Exam #1: Supplemental Nutrition Flashcards
What patient populations are at risk for malnutrition?
- Poor diet
- Recent weight loss
- Increased need
- Iatrogenic
- Nutrient loss
- Global assessment
What patients are at risk for a poor diet?
1) Low income
2) Institutionalized
3) Age
What patients are at risk for malnutrition b/c of recent weight loss?
- Intentional weight loss due to dieting
- Unintentional– multifactorial
What patients are at increased need for nutritional support?
- Disease process
- Surgery
- Physiologic stress
What are some of the iatrogenic causes for nutritional support?
- Medications
- Roux-en-Y or other bariatric surgery procedures
What are the different methods for measuring body fat?
- Underwater weighing
- Whole-body air displacement plethysmography
- DEXA
- Near-infrared interactance
- Bioelectrical impedence analysis (bathroom scale)
What are the anthropometric methods of determining body fat?
- Skinfold methods
- US
- BMI
- Waist to hip ratio*****
*****Best correlation for cardiac risk
What is the “american” formula for determining BMI?
Weight (lb)/height^2 x 703
Outline the BMI interpretation for underweight, normal, overweight, and obese patients.
Below 18.5= underweight
- 5-24.9= normal
- 0-29.9= overweight
- 0= obese
For the weight to hip ratio, where do you measure?
Waist= 1 inch above the navel or narrowest point
Hip= widest portion of the buttocks/ greater trochanters
What is an excellent WHR for males? Females?
Males= less than 0.85 Females= less than 0.75
What is a good WHR for males? Females?
Males= 0.85-0.89 Females= 0.75-0.79
What is an average WHR for males? Females?
Males= 0.90-0.95 Females= 0.80- 0.86
What WHR ratio places on “at risk” for males? Females?
- Males= greater than 0.95
- Females= greater than 0.86
What are the pros and cons of the WHR?
Pros= best for detecting the health risks of obesity (cardiac)
Cons= Not good for malnutrition
What are the pros and cons of BMI?
Pros= good standard for over and under weight
Cons=
- Less accuracy in v. fit and poorly fit
- Less accurate in elderly
What are the lab tests used to assess for malnutrition?
1) CBC= decreased RBC and TLC (Total Lymphocyte Count)
2) BMP= decreased protein and albumin
3) Prealbumin
4) Micronutrient levels (K+, Mg++ and phosphorus)
5) Lipid panel
What are the nutritional screening tools?
NRS-2002= Nutritional Risk Screening*
MUST= Malnutrition Universal Screening Tool
What are the red flags in a nutritional risk screening?
- BMI less than 20.5
- Weight loss in 3 months
- Reduced dietary intake in last week
- Requires ICU admission
*****If any of these are positive, patient requires more in-depth screening
What do 0-3 correspond with in the NRS-2002?
0= Normal 1= Mild 2= Moderate 3= Severe
What should you do if a patient is at high risk for malnutrition?
- Refer: dietitian, nutritional support team, and implement local policy
- Set goals and improve overall nutritional intake
- Monitor and review care
If a patient has bad teeth e.g. from chronic methamphetamine use, what should you recommend?
Mechanical soft food i.e. that patient doesn’t actually have to chew the food
*****These are food that are easy to chew
If a patient has poor teeth and dysphagia, what should you recommend?
Pureed food
*****This is a smooth, cohesive, pudding-like food (baby food)
If a patient can’t swallow, what should you recommend?
Tube feeding
If a patient’s GI tract is impaired, what should you recommend?
Parenteral
What are the three methods of enteral nutrition?
- NG (nasogastric tube)
- PEG (percutaneous endoscopic gastrostomy
- J-tube (jejunostomy tube)
What patient population is an NG tube a good option for?
Short-term placement in conscious or semi-conscious patients
What patients is a G-tube or PEG tube good for?
Long-term placement
What are the main disadvantages of a NG/G-tube vs. a J-tube?
- NG/G-tube lead to regurgitation
- J-tube is best for long-term feeding AND prevents reflux
What are the methods for determining caloric need?
- Harris Benedict Equation
- Indirect Calorimetry
- Resting Energy Expenditure (REE)
What is a stress factor used for?
This is a factor that accounts for increased caloric need in critical illness
How do you start enteral feeding? What is the thought process?
1) Choose formula
2) Pick route based on pt.
3) Choose delivery (bolus, intermittent…etc.)
4) Determine rate
*****Be sure to give routine water boluses
What are the typical complications of enteral feeding?
- Clogged tubes
- Aspiration
- Ileus*
- Diarrhea
- Infection
*Painful obstruction of the ileum or other part of the intestine
What is parenteral nutrition? What are the two routes of parenteral nutrition?
Feeding NOT through the GI Tract
1) PPN
2) TPN
What is the difference between PPN and TPN?
PPN= peripheral parenteral nutrition (peripheral IV)
TPN= Total Parenteral Nutrition
- Central line
- PICC line
- Port
When is PPN normally utilized?
Short-term (vs. TPN for long-term)
