Considerations in Nutrition Support of the Older Adult Flashcards
Vitamin D (25, hydroxyvitamin D) deficiency can manifest as
muscle weakness
Older adults are more at risk for vitamin D deficiency since they are more likely to stay indoors, have reduced ability to synthesize vitamin D in the skin when exposed to sunlight, use sunscreens and may have inadequate vitamin D intake. There are vitamin D receptors (VDRs) throughout the body including the parathyroid glands, muscle tissue, cardiovascular system and kidneys. Without vitamin D binding to VDRs, parathyroid hormone excretion is reduced resulting in increased production of PTH; stimulation of muscle fibers is decreased causing muscle weakness; renin activity is increased resulting in hypertension; and there is a potential for hyperlipidemia given the need for vitamin D in lipid cell membranes formation. In Vitamin D deficiency PTH production is increased.
Which of the following best describes the use of artificial nutrition and hydration (ANH) in terminally ill patients?
those who forego AHN have fewer side effects
A common fallacy in terminally ill patients is that dehydration is thought to be an uncomfortable state. In fact, at the end of life, patients often experience a decrease in hunger and thirst drive. The analgesic theory proposes that starvation boosts the production of ketones, thereby having an anesthetic effect. Aggressive artificial nutrition and hydration (ANH) can be more harmful and can produce life-threatening symptoms including edema, ascites, nausea, vomiting, and pulmonary congestion. Numerous studies report that patients who are dying have electrolyte values that run in the normal range.
A 70-kg adult patient receiving PN providing 3000 kcal/day presents with mild to moderate elevations of serum aminotransferases and mild elevations of bilirubin and serum alkaline phosphatase. This patient is most likely exhibiting what type of PN-associated liver disease (PNALD)?
hepatic steatosis
There are 3 basic types of hepatobiliary disorders associated with PN: steatosis, cholestasis, and gallbladder sludging (stones). Hepatic steatosis generally occurs in adults and presents with mild elevations in aminotransferases, serum alkaline phosphatase, and bilirubin concentrations. This particular type of hepatobiliary disorder is most often a complication of overfeeding. Cholestasis, occurring primarily in children, is characterized by impaired biliary secretion. Elevated conjugated bilirubin levels are the most common laboratory manifestation in this population. Finally, gallbladder sludging or stones is thought to result from the lack of enteral stimulation in the GI tract and occurs with long-term PN use. In this question, this adult patient is receiving an inappropriately high amount of calories (overfeeding) and has the accompanying lab values consistent with hepatic steatosis.
What type of sodium/fluid imbalance is primarily associated with hyperglycemia in a patient receiving PN?
Hypertonic hyponatremia, also referred to as pseudohyponatremia is caused by the presence of osmotically active substances other than sodium in the extracellular cellular fluid (ECF), which cause water to move from the intracellular fluid (ICF) to the ECF in order to equilibrate osmolality. This movement will cause sodium dilution in the ECF, leading to hyponatremia. Common causes of hypertonic hyponatremia include hyperglycemia and infusion of hypertonic fluids (with little or no sodium) or medications (e.g. mannitol). For each 100 mg/dL increase in blood glucose above 100 mg/dL, serum sodium is expected to fall by 1.6 mEq/L.
