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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
Q

PPN

Peripheral Lines

How are they used? What to know about them.

A

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

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22
Q

TPN Macronutrients

Dextrose

A
  • 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
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23
Q

TPN Macronutrients

Amino Acids

A
  • Provides 4kcal/g
  • High AA concentration sent directly into the bloodstream can raise lab levels, does not indicated kidney failure
24
Q

TPN Macronutrients

What does a 2 in 1 solution mean?

A

Lipids are not infused

25
Q

TPN Macronutrients

What does a 3 in 1 Solution mean?

A

Lipids are infused into solution

26
Q

Refeeding Syndrome

What causes it?

A
  • 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
Q

Refeeding Syndrome

Biochemical Cause

A

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
Q

Refeeding Syndrome

Effects of Hypophosphatemia

A

Causes hypoxia, myocardial dysfunction, respiratory failure, seizures

Hypoxia: lack of oxygen in body

29
Q

How to reintroduce nutrition in to patients without causing refeeding?

A
  • 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
Q

CVD

Risk Factors to Consider

A
  • 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
Q

CVD

CAGE Questions

Foods to consider during diet recall

A

Cheese
Animal Fats
Got it away from home
Eating high fat commercial products

32
Q

CVD

Fiber Goals

Total Fiber and Soluble

A

25-30g total fiber/daily
6-8g soluble fiber/daily

Soluble Fiber = ~25% total fiber

33
Q

CVD

Stanol and Sterol Ester Containing Foods

What are they? Significance?

A
  • 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
Q

CVD

Desirable Lipid Profile

Total Cholesterol, LDL, HDL, Triglycerides

A
  • Cholesterol <200
  • LDL <100
  • HDL >60
  • TG <150
35
Q

Soluble Fiber

A
  • 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
Q

CVD

Insoluble Fiber

A
  • Speeds up passage of food through stomach, adds bulk to stool
  • Helps with constipation
  • Sources: wheat bran, vegetables, whole grains
37
Q

Soluble Fiber Sources

Beta Glucan

A
  • Polysaccharide, soluble fiber found in cell walls
  • Prevents body from absorbing cholesterol
38
Q

Soluble Fiber Sources

Pectin

A
  • Polysaccharide found in fruit
  • Function: thickens
39
Q

Soluble Fiber Sources

Resistant Starches

A
  • Pass through small intestine undigested, into L. Intestine, is fermented there
  • Helps reduce inflammation
40
Q

Why is the use of enteral nutrition preferred?

A

Most physiologic, safest, and cost effective method

41
Q

Enteral Nutrition

Indications for using Enteral Nutrition

A
  • 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
Q

Enteral Nutrition

When is Enteral Nutrition not recommened?

A
  • Intestinal Obstructions
  • Intractable vomiting
  • Ileus
  • Severe diarrhea
  • High-output enterocutaneous fistula

Illeus: intestine not working; causes disruption in movement of food

43
Q

Why use Enteral Nutrition?

A
  • Provides adequate nutrition for healing/stress
  • Maintain gut integrity
  • Prevents bacterial translocation
  • Better substrate utilization
  • Fewer mechanical complications
  • More cost effective

Substrate: nutrients

44
Q

Types of Enteral Products

Oral Supplements

A
  • Use when oral intake is inadequate from “usual” diet
  • Use as supplement, not replacement
  • Taste is an important factor
45
Q

Types of Enteral Products

Standard Formula

Fibersource HN, Isosource HN

Products at NebMed

A
  • Normal, complete TF
  • Used for a variety of medical surgical conditions
46
Q

Types of Enteral Products

Standard, High Protein

Peptamen Intense VHP

Supplement at NebMed

A
  • 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
Q

Types of Enteral Products

High Caloric Density

Isosource 1.5, Nutren 1.5/2.0

Supplements at NebMed

A
  • Used for pts on fluid restricition or in a hypermetabolic state
  • Ex. cystic fibrosis, burn pts
48
Q

Types of Enteral Products

Elemental and *Semi-Elemental

Vivonex TEN, *Peptamen

Supplements at NebMed

A
  • Used in pts with reduced digestive or absorptive capacity
49
Q

Types of Enteral Products

Disease Specific - Renal/Hepatic

Novasource Renal 2.0

Supplement at NebMed

A
  • Lower in K+, Na, P
  • Used for organ failure patients and comprised organ function pts
50
Q

Types of Enteral Products

Critical Care/Immune Enhancing

Impact Peptide 1.5, Peptamen Intenve VHP

Supplements at NebMed

A
  • 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
Q

Types of Enteral Products

Real Food Tube Feeds

Compleat 1.4/1.5

Supplements at NebMed

A
  • Used for pts who have allergies, intolerances, philosophical reasons, etc.
52
Q

Where Enteral Nutrition is Administered

Nasogastric Tube

A

Inserted through nose into stomach

53
Q

Where Enteral Nutrition is Administered

Nasoduodenal Tube

A

Inserted through nose into duodenum

54
Q

Where Enteral Nutrition is Administered

Gastrostomy Tube

Longer Term acces (>1 month)

A

Inserted through abdomen into stomach

55
Q

Where Enteral Nutrition is Administered

Jejunostomy Tube

Longer term access (>1 month)

A

Surgically placed into small intestine

56
Q

Where Enteral Nutrition is Administered

Nasojejunal Tube

A

Inserted through nose into jejunum

57
Q

Where Enteral Nutrition is Administered

PEG Tube

Percutaneous Endoscopic Gastrostomy

A
  • 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
Q

Complications of Enteral Nutrition

A
  • Aspiration
  • GI complications
  • Metabolic Complications
  • Mechanical Complications
59
Q

GI Complications of Enteral Nutrition

Diarrhea Treatment

>500mL every 8hrs OR >3 stools/day for 2 days

A

*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
Q

GI Complications of Enteral Nutrition

Constipation Treatment

No stool for 3 days

A
  • Add to bowel regimen
  • Use TF with fiber or add nutrisource fiber
  • Increase enteral water provided
  • Consider abdominal xray to check for obstructions
61
Q

GI Complications of Enteral Nutrition

Gastric Retention

A
  • 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
Q

Complications of Enteral Nutrition

Tube Occlusion

“Clogging”

A
  • 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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