Chapter 5: Nutritional Needs Flashcards by Lisa Conticello

Chronic disease related malnutrition with inflammation is also known as

Cachexia

How well did you know this?

Not at all

Perfectly

Effect of systemic inflammation on protein metabolism

-changes in protein synthesis & degradation
-loss of fat & muscle mass
-increase in acute-phase proteins (aka CRP)

How well did you know this?

Not at all

Perfectly

Effect of systemic inflammation on carbohydrate metabolism

Insulin resistance and impaired glucose tolerence

How well did you know this?

Not at all

Perfectly

Effect of systemic inflammation on lipid metabolism

maintained or increased lipid oxidation (d/t free radicals), particularly in the presence of weight loss

How well did you know this?

Not at all

Perfectly

Individuals with cancer are at risk for loss of muscle mass resulting from two conditions

Sarcopenia (age related muscle breakdown)
Cachexia

How well did you know this?

Not at all

Perfectly

These 7 cancers have found to be hypermetabolic

pancreatic
gastric
bile duct
kidney
adrenal
NSCL
H&N

How well did you know this?

Not at all

Perfectly

There is controversy amongst advanced cancers and if they may be hypermetabolic or hypometabolic. What about metastatic cancer to the liver?

Hypermtabolic

How well did you know this?

Not at all

Perfectly

These 3 cancers are considered normometabolic

breast
colorectal
bladder

How well did you know this?

Not at all

Perfectly

The Dietary Reference Intakes are developed for ___________ but cannot be used to ensure adequacy for __________

Groups
Individuals

*Use a reference point or approximation

How well did you know this?

Not at all

Perfectly

Protein needs for individual with cancer

1-1.5 g/kg

How well did you know this?

Not at all

Perfectly

Protein needs for cancer cachexia

1.5-2.5 g/kg

How well did you know this?

Not at all

Perfectly

Protein needs for hematopoietic stem cell transplant

1.5 g/kg

How well did you know this?

Not at all

Perfectly

Protein needs for healthy young adult

0.8 g/kg
ADMR: 10-35%

How well did you know this?

Not at all

Perfectly

Protein needs for healthy older adult

1.0-1.2 g/kg

How well did you know this?

Not at all

Perfectly

Protein needs for acutely ill or chronically ill older adult

1.2-1.5 g/kg

How well did you know this?

Not at all

Perfectly

Nitrogen balance can be used to assess

Adequacy of recommended protein values

How well did you know this?

Not at all

Perfectly

RDA for carbohydrates

130 g/day
ADMR: 45-65%

How well did you know this?

Not at all

Perfectly

RDA for fats

None set, but need for essential fatty acids can usually be met when linoleic & linolenic acid provide 2-4% of total intake

ADMR: 20-35%

How well did you know this?

Not at all

Perfectly

Cisplatin in a ______toxic chemotherapy

Nephrotoxic

How well did you know this?

Not at all

Perfectly

3 methods used to calculate fluid needs

Weight (Holliday-Segar)
Body surface area
RDA

How well did you know this?

Not at all

Perfectly

RDA method for calculating fluid needs

1 mL/kcal

How well did you know this?

Not at all

Perfectly

Body surface area calculation

1500 mL x BSA

How well did you know this?

Not at all

Perfectly

Weight (Holliday-Segar) method calculation

0-10 kg = 100 mL/kg
10-20 kg= 1000 mL + 50 mL for each kg over 50
>20 kg
- </= 50 years old, 1500 mL + 20 mL for each kg over 20 kg
- > 50 years old, 1500 mL + 15 mL for each over 20 kg

How well did you know this?

Not at all

Perfectly

5 conditions that increase fluid requirements

Fever
Sweating
Hyperventilation
Hyperthyroidism
Gastric or renal losses

How well did you know this?

Not at all

Perfectly

Levels of these 4 nutrients are not usually lowered in the presence of inflammation (thus low levels may = deficiency) *b strong

1. Thiamine 2. Riboflavin 3. Folate (B9) 4. Vitamin B12

Levels of these 4 nutrients are lowered during the inflammatory process

1. Selenium 2. Copper 3. Iron 4. Zinc

These are the 2 primary methods for assessing energy requirements

1. Predictive equations - predicted REE 2. Indirect calorimetry - measured REE

BEE

Basal Energy Expenditure Minimum amount of energy expended to be compatible with life

BMR

Basal Metabolic Rate measurement made early in the morning before activity & 10-12 hours after ingestion of food, beverage, or nicotine rate = measurement

