Ch 22: Neurologic Impairment Flashcards
What are protein requirements for patients with a stroke?
Protein requirements should be determined by assessing patient’s pre-stoke nutrition status and renal/liver function immediately following stroke; recommended goals rate from 1.0-1.5 kg/kg/d
SCI patients have an elevated risk of what?
Obesity; • A modified BMI scale has been proposed for individuals with SCI, with normal weight being 18-22, overweight as 22-25, and obese as BMI > 25
What are the general energy recommendations for weight maintenance in quadriplegic patients?
20-22 kcal/kg/day or 55-90% of energy goal estimated by HBE.
What electrolyte disturbance is common in TBI?
Hyponatremia (Na < 135 mEq/L). Fluid restriction in the primary method of treatment; however, use caution in acute phase of neuro insult b/c volume restriction may be inappropriate; treatment using demeclocycline, sodium supplementation, or vasopressin antagonists should only be used in refractory cases
SCI patients often have ____ energy requirements when compared to patient’s with a TBI
Lower–SCI patients may have 48% lower energy need compared to patients with TBI; extent of injury seems to affect energy need in patients with SCI; measure REE is lower in patients with higher and more complete SCI
How should protein needs be calculated for patients with ALS?
0.8-1.2 g/kg/d
What are the protein requirements for a patient with a TBI?
1.3-2.5 g/kg/d
Which micronutrient deficiencies are common in patients with neurologic injury?
folic acid, zinc, selenium, vit D
What are the general energy energy recommendations for weight maintenance in paraplegic patients?
22-24 kcal/kg/d
How should energy needs be calculated for patients with ALS?
Energy needs should be adjusted to 130% of what HBE calculates; pt’s wit ALS may require 34-35 kcal/kg/day
How should protein/energy be estimated for a SCI patient with a wound?
30-35 kcal/kg and 1.25-1.5 g/kg/day (NPUAP guidelines). Also provide enough fluid, and vit/mineral supp is poor intake or deficiencies suspected
What factor is associated with reduced mortality in patients with a TBI?
Provision of early nutrition (with 24-72 hours of injury) is associated w/ trend towards reduced mortality– given poor outcomes associated w/ delayed nutrition in TBI, a low threshold for using PN if patient does not tolerate EN is advised
How should energy needs be estimated for a patient with a TBI?
When available, IC is recommended; otherwise, use 140% of what the HBE predicts
In TBI, which medications are associated with a reductions in energy expenditure?
Neuromuscular blocking agents, non-selective beta blockers, morphine, and barbiturates
What are the protein requirements for patients with a SCI?
Comparable to healthy individuals, 0.8-1.0 g per kg IBW per day
The acute phase of TBI can be categorized as what?
Hypermetabolic, catabolic–it is proportion to severity of injury
What are protein needs for SCI patients immediately after injury?
1.5-2 g/kg/d
What is the “gold standard” to diagnose oropharyngeal dysphagia
Modified Barium Swallow Study
How should energy needs be estimated for patient with ischemic stroke?
HBE or PSE seems to provide energy prediction closest to actual energy expenditure as measured by IC in ischemic stroke
What ratio of fat to CHO and protein is recommended to decrease frequency of seizures in ketogenic diet?
4:1
Valproic acid has been shown to induce a deficiency in which nutrient?
Carnitine
