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Nutrition Diagnosis and Related Care > Exam 1 > Flashcards

Exam 1 Flashcards

Nutrition ADIME, NFPE/malnutrition, CVD, Elderly, Enteral/Parenteral Nutrition

1
Q

What is Malnutrition?

A

Over or undernutrition with or without inflammation, that causes changes in body composition or functionality

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2
Q

Method for Diagnosising Malnutrition

GLIM Criteria

Phenotypic Criteria

A
  • Unintentional weight loss of >5% with 6 months or 10% in 6+ months
  • BMI <20 if older than 70 or <22 if >70
  • Reduced Muscle mass according to NFPE
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3
Q

Method for Diagnosising Malnutrition

GLIM Criteria

Etiologic Criteria

A
  • Reduced food intake of <50% for 1-2 weeks or any reduction for >2 weeks
    OR
  • Any chronic GI condition that affects consumption/absorption
  • Presence of acute or chronic disease
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4
Q

Criteria for Diagnosising Malnutrition

GLIM Severity Requirements

Stage 1

A
  • Unintentional weight loss of 5-10% in 6 months OR 10-20% in >6 months
  • BMI of <20 if younger than 70 OR BMI of <22 if 70+
  • Mild to moderate muscle loss

Moderate Mulnutrition

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5
Q

Criteria for Diagnosis Malnutrition

GLIM Severity Requirements

Stage 2

A
  • Unintentional weight loss of >10% in 6 months OR >20% in 6+ months
  • BMI of 18.5 if <70 OR <20 if 70+
  • Severe muscle loss

Severe Malnutrition

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6
Q

Cachexia

Wasting Syndrome

A

condition that causes significant weight/muscle loss

Affects individuals with chronic diseases

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7
Q

Nutrition Specific

Evidence of Inflammation

A
  • Looking for GI illness that would cause inflammation
  • Evidenced by cytokine-mediated response, loss of muscle and diminshed function, elevated energy expenditure, APP chances

IBD, cancer, intestinal inflammation

APP = Acute Phase Protein

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8
Q

Criteria for Diagnosising Malnutrition

AND/ASPEN Criteria

Three Types

A
  • Starvation Related: due to chronic starvation
  • Chronic Disease Related: inflammation is chronic and mild-moderate
  • Acute Illness Related: inflammation is acute and severe

Chronic: >1 month
Acute: < 1 month

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9
Q

Criteria for Diagnosis Malnutrition

AND/ASPEN Criteria

Moderate Acute Disease Related Criteria

A
  • Unintedned weight loss of 6% in 3 months
  • <60% of estimated intake for 1 month
  • NPO for 5+ days

Typically related to GI function alteration

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10
Q

What is the goal for nutrition interventions in geriatric patients?

A

Maintain weight and functionality

Goal is not to lose weight!!

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11
Q

What are the parameters of a healthy Geriatric patient?

MyPyramid for Older Adults

A
  1. Physical Activity
  2. Hydration
  3. Diet
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12
Q

Parameters to Assess in Geriatric Patients

A
  • Wt. loss overtime, insufficient energy intake
  • Muscle/fat wasting, fluid status, edema
  • Functional Status
  • Swallowing Difficulties/altered GI function
  • Dental Health (dentures, missing teeth, etc.)
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13
Q

Why does weight loss have a bigger effect on Geriatric Patients?

A
  • Have less stores
  • Harder to gain weight back
  • Wt. loss typically = muscle loss –> functionality loss
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14
Q

Determining Caloric Intake in Geriatric Population

What needs to be considered when determining caloric intake?

A
  • Adequate range but also, is it possible for patient to consume that much food.

Is it possible for a 90 year old, 95lb lady to consume 1700kcals/day?

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15
Q

Geriatric Population

Recommended Protein Goals

A

1-1.25g of Protein/kg

25-30g per meal

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15
Q

Geriatric Population

Dehydration

Causes, Effects, Recommendations

A
  • Decreased thirst sensation
  • Causes confusion, dark urine, decreased skin turgor, UTIs, etc.
  • Goal: 30mL/kg

Confusion can be a major indicator of dehydration

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15
Q

Geriatric Population

Vitamin D Requirements

A

600-1000 IU/day

The more sun exposure, the less needed and vice versa

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15
Q

Geriatric Population

Constipation

Causes, Recommendations

A
  • Lack of a BM for 3 days
  • Bowel motility decreases with age
  • > 25g/day of fiber

Fluid intake will need to be increased with fiber increase

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16
Q

Geriatric Population

Swallowing Problems

Recommendations

A
  • Consult SLP as soon as possible
  • Try to get patient on LEAST restrictive diet, that is still safe
  • Include food and drinks that are nutrient dense
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16
Q

Total Parenteral Nutrition (TPN)

What is it? Why is it used?

