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Medical Nutrition Therapy > Exam 1 > Flashcards

Exam 1 Flashcards

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USMLE® Step 1 flashcards
1
Q

Nutrition Support

A

Delivery of formulated enteral or parenteral nutrients to maintain or restore nutritional status.

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2
Q

Enteral nutrition

A

Provision of nutrients into the GIT through a tube or catheter when oral intake is inadequate. (may include formulas as oral supplements or meal replacements)

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3
Q

Parenteral nutrition

A

Provision of nutrients intravenously

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4
Q

Enteral Rationale and Criteria

A

Enteral nutrition: functional GIT, for those who can’t eat or can’t eat enough, and should be first consideration

Parenteral nutrition: Insufficient GIT function

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5
Q

Proposed Benefits of Enteral Versus Parenteral Nutrition

A
  • Better GI barrier function
  • Preserved GI immunity
  • Attenuate catabolic response
  • Better blood glucose control
  • Decreased rates of infection
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6
Q

Conditions That Often Require Enteral Nutrition

A

Impaired nutrient ingestion: Neurologic disorders, facial trauma, oral or esophageal trauma, congenital anomalies, respiratory failure, cystic fibrosis, GI tract surgery (e.g., esophagectomy)

Inability to consume adequate nutrition orally: Hypermetabolic states such as trauma and burns; cancer

Impaired digestion, absorption, metabolism: Severe gastroparesis, inborn errors of metabolism, Crohn disease, ulcerative colitis

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7
Q

Conditions That Often Require Parenteral Nutrition

A

GI incompetence:
-Short bowel syndrome, severe acute pancreatitis, severe IBD, small bowel ischemia, intestinal atresia, severe liver failure

Critical illness with poor enteral tolerance or accessibility: -Multiorgan system failure, bone marrow transplantation, severe wasting in renal failure with dialysis, small bowel transplantation

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8
Q

Determining EN Access

A
  • Anticipated length of time of enteral feeding
  • Risk for aspiration or tube displacement
  • Clinical status
  • Presence or absence of normal digestion and absorption
  • Planned surgical intervention
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9
Q

Nasogastric route

A
  • Short term: Up to 3 or 4 weeks
  • Normal GI function
  • Bolus, intermittent, or continuous infusions
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10
Q

Nasoduodenal or nasojejunal route

A
  • Short term: Up to 3 or 4 weeks

* Gastric motility disorders, esophageal reflux, or persistent nausea and vomiting

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11
Q

Percutaneous endoscopic gastrostomy or jejunostomy

A

Percutaneous endoscopic gastrostomy or jejunostomy

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12
Q

Other minimally invasive techniques

A

Laparoscopic or fluoroscopic techniques

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13
Q

Surgically placed enterostomies

A

Gastrostomies and jejunostomies

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14
Q

Multiple lumen tubes

A

Prolonged GI decompression and small bowel feeding

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15
Q

Types of Enteral Formulas

A

Health care facilities develop a formulary of products to meet the needs of their patients/residents

Modular - isolated nutrient supplement 
Blenderized - real food blend
Specialty - ex. keto diet 
Elemental - AA based 
Semi-elemental - pre-digested peptide bond based 
Standard - body breaks it down
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16
Q

Choosing an Enteral Formula

A
  • Nutrient requirements
  • Clinical status and GIT function
  • Caloric and protein density
  • Form and amount of protein, fat, CHO, and fiber in the formula
  • Electrolyte content
  • Cost-effectiveness
  • Patient compliance
17
Q

Standard Polymeric Formulas

A
  • Lactose-free
  • 1 kcal/mL
  • Balanced CHO, fat, and protein
  • Meet AMDR
  • Concentrated standard formulas: 1.5 to 2 kcal/ml for fluid restriction
18
Q

Home Blenderized Formulas

A

ADVANTAGES: Health benefits of using whole foods, Cost effectiveness, Tailor formula to meet individual needs, Social bond with caregiver

DISADVANTAGES: Short hang time, Cannot use with jejunal feedings, Avoid in patients with multiple allergies, immunosuppression, fluid restrictions, Requires large bore feeding tube

19
Q

Enteral Formula Composition: Protein

A
  • Intact protein, di- and tri-peptides, amino acids and/or crystalline amino acids
  • Special amino acids: Branched-chain amino acids, arginine, taurine
  • Content varies from 6% to 37% of total kcal
20
Q

Enteral Formula Composition: Carbohydrate

A
  • Content varies from 30% to 85% of total kcal
  • Lactose-free
  • Fiber
  • FODMAPs
21
Q

Enteral Formula Composition: Lipid

A
  • Content varies from 1.5% to 55% of total kcal
  • 2% to 4% of fat is linoleic acid to prevent essential fatty acid deficiency (EFAD)
  • Standard formula provides 15% to 30% kcal from fat
22
Q

