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Additional CSO Cards > Chapter 5: Nutritional Needs > Flashcards

Chapter 5: Nutritional Needs Flashcards

1
Q

Chronic disease related malnutrition with inflammation is also known as

A

Cachexia

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2
Q

Effect of systemic inflammation on protein metabolism

A

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

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3
Q

Effect of systemic inflammation on carbohydrate metabolism

A

Insulin resistance and impaired glucose tolerence

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4
Q

Effect of systemic inflammation on lipid metabolism

A

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

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5
Q

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

A
  1. Sarcopenia (age related muscle breakdown)
  2. Cachexia
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6
Q

These 7 cancers have found to be hypermetabolic

A
  1. pancreatic
  2. gastric
  3. bile duct
  4. kidney
  5. adrenal
  6. NSCL
  7. H&N
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7
Q

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

A

Hypermtabolic

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8
Q

These 3 cancers are considered normometabolic

A
  1. breast
  2. colorectal
  3. bladder
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9
Q

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

A

Groups
Individuals

*Use a reference point or approximation

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10
Q

Protein needs for individual with cancer

A

1-1.5 g/kg

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11
Q

Protein needs for cancer cachexia

A

1.5-2.5 g/kg

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12
Q

Protein needs for hematopoietic stem cell transplant

A

1.5 g/kg

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13
Q

Protein needs for healthy young adult

A

0.8 g/kg
ADMR: 10-35%

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14
Q

Protein needs for healthy older adult

A

1.0-1.2 g/kg

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15
Q

Protein needs for acutely ill or chronically ill older adult

A

1.2-1.5 g/kg

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16
Q

Nitrogen balance can be used to assess

A

Adequacy of recommended protein values

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17
Q

RDA for carbohydrates

A

130 g/day
ADMR: 45-65%

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18
Q

RDA for fats

A

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%

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19
Q

Cisplatin in a ______toxic chemotherapy

A

Nephrotoxic

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20
Q

3 methods used to calculate fluid needs

A
  1. Weight (Holliday-Segar)
  2. Body surface area
  3. RDA
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21
Q

RDA method for calculating fluid needs

A

1 mL/kcal

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22
Q

Body surface area calculation

A

1500 mL x BSA

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23
Q

Weight (Holliday-Segar) method calculation

A

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

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24
Q

5 conditions that increase fluid requirements

A
  1. Fever
  2. Sweating
  3. Hyperventilation
  4. Hyperthyroidism
  5. Gastric or renal losses
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25
Q

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

*b strong

A
  1. Thiamine
  2. Riboflavin
  3. Folate (B9)
  4. Vitamin B12
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26
Q

Levels of these 4 nutrients are lowered during the inflammatory process

A
  1. Selenium
  2. Copper
  3. Iron
  4. Zinc
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27
Q

These are the 2 primary methods for assessing energy requirements

A
  1. Predictive equations - predicted REE
  2. Indirect calorimetry - measured REE
28
Q

BEE

A

Basal Energy Expenditure

Minimum amount of energy expended to be compatible with life

29
Q

BMR

A

Basal Metabolic Rate

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

rate = measurement

30
Q

RMR

A

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

31
Q

REE

A

Resting Energy Expenditure

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

32
Q

EEE

A

Estimated Energy Expenditure

Energy needed per day to maintain normal body functions

*Equations

33
Q

EER

A

Estimated Energy Requirement

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

34
Q

4 physical activity levels defined by the National Academy of Medicine

A

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

35
Q

What is the Respiratory Quotient?

A

Derived from Indirect Calorimetry (metabolic cart)

CO2 produced (VCO2)/Oxygen consumed (VO2)

36
Q

What are inaccurate RQ values?

A

<0.7 or >1.0

<0.7 = hypoventillation or prolonged fasting
(low slow)

> 1 = hyperventilation or inaccurate gas collection
(high fast)

37
Q

What is interpretation of RQ?

A

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

38
Q

What is the Weir Formula?

A

Formula to determine REE using indirect calorimetry

REE = (4VO2 + 1 VCO2) x 1.44

39
Q

Cistplatin causes a decrease in the mineral

A

Magnesium

40
Q

Critical illness causes a decrease in vitamin

A

C despite supplementation

41
Q

Gastrectomy or terminal ileum resection causes a decrease in

A

Iron & vitamin B12

42
Q

Pancreatitis causes a decrease in absorption of vitamin

A

B12

43
Q

Alcoholic liver causes a decrease in these 4 nutrients

A

Folate, thiamine, pyridoxine, vitamin A

44
Q

Renal failure causes a decrease in these 3 nutrients

A

pyridoxine, folate, vitamin c

45
Q

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

A

Fat soluble vitamins (ADEK)
Micronutrients

46
Q

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

A

Mifflin St Jeor

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

47
Q

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

A

Pennstate 2003b

48
Q

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

A

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

49
Q

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

A

Penn State 2010

50
Q

Penn State 2003b Equation

A

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

51
Q

Penn State 2010 Equation

A

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

52
Q

What 3 components do the Penn state Equations utilize

A

Max body temp
Ventilation rate (L/min)
Mifflin

53
Q

Cancer, inactive, nonstressed

A

25-30 kcal/kg

54
Q

Cancer, repletion or wt gain energy needs

A

30-35 kcal/kg

55
Q

Cancer, hypermetabolic, stressed

A

35 kcal/kg

56
Q

Sepsis

A

25-30 kcal/kg

57
Q

Hematopoietic cell transplant

A

30-35 kcal/kg

58
Q

Obese, critically ill & non-critically ill obese

A

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

59
Q

What are hypocaloric feeds?

A

Calorie-reduced, high protein diets

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

60
Q

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

A

65-70%

14 kcal

1.2 g

2-2.5 g

61
Q

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

A

25-35 kcal/kg

62
Q

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

A

30-40 kcal/kg

63
Q

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

A

3 days

64
Q

Supplementation of this vitamin may reduce risk for refeeding syndrome

A

Thiamine

65
Q

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

A

25%

3-5 days

Additional CSO Cards (26 decks)

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