Exam #1: Supplemental Nutrition

Question 1

What patient populations are at risk for malnutrition?

Answer 1

• Poor diet
• Recent weight loss
• Increased need
• Iatrogenic
• Nutrient loss
• Global assessment

Question 2

What patients are at risk for a poor diet?

Answer 2

1) Low income
2) Institutionalized
3) Age

Question 3

What patients are at risk for malnutrition b/c of recent weight loss?

Answer 3

• Intentional weight loss due to dieting

- Unintentional– multifactorial

Question 4

What patients are at increased need for nutritional support?

Answer 4

• Disease process
• Surgery
• Physiologic stress

Question 5

What are some of the iatrogenic causes for nutritional support?

Answer 5

• Medications

- Roux-en-Y or other bariatric surgery procedures

Question 6

What are the different methods for measuring body fat?

Answer 6

• Underwater weighing
• Whole-body air displacement plethysmography
• DEXA
• Near-infrared interactance
• Bioelectrical impedence analysis (bathroom scale)

Question 7

What are the anthropometric methods of determining body fat?

Answer 7

• Skinfold methods
• US
• BMI
• Waist to hip ratio*****

*****Best correlation for cardiac risk

Question 8

What is the “american” formula for determining BMI?

Answer 8

Weight (lb)/height^2 x 703

Question 9

Outline the BMI interpretation for underweight, normal, overweight, and obese patients.

Answer 9

Below 18.5= underweight

18. 5-24.9= normal
19. 0-29.9= overweight
20. 0= obese

Question 10

For the weight to hip ratio, where do you measure?

Answer 10

Waist= 1 inch above the navel or narrowest point

Hip= widest portion of the buttocks/ greater trochanters

Question 11

What is an excellent WHR for males? Females?

Answer 11

Males= less than 0.85 
Females= less than 0.75

Question 12

What is a good WHR for males? Females?

Answer 12

Males= 0.85-0.89 
Females= 0.75-0.79

Question 13

What is an average WHR for males? Females?

Answer 13

Males= 0.90-0.95 
Females= 0.80- 0.86

Question 14

What WHR ratio places on “at risk” for males? Females?

Answer 14

• Males= greater than 0.95

- Females= greater than 0.86

Question 15

What are the pros and cons of the WHR?

Answer 15

Pros= best for detecting the health risks of obesity (cardiac)

Cons= Not good for malnutrition

Question 16

What are the pros and cons of BMI?

Answer 16

Pros= good standard for over and under weight

Cons=

• Less accuracy in v. fit and poorly fit
• Less accurate in elderly

Question 17

What are the lab tests used to assess for malnutrition?

Answer 17

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

Question 18

What are the nutritional screening tools?

Answer 18

NRS-2002= Nutritional Risk Screening*

MUST= Malnutrition Universal Screening Tool

Question 19

What are the red flags in a nutritional risk screening?

Answer 19

• 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

Question 20

What do 0-3 correspond with in the NRS-2002?

Answer 20

0= Normal
1= Mild 
2= Moderate 
3= Severe

Question 21

What should you do if a patient is at high risk for malnutrition?

Answer 21

• Refer: dietitian, nutritional support team, and implement local policy
• Set goals and improve overall nutritional intake
• Monitor and review care

Question 22

If a patient has bad teeth e.g. from chronic methamphetamine use, what should you recommend?

Answer 22

Mechanical soft food i.e. that patient doesn’t actually have to chew the food

*****These are food that are easy to chew

Question 23

If a patient has poor teeth and dysphagia, what should you recommend?

Answer 23

Pureed food

*****This is a smooth, cohesive, pudding-like food (baby food)

Question 24

If a patient can’t swallow, what should you recommend?

Answer 24

Tube feeding

Question 25

If a patient’s GI tract is impaired, what should you recommend?

Answer 25

Parenteral

Question 26

What are the three methods of enteral nutrition?

Answer 26

• NG (nasogastric tube)
• PEG (percutaneous endoscopic gastrostomy
• J-tube (jejunostomy tube)

Question 27

What patient population is an NG tube a good option for?

Answer 27

Short-term placement in conscious or semi-conscious patients

Question 28

What patients is a G-tube or PEG tube good for?

Answer 28

Long-term placement

Question 29

What are the main disadvantages of a NG/G-tube vs. a J-tube?

Answer 29

• NG/G-tube lead to regurgitation

- J-tube is best for long-term feeding AND prevents reflux

Question 30

What are the methods for determining caloric need?

Answer 30

• Harris Benedict Equation
• Indirect Calorimetry
• Resting Energy Expenditure (REE)

Question 31

What is a stress factor used for?

Answer 31

This is a factor that accounts for increased caloric need in critical illness

Question 32

How do you start enteral feeding? What is the thought process?

Answer 32

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

Question 33

What are the typical complications of enteral feeding?

Answer 33

• Clogged tubes
• Aspiration
• Ileus*
• Diarrhea
• Infection

*Painful obstruction of the ileum or other part of the intestine

Question 34

What is parenteral nutrition? What are the two routes of parenteral nutrition?

Answer 34

Feeding NOT through the GI Tract

1) PPN
2) TPN

Question 35

What is the difference between PPN and TPN?

Answer 35

PPN= peripheral parenteral nutrition (peripheral IV)

TPN= Total Parenteral Nutrition

• Central line
• PICC line
• Port

Question 36

When is PPN normally utilized?

Answer 36

Short-term (vs. TPN for long-term)