RMR

Resting Metabolic Rate measurement taken when any requirement for BMI is not met, also in the fasting state (at least 5 hours); generally 10-20% higher than BMR

REE

Resting Energy Expenditure Energy needed to maintain normal body functions measured after 30 minutes of recumbent rest

EEE

Estimated Energy Expenditure Energy needed per day to maintain normal body functions *Equations

EER

Estimated Energy Requirement Average predicted nutrition intake for maintenance of energy based on age, sex, weight, height, activity level

4 physical activity levels defined by the National Academy of Medicine

Sedentary - ADLS Low active - ADLS + 30 mins moderate Active - ADLs + 60 mins moderate Very active - ADLS + 60 mins vigorous or 120 mins moderate

What is the Respiratory Quotient?

Derived from Indirect Calorimetry (metabolic cart) CO2 produced (VCO2)/Oxygen consumed (VO2)

What are inaccurate RQ values?

<0.7 or >1.0 <0.7 = hypoventillation or prolonged fasting (low slow) >1 = hyperventilation or inaccurate gas collection (high fast)

What is interpretation of RQ?

0.7 = using mostly lipids 0.8 = using mostly protein (normal) 1.0 = using mostly carbs

What is the Weir Formula?

Formula to determine REE using indirect calorimetry REE = (4VO2 + 1 VCO2) x 1.44

Cistplatin causes a decrease in the mineral

Magnesium

Critical illness causes a decrease in vitamin

C despite supplementation

Gastrectomy or terminal ileum resection causes a decrease in

Iron & vitamin B12

Pancreatitis causes a decrease in absorption of vitamin

B12

Alcoholic liver causes a decrease in these 4 nutrients

Folate, thiamine, pyridoxine, vitamin A

Renal failure causes a decrease in these 3 nutrients

pyridoxine, folate, vitamin c

Loss of bile cause a decrease in ___________________ while chyle leaks/fistulas cause a decrease in _______________

Fat soluble vitamins (ADEK) Micronutrients

This predictive equation has been shown to be the best predictive value in healthy (not critically ill) oncology patients ages 20-82, either obese or not-obese

Mifflin St Jeor (10 x kg) + (6.25 x cm) - (5 x years) + 5 for men - 161 for wome

What formula should be used for critically ill patients not appropriate for hypcaloric feedings under 60?

Pennstate 2003b

These equations are used for critically ill obese patients that ARE appropriate for hypocaloric regimens

22-25 kcal/kg IBW 11-14 kcal/kg ABW

What equation should be used for critically ill patients over 60 not appropriate for hypocaloric feedings?

Penn State 2010

Penn State 2003b Equation

RMR = (Mifflin x 0.96) + (ventilation in L/min x 31) + (max daily body temp in Celsius x167) -6212

Penn State 2010 Equation

RMR = (Mifflin x 0.71) + (ventilation in L/min x 64) + (max daily body temp in C x 85) - 3085

What 3 components do the Penn state Equations utilize

Max body temp Ventilation rate (L/min) Mifflin

Cancer, inactive, nonstressed

25-30 kcal/kg

Cancer, repletion or wt gain energy needs

30-35 kcal/kg

Cancer, hypermetabolic, stressed

35 kcal/kg

Sepsis

25-30 kcal/kg

Hematopoietic cell transplant

30-35 kcal/kg

Obese, critically ill & non-critically ill obese

11-14 kcal/kg ABW 22-25 kcal/kg IBW

What are hypocaloric feeds?

Calorie-reduced, high protein diets Often used in critically ill overweight or obese patients, which can positively affect protein anabolism, reduce HLD/hyperglycemia

Hypocaloric feeds should not exceed _____-_____% estimated energy needs Should not provide less than ______ kcal/kg Should provide at least _____ g/kg pro ABW OR _____-______ g/kg IBW

65-70% 14 kcal 1.2 g 2-2.5 g

kcal/kg for healthy older women (64-84)

25-35 kcal/kg

kcal/kg for healthy older men (64-84)

30-40 kcal/kg

During refeeding syndrome, reintroduction of CHO triggers insulin which forces K+, Phos, Mg back from the serum to the cells. Low phos usually occurs within ____ days of starting nutrition intervention

3 days

Supplementation of this vitamin may reduce risk for refeeding syndrome

Thiamine

For those at risk for refeeding syndrome, start at _____% estimated needs and advance to the target goal over _____-______ days while monitoring electrolyte imbalances

25% 3-5 days