Enteral Formula Composition: Micronutrients

A

DRIs for 25 vitamins and minerals typically met with varying intake levels
•1000mL for children
•1500mL for over 12 years

23
Q

Enteral Formula Composition: Fluid

A
  • 1 kcal/ml formulas are about 85% water
  • 2 kcal/ml formulas are about 70% water
  • Provide 30 to 35 ml/kg of body weight unless fluid restricted
24
Q

Enteral Administration

A

Closed vs. open system
Bolus: 500mL, 5-20min, 3-4x
Intermittent/cyclic: 100-150mL, 20-60 min, several x
Continuous

25
Q

Complications of Enteral Feeding

A
  • Access problems (e.g., tube displacement or obstruction, leakage)
  • Administration problems (e.g., aspiration, regurgitation, microbial contamination)
  • GI complications (e.g., nausea, vomiting, delayed gastric emptying, high gastric residuals, constipation, diarrhea, malabsorption)
  • Metabolic complications (e.g., refeeding syndrome, glucose intolerance, dehydration or overhydration)
26
Q

Monitoring Enteral Nutrition

A
  • Abdominal distension and discomfort
  • Tube placement
  • Fluid intake and output
  • Gastric residuals if appropriate
  • Signs and symptoms of edema or dehydration
  • Stool output and consistency
  • Weight
  • Adequacy of enteral intake
  • Serum glucose, calcium, electrolytes, blood urea nitrogen, creatinine
27
Q

Oral Supplements

A
  • Used to augment intake of solid foods
  • Commonly provide 250 to 360 kcal/8 ounces
  • Variety of flavors, consistency and nutrients
  • Sweeter taste with more simple CHO
  • Unpalatable with hydrolyzed protein
  • Taste fatigue
  • Modular supplements
28
Q

Central parenteral nutrition (CPN):

A

catheter tip placed in large, high-blood-flow vein

29
Q

Peripheral parenteral nutrition (PPN):

A

catheter tip placed in small vein, typically the arm

30
Q

Routes of Parenteral nutrition

A

Peripheral access
•Up to 800 to 900 mOsm/kg
•Principal complication is thrombophlebitis

Short-term central access.
•Direct puncture of subclavian or jugular veins

Long-term central access
•Peripherally inserted central catheter (PICC)
•Tunneled catheter

31
Q

Parenteral Protein

A

All essential amino acids; some nonessential

Concentration between 3% and 20% by volume

4 kcal/g

Provides15% to 20% of total kcal

32
Q

Parenteral CHO

A

Dextrose monohydrate

Concentration between 5% to 70% by volume

3.4 kcal/g

Maximum rate should not exceed 5 to 6 mg/kg/min

33
Q

Parenteral Lipid Emulsions

A

10%, (1.1 kcal/ml) and 20% (2 kcal/ml)

Provide 20% to 30% total kcal as lipid
•Provide about 1 gm/kg
•Do not exceed 2 gm lipid/kg per day
•Stop if triglycerides >400 mg/dl

Soybean oil with egg yolk phospholipid used as emulsifierProvides essential fatty acids

Proinflammatory

34
Q

Alternative lipid

A
  • Lipid emulsion made of soybean oil, olive oil, fish oil, MCT
  • Fish oil emulsion
  • Fish oil an MCT reduce inflammation and produce less immunosuppression
35
Q

Compounding Methods

A

2-in-1: All nutrients in one bag except fat emulsion, which is infused separately

3-in-1:Total nutrient admixture or three-in-one solution contains lipid, amino acids, and glucose.

36
Q

Parenteral Administration

A

Continuous infusion

  • Increase incrementally over 2 or 3 days to reach goal rate
  • Avoid abrupt cessation to prevent rebound hypoglycemia

Cyclic infusion

  • 8 to 12 hours per day, usually at night
  • Higher rate or more concentrated solution
  • Contraindicated with uncontrolled hyperglycemia and fluid intolerance
37
Q

Parenteral Complications

A
  • Mechanical
  • Infection or sepsis
  • Metabolic
  • GI
38
Q

Refeeding Syndrome

A

Caused by overly aggressive parenteral nutrition, specifically carbohydrate

Potentially lethal

Cardiac and pulmonary complications from fluid overload

Monitor serum magnesium, potassium, and phosphorus

Start with 25% to 50% of goal parenteral nutrition in those at risk

39
Q

Transitional Feeding

A

Parenteral to enteral

  • Takes 2 to 3 days
  • Stop parenteral when enteral reaches 75%

Parenteral to oral
-Stop parenteral when oral consistently provides 75% of needs

Enteral to oral
-Cycle enteral at night to reestablish hunger and satiety cues

Medical Nutrition Therapy (1 decks)

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