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Gastrointestinal, Liver and Nutritional Alterations 531

Research vignette, Continued
excessive and the ideal frequency of checking GRV have not been and risk of contamination but exposes staff to splash injury; these
established. Similarly, whether to return or discard gastric aspirate events were not measured. While this study provides some infor-
is controversial. The argument to support return of aspirates to mation about GED, high quality research is needed to answer some
maintain electrolyte and fluid balance was not shown in this study. of these difficult questions. There is not enough evidence from this
Discarding aspirates minimises handling of feed delivery systems study to guide or change practice.

Learning activities
1. How do changes to the gastrointestinal system in critical illness these strategies over other pharmacological agents to prevent
influence your patient’s ability to achieve their energy–protein the development of stress-related mucosal disease.
goals? 6. Consider why acute liver dysfunction/failure causes serious
2. With reference to the case study, what factors may contribute systemic sequelae, such as coagulopathy and hepatic enceph-
to malnutrition and how might you address these in your clini- alopathy, and why liver function can be restored following the
cal practice? insult.
3. After reviewing the case study, what interruptions to enteral 7. Identify the current practice for glycaemia control in the unit
feeding were necessary and what could have been avoided? you work in or have access to. If tight glycaemia control is used,
What impact might repeated interruptions have on patient identify the practices that have been instituted to minimise the
outcomes? incidence and severity of hypoglycaemia. If tight glycaemia
4. Review your patients’ notes and calculate what their total daily control is not used, identify what protocol is used and what BSL
caloric intake should be. Once you have obtained this figure, threshold is used. Describe the rationale that supports the
compare the prescribed intake to the actual intake. If patients practice you identify.
have not received their total daily caloric intake, consider what 8. Compare and contrast the physiological changes that occur in
factors may have contributed to this and how these might be DKA and HHNS. How do these differences influence the man-
overcome in future. agement strategy for restoring normoglycaemia?
5. Identify what types of stress ulcer prophylaxis are used in your
clinical area. Discuss with your colleagues the advantage of

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