A
  • Use of veins to provide nutrition to Patient
  • Used when GI tract has obstruction, pt has severe malabsorptive conditons, PO intake is not tolerated
  • Excessive output of Fistula
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17
Q

What is a fistula?

A

Abnormal opening connecting one organ to another or to an outer area
* Caused by postop complications, IBD, infections, trauma, cancer/tumours, etc

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18
Q

TPN Central Lines

What are they? How do they work?

A
  • Tube placed in femoral, subclavian, or internal jugular vein
  • Delivered nutrients directly to heart = directly into bloodstream to bypass GI tract
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19
Q

TPN

Benefits of a Central Line

A

More reliable, allows for higher solution concentration, can be used for months-years

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20
Q

PICC Lines

Peripheral Inserted Central Catheter

A

Placed in arm vein and threaded up to the heart to supply nutrients directly into blood
* Used when TPN is provided for >1 month

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21
# PPN Peripheral Lines | How are they used? What to know about them.
Placed in arm veins, like an IV * Can only be used for a short amount of time <7 days * Solutions can be concentrated up to 900 mOsm/L, if higher, it will caused vein rupture or irritation | Supplies nutrition until oral diet is fixed or central line is placed
22
# TPN Macronutrients Dextrose
* main source of carbohydrates in TPN solutions * Provides 3.4kcal/g * Provides 50-70% of total kcals * Start with 5-6g/kg/day OR 100-200g/day to minimize refeeding risk
23
# TPN Macronutrients Amino Acids
* Provides 4kcal/g * High AA concentration sent directly into the bloodstream can raise lab levels, does not indicated kidney failure
24
# TPN Macronutrients What does a 2 in 1 solution mean?
Lipids are not infused
25
# TPN Macronutrients What does a 3 in 1 Solution mean?
Lipids are infused into solution
26
Refeeding Syndrome | What causes it?
* Caused by major electrolyte and fluid shifts during initial stages of nutrient replenishing * Pts who have lost 70% of IBW or have rapidly lost weight are at higher risk, even if they have a normal BMI
27
# Refeeding Syndrome Biochemical Cause
Glucose induced hypophosphatemia, hypokalemia, hypomagnesemia * Phosphate is depleted during starvation, when glucose is reintroduced, insulin is released * The release of insulin causes a higher reuptake of already depleted phosphate, it also makes ATP, which requires more phosphate
28
# Refeeding Syndrome Effects of Hypophosphatemia
Causes hypoxia, myocardial dysfunction, respiratory failure, seizures | Hypoxia: lack of oxygen in body
29
How to reintroduce nutrition in to patients without causing refeeding?
* Provide half the energy requirements * 15kcal/kg/day on day one * Managing and slowly increasing dextrose is most crucial (2mg/kg/min OR 1-2g/kg) | Provide full energy needs in next 3-5 days
30
# CVD Risk Factors to Consider
* Family Hx * Age (65+) * Sex (male) * Obesity, physical activity, DM, HTN * Smoking * Dyslipidemia * Obstructive Sleep apnea | Women are more susceptible when they hit menopause
31
# CVD CAGE Questions | Foods to consider during diet recall
Cheese Animal Fats Got it away from home Eating high fat commercial products
32
# CVD Fiber Goals | Total Fiber and Soluble
25-30g total fiber/daily 6-8g soluble fiber/daily | Soluble Fiber = ~25% total fiber
33
# CVD Stanol and Sterol Ester Containing Foods | What are they? Significance?
* naturally occuring compounds in plants that are similar to cholesterol * Plant sterols containing food can decrease LDL levels by 15% * Sources: wheat germ, sesame seeds, pistachios | Recommend 2g/day
34
# CVD Desirable Lipid Profile | Total Cholesterol, LDL, HDL, Triglycerides
* Cholesterol <200 * LDL <100 * HDL >60 * TG <150
35
Soluble Fiber
* Dissolves in water, forms a gel, slow digestion * Helps with constipation AND diarrhea * Helps control blood sugar, decreases cholesterol levels, decreases heart disease risk * Sources: oats, beans, gums, beta glucan, pectin, resistant carbs
36
# CVD Insoluble Fiber
* Speeds up passage of food through stomach, adds bulk to stool * Helps with constipation * Sources: wheat bran, vegetables, whole grains
37
# Soluble Fiber Sources Beta Glucan
* Polysaccharide, soluble fiber found in cell walls * Prevents body from absorbing cholesterol
38
# Soluble Fiber Sources Pectin
* Polysaccharide found in fruit * Function: thickens
39
# Soluble Fiber Sources Resistant Starches
* Pass through small intestine undigested, into L. Intestine, is fermented there * Helps reduce inflammation
40
Why is the use of enteral nutrition preferred?
Most physiologic, safest, and cost effective method
41
# Enteral Nutrition Indications for using Enteral Nutrition
* Patients who can't eat * Patients who won't eat * Patients who can't eat ENOUGH * Other types of patients | Other: ventilated, paralyzed, sedated
42
# Enteral Nutrition When is Enteral Nutrition not recommened?
* Intestinal Obstructions * Intractable vomiting * Ileus * Severe diarrhea * High-output enterocutaneous fistula | Illeus: intestine not working; causes disruption in movement of food
43
Why use Enteral Nutrition?
* Provides adequate nutrition for healing/stress * Maintain gut integrity * Prevents bacterial translocation * Better substrate utilization * Fewer mechanical complications * More cost effective | Substrate: nutrients
44
# Types of Enteral Products Oral Supplements
* Use when oral intake is inadequate from "usual" diet * Use as supplement, not replacement * Taste is an important factor
45
# Types of Enteral Products Standard Formula | Fibersource HN, Isosource HN ## Footnote Products at NebMed
* Normal, complete TF * Used for a variety of medical surgical conditions
46
# Types of Enteral Products Standard, High Protein | Peptamen Intense VHP ## Footnote Supplement at NebMed
* Use for pts in hypercatabolic state * For pts with proporitionally higher PRO needs, compared to kcals (ex. surgery recovery, infection, obese) | Hypercatabolic: body breaking down tissue/substances at higher rate
47
# Types of Enteral Products High Caloric Density | Isosource 1.5, Nutren 1.5/2.0 ## Footnote Supplements at NebMed
* Used for pts on fluid restricition or in a hypermetabolic state * Ex. cystic fibrosis, burn pts
48
# Types of Enteral Products Elemental and *Semi-Elemental | Vivonex TEN, *Peptamen ## Footnote Supplements at NebMed
* Used in pts with reduced digestive or absorptive capacity
49
# Types of Enteral Products Disease Specific - Renal/Hepatic | Novasource Renal 2.0 ## Footnote Supplement at NebMed
* Lower in K+, Na, P * Used for organ failure patients and comprised organ function pts
50
# Types of Enteral Products Critical Care/Immune Enhancing | Impact Peptide 1.5, Peptamen Intenve VHP ## Footnote Supplements at NebMed
* Used for pts who are metabolically stress or immune suppressed * Higher in PRO, arginine, RNA, contains less pro-inflammatory fats * Ex. multiple traumas, sepsis, burn pts, critically ill obese
51
# Types of Enteral Products Real Food Tube Feeds | Compleat 1.4/1.5 ## Footnote Supplements at NebMed
* Used for pts who have allergies, intolerances, philosophical reasons, etc.
52
# Where Enteral Nutrition is Administered Nasogastric Tube
Inserted through nose into stomach
53
# Where Enteral Nutrition is Administered Nasoduodenal Tube
Inserted through nose into duodenum
54
# Where Enteral Nutrition is Administered Gastrostomy Tube | Longer Term acces (>1 month)
Inserted through abdomen into stomach
55
# Where Enteral Nutrition is Administered Jejunostomy Tube | Longer term access (>1 month)
Surgically placed into small intestine
56
# Where Enteral Nutrition is Administered Nasojejunal Tube
Inserted through nose into jejunum
57
# Where Enteral Nutrition is Administered PEG Tube | Percutaneous Endoscopic Gastrostomy
* Inserted through the abdomen into the stomach * Has to be placed for 6 weeks before it can be removed, does not mean it is being used that whole time
58
Complications of Enteral Nutrition
* Aspiration * GI complications * Metabolic Complications * Mechanical Complications
59
# GI Complications of Enteral Nutrition Diarrhea Treatment | >500mL every 8hrs OR >3 stools/day for 2 days
*Decrease doses or hold agents in bowel regimen * Look for a cause - C Diff or sorbitol/xylose in meds * Add Fiber * Consider adding Imodium or Lomotil
60
# GI Complications of Enteral Nutrition Constipation Treatment | No stool for 3 days
* Add to bowel regimen * Use TF with fiber or add nutrisource fiber * Increase enteral water provided * Consider abdominal xray to check for obstructions
61
# GI Complications of Enteral Nutrition Gastric Retention
* Gastric Residuals: fluid left in stomach after enteral TF * Gastric residual should be >500mL before stoping tube feed, indicated gastric retention * Treatment: reglan or erythromycin, distally place TF | Reglan/Eryth: increases motility
62
# Complications of Enteral Nutrition Tube Occlusion | "Clogging"
* Primary Cause: medication or inadequate tube flush Treatment: * Water flush before and after each medication and when TF is stopped/restarted * Use liquid medications as able * Use clog zapper (pancreatic enzyme) * Avoid acidic flushing liquids * Replace feeding tube as last resort

Nutrition Diagnosis and Related Care (2 decks)

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