify those at high risk of refeeding 2) Refer to trained and skilled HCPs with expert knowledge of the nutritional requirements and nutrition support 3) Follow Trust guidelines 4) Referral to a dietitian or doctor Who should determine the interventions for a patient with refeeding syndrome? A dietitian or doctor. How much nutritional intake should someone have who has had little/no nutritional intake for more than 5 days? No more than 50% of requirements for the first 2 days. What are the two routes for nutritional support? 1) Enteral nutrition 2) Parenteral nutrition What is the difference between enteral and parenteral nutrition? Enteral: using the GI tract to deliver nutrients to the body (either by tube, or oral/liquid supplement) Parenteral: delivers nutrients via a vein Name the four different tubes that could be used for enteral nutrition? 1) Gastrostomy 2) Jejunostomy 3) Nasogastric 4) Nasojejunal If a tube is made of polyurethane or silicone, how long should they be used for? 4 - 6 weeks. If a tube is made of PVC, how long do they last for? 7 - 10 days. What are the most common sizes of tubes used for feeding purposes? (in French Gauge) 6 - 8 FG. Which two of the tube types can only be inserted by specialist units? Jejunostomies and Nasojejunals. In what conditions/contexts should NG tubes NOT be inserted by nurses? 1) Maxillo-facial disorders or surgery 2) Laryngectomy 3) Oesphageal disorders or surgery 4) Coagulation abnormality 5) Any other circumstances in the Trust policy What are some important things to remember when inserting an NG tube? 1) Hand hygiene and appropriate PPE - seek information from Trust policy 2) Ensure there is working oxygen and suction at the bed space 3) NOTHING to be introduced down the tube unless gastric placement has been confirmed 4) Check the positioning of the tube according to NPSA What does the tube need to be made of in order to be able to check that it is in the right place? It needs to be made of a radio-opaque material (to be able to be seen via X-Ray). What needs to be obtained, using a syringe, as evidence for the correct placement of an NG tube? An aspirate.