ABCs of Nutrition PDF

11/9/2024 ABCs of Nutrition CSCD 6306 15 Nov 2024 1 Why should we be concerned about nutrition in people with dysphagia? 15/11/2024...

11/9/2024 ABCs of Nutrition CSCD 6306 15 Nov 2024 1 Why should we be concerned about nutrition in people with dysphagia? 15/11/2024 2 2 Malnutrition “A pathological condition resulting from a relative or absolute absence of one or more essential nutrients.” It leads to: - ↑ healthcare costs - Impairs health outcomes - ↑ Increases hospital stay - ↑ risk of infections - Impairs recovery (poor post op results, delayed wound healing) - ↑ mortality 15/11/2024 3 3  11/9/2024 Malnutrition develops when: Metabolic requirements exceed intake Reduced nutritional intake Increased nutrient requirement Altered ability to utilize or absorb nutrients 15/11/2024 4 4 Red flags for formal dietary consult Significant change in weight trends and hydration: Significant unintentional weight loss Suboptimal dehydration: rapid weight loss (neg fluid balance), complaint of thirst, skin changes, decreased urination, hypernatremia A dietician is consulted if desired outcomes of weight maintenance, gain, or loss are not obtained. 15/11/2024 5 5 Nutritional Support Many illnesses and complications secondary to the primary disease are associated with a reduction in nutrition and weight loss. When to consider nutritional support : once 7 days have elapsed without the patient being able to achieve a sufficient oral intake Or if the patient has been unable to take at least 60% of the estimated daily nutrient demands Appropriate and timely nutritional intervention prevents malnutrition and promotes recovery 15/11/2024 6 6  11/9/2024 Nutritional support Treating malnutrition can itself cause complications, partly depends on the route of access. 15/11/2024 7 7 Oral Feeding: Consistencies Liquids: Thin liquid Nectar-thick liquid Honey-thick liquid Solids: Puree Mechanical soft solid Regular solid 15/11/2024 8 8 IDDSI https://www.iddsi.org/ International Dysphagia Diet Standardization Initiative 15/11/2024 9 9  11/9/2024 Thickeners Natural Artificial Rice cereal Gum based Blended fruits Starch based Blended veggies Yogurt Wheat Pre-thickened formula MUST consult with the clinical dietician to determine the most appropriate thickening agent considering pt age, medical condition and all other risk factors. 15/11/2024 10 10 Non-Oral Feeding Routes Enteral Feeding: Orogastric (OG), NG (Nasogastric), Gastrostomy Tube (GT), Jejunostomy Tube (JTube), Nasoduodenal, Nasojejunal (NJ) Parenteral Feeding 15/11/2024 11 11 Contraindications of Tube Feeding (Yi, 2018) Absolute contraindication: Problems with GI function: Mechanical, e.g. paralytic or mechanical ileus Structural, e.g. intestinal obstruction or perforation Relative contraindication: Intestinal dysmotility, necrotizing enterocolitis, toxic megacolon, diffuse peritonitis, gastrointestinal bleeding, and high-output enteric fistula 15/11/2024 12 12  11/9/2024 Feeding Route Decision is based on: underlying disease structural and functional status of the GI tract the purpose and duration of EN 15/11/2024 13 13 What goes through the tube? Blenderised food Commercially prepared enteral feeds Bolus or continuous drip feeds 15/11/2024 14 14 Complications Clogging, (Accidental) tube removal: requiring reinsertion, Dispositioning, Local irritation Wound infection, contamination of formulas & delivery sets Abdominal discomfort, bloating, and cramping Nausea and vomiting due to? Regurgitation or aspiration 15/11/2024 15 15  11/9/2024 OG & Aspiration (Leder et al, 2011) Study included 8 adults & 2 peds (17-day-old, 3-month-old) OGT does not increase risk of laryngeal aspiration on VFSS An orogastric tube did not affect incidence of aspiration 15/11/2024 16 16 NGT & VFSS findings (Alnassar et al, 2011) Compared 46 children w/ & w/out NGT under videofluoroscopy NGT does not alter the findings of VFSS: sucking, incoordination, nasopharyngeal reflux, valecular & pyriform sinus pooling, penetration, aspiration and associated cough May ↑ the incidence of respiratory compromise (desaturation) when Alnassar et al, 2011 aspirating* 15/11/2024 17 17 References Alnassar, M., Oudjhane, K. & Davila, J. (2011). Nasogastric tubes and videofluoroscopic swallowing studies in children. Pediatr Radiol 41: 317–321. DOI 10.1007/s00247-010-1834-0 Pearce, C. & Duncan, H. (2001) Enteral feeding. Nasogastric, nasojejunal, percutaneous endoscopic gastrostomy, or jejunostomy: Its indications and limitations. Postgrad Med J (78) 198–-204. doi: 10.1136/pmj.78.918.198 Gallegos, C., Fuente, E., P. Clave, P., Costa, A., Assegehegn, G.(2017) Nutritional Aspects of Dysphagia Management. Advances in Food and Nutrition Research; 81, 271-318. DOI: 10.1016/bs.afnr.2016.11.008 Leder, S., Lazarus, C., Suiter, D., & Acton, L. (2011). Effect of orogastric tubes on aspiration status and recommendations for oral feeding. Otolaryngology–Head and Neck Surgery, 144 (3):372-5. DOI: 10.1177/0194599810391726. Yi, D. (2018) Enteral nutrition in pediatric patients. Pediatr Gastroenterol Hepatol Nutr, 21 (1): 12–19. DOI: 10.5223/pghn.2018.21.1.12 15/11/2024 18 18