3- nutrition Flashcards
tube feeds uses
for any patient requiring to be NPO for 1-2 wk, consider tube feeding to maintain the integrity of the intestines and bacteria and an easier transition back to oral feeding
tube feeds contraindications
bowel obstruction, bowel perforation, bowel ischemia, pancreatitis, and sometimes perioperative bowel; for delayed gastric emptying,
Indirect calorimetry
process that calculates heat that the patient produces by measuring either the production of carbon dioxide and nitrogen waste or from the consumption of oxygen; calculates the REE
Resting energy expenditure (REE)
energy used at rest; correlates with lean body mass; accounts for 75-95% of TEE;
basal energy expenditure (BEE)
similar but more restrictive
66.5 + [13.8 x kg] + [5 x cm] – [6.8 – yr] x stress factor
Respiratory quotient (RQ)
ratio of CO2 eliminated (VCO2) over O2 consumed (VO2); used in calorimetry since it correlates with the metabolism of food and can be used to determine which substance is being utilized
RQ for carbs, proteins, fats
carbs have an RQ of 1.0,
protein 0.8,
fat 0.7;
what can increase RQ
hyperventilation (↑ CO2 elimination), metabolic acidosis (buffering acid generates CO2 → ↑ CO2 elimination), overfeeding (↑ lipogenesis
What enteral formula and goal rate would you order and why?
Unless fluid restricted or with malabsorption, use 1 kcal/ml in isotonic, polymeric, lactrose-free solution; usually have 12-20% kcal protein, 45-60% kcal carbs, 30-40% kcal fat
Protein needs increase in which state and decrease in what state to prevent uremia and encephalopathy
inc- anabolic states
dec- renal and hepatic failure
- 6 -0.8 g = renal failure and not on dialysis
- 8 g = healthy individual
- 0-1.2 = g fever, infection
- 3-1.5 = g wound healing, trauma, surgery, repletion
If you need more protein without exceeding calories, what should you do
decrease feeding volume and add supplemental powder
Explain why the patient’s PCO2 decreased with the change in the enteral formula and goal rate.
CO2 production declines as energy intake more closely matches the patient’s ability to utilize calories and avoid lipogenesis
High gastric residuals are most common in
diabetics and head trauma;
associated with regurgitation and thus aspiration in patients unable to protect their airway
high gastric residual goal
should be less than hourly goal rate (150 ml if goal rate is 75 ml/hr)
treatment for high gastric residual
continuous infusion rather than boluses; elevate head of bed to 30-45 degrees during feeding and after for 1 hr; use isotonic formula
place jejunal tube if unsuccessful
How would you reassess the patient’s nutritional status during hospitalization course?
Repeat indirect calorimetry for present REE and RQ, reassess stress factors;
prealbumin (half life 1-2 days) is better than albumin (halflife 21 days);
24 hr urine nitrogen collection for nitrogen balance study
Parentral nutrition is indicated in
in hemodynamic instability, significant arrhythmias, significant abdominal distention, and ischemic bowel
describe pertinent nutritional support monitoring parameters
Monitor for fluid overload, ↑ or ↓ BP, electrolyte imbalance, glucose, triglycerides, LFTs, H/H, strength and activity
refeeding syn
– starvation is associated with muscle wasting and ↓ Phos; with refeeding, insulin isreleased causing uptake of glucose, phos, water and other components into ells and stimulates anabolic protein synthesis; this causes further ↓ in Phos and may cause cardiac, respiratory, and neuromuscular dysfunction; K and Mag are also driven into cells causing low serum levels; together this can cause arrhythmias and death; monitor for hyperglycemia and hypokalemic metabolic alkalosis
Describe how to transition TPN patient to enteral support
Give less than full salt, fluid, and caloric need and advance slowly; increase feeding while slowly decreasing TPN
Patient may have difficulty swallowing from intubation; may need to place an NG; do not place hyperosmolar solutions such as medications in tube feeding
refeeding syn
– starvation is associated with muscle wasting and ↓ Phos; with refeeding, insulin isreleased causing uptake of glucose, phos, water and other components into ells and stimulates anabolic protein synthesis; this causes further ↓ in Phos and may cause cardiac, respiratory, and neuromuscular dysfunction; K and Mag are also driven into cells causing low serum levels; together this can cause arrhythmias and death; monitor for hyperglycemia and hypokalemic metabolic alkalosis
Describe how to transition this patient to enteral support when it is appropriate.
Give less than full salt, fluid, and caloric need and advance slowly; increase feeding while slowly decreasing TPN
Patient may have difficulty swallowing from intubation; may need to place an NG; do not place hyperosmolar solutions such as medications in tube feeding
What are some of the other complications that this patient can have because of her shortened bowel and what is basic mechanism?
PUD- incr. hormones to inc gastric acid
Gallstones- dec. reabsorption of bile acids in ileum
Kidney stones- Ca bound to unabsorbed fatty acids–> oxalate»calcium
drunken state syn.
Drunken state syndrome
unabsorbed carbs ferment in colon
→ d-lactate is produced and absorbed
→ slurred speech, ataxia, altered affect;
treat with lower carb